Real-Time Claims is a Blue Shield of CA initiative to simplify and add transparency to the current claim submission process.
Blue Shield of California
Role: Principal UX Designer and Strategist
The claims submission and adjudication process at Blue Shield of California has been the same for the last 30+ years. The Real-Time Claims (RTC) tool does away with paper forms, faxes, and months-long waits to determine whether or not a claim was submitted properly. In seconds, a provider will know if they have submitted the claim properly, how much they will get paid, and the member's responsibility.
Where we started
A proof of concept was created by the tech leads in 2018 as a test to see if they could create the capability to search by the medical numerical code and intake a claim into directly into the BSC systems.
BSC and most of our competitors were still accepting faxed 837 forms. The only other alternative to submit a medical claim at the time of this writing was a digitally optimized PDF version of the paper form.
High-level overview of account status
Easily sortable table
Bulk claim submission
Transaction quick view
Human language to the codes
Auto-populated data on select fields
Claim feedback in seconds
End to dirty claim submissions
Near real-time validation
Cut the claim submission process from months to seconds
The patient will know their payment responsibility at the time of service
Real-Time Claims Demo
Single-line medical claim demo given to providers