Insurance Authorization • Tilly

Visualizing complex insurance information to empower small business owners without confusion

A key challenge in ABA therapy for autism is that insurance companies authorize hundreds of hours of care at a time. ABA practices need to stay on top of this bank of hours to ensure that they’ll optimize for care plan adherence, revenue, and reauthorization. As the lead designer, I partnered closely with the Revenue Cycle Manager and a product manager to create a summary of authorized hour progress.

Outcomes

⏱️  Operational efficiency

Practice owners receive visibility into data they didn’t have before, which reduces a significant volume of back and forth emails


💰  Increased revenue 

By giving practice owners this information, we expect better utilization of hours and increased revenue for everyone


🏋️  Flexibility

Adapts well to complexity of Kaiser and simplicity of newer business lines

Contributions

Data viz, concept generation, info hierarchy

Team

Revenue cycle manager, product manager

Dates

July - August 2024

Problem overview


Tilly's model is that behavior analysts can own their own practices, and Tilly takes a profit share in exchange for handling administrative tasks, particularly dealing with insurance. Before we built this product, only our small Revenue Cycle team could see what each patient's insurance had authorized - the total hours permitted, the number of hours completed, which services were permitted, and the dates. Practice owners were heavily requesting this visibility, as was our operational team, because having this information would save both parties time.

How can we summarize authorized hours in a way that is simple to understand but scales well to different industries and insurance plans?


My approach

Defined UX goals aligned to user needs

After talking to the revenue cycle team and a few practice owners, I prioritized the goals of this product to help inform the information hierarchy and how to prioritize features for MVP.


Indirect & direct competitor analysis

I took a look at our direct competitors' views for this, but was a bit underwhelmed. Then, I sought inspiration elsewhere, like The New York Times.



Design decisions through ideation


I created 6 options to get started which helped me align on a single column view, rather than using 2 columns of cards, since it felt easier to scan which services were on track and which were not.




I created another 9 options in response to product feedback on what would common use cases would look like, engineering feedback on lift, design critique, and my own desire to nail something that really highlighted where I should be "today" in a nuanced way that didn't create alert fatigue. We knew there were edge cases where you were expected not to utilize hours linearly throughout the authorization period, but I wanted it to be easy to see that comparison for the majority of use cases.


Solution

The final solution organizes information in a way that works very well for the most likely use cases.





Additionally, I have considered and optimized the design to work in edge cases like a patient receiving only one service, having multiple active authorizations or insurance plans, or having an authorization where they need to use up one service code before they can start billing to another service code.


This is the first visualization of its kind for autism services. Practice owners who provided feedback on these designs were thrilled with how easy it was to understand and reach out weekly asking for it to be released, which is expected in October 2024.