Unite Us

Payer Invoice Work Queue

In 2022, the North Carolina Department of Health and Human Services launched the Healthy Opportunities Pilot, providing services to address social determinants of health (SDOH) for Medicaid Members. Unite Us has served as the infrastructure for this program, delivering 762k+ services for over 29,000 enrollees.

A large part of this initiative is to offer reimbursement streams for the CBOs who provide the services. We needed to design and build a work queue that enabled CBOs to track their invoices, and Payers to also effectively manage and respond to them. Through our work, we've facilitated reimbursement of $152M+ to CBOs with a 1.5% payer rejection rate compared to the 18% national average.

Role

UX Designer and Engineer

DEFINE

Build a Payer Invoice Work Queue for payers to track their invoices requests, and improve existing WQ designs for increased invoice review efficiency.

Old Invoice Work Queue table design

We already supported an invoice work queue for the CBOs, so our job was to reuse and assemble the components for the Payer's needs. We also needed to improve its design to increase invoice review efficiency.

Work Queue ERD

A diagram showing the React component tree for the invoice work queue.

Above is an diagram showing the major React components of the reusable invoice work queue along with notable hooks in the Invoice Work Queue (IWQ) component. Understanding the existing components was crucial to incorporating our own Needs for the Payer work queue, and introducing new ones like Bulk Actions.

DESIGN + ENGINEERING

Improve Payer WQ efficiency with enhancements like bulk actions and invoice assignment. Improved workflows means more services provided and reimbursed, and ultimately more people getting care at a more efficient pace.

Bulk Actions

Give users the ability to respond to multiple invoices at the same time toincrease efficiency.

Users have had to go through hundreds of invoices one at a time, greatly reducing their efficiency. We introduced bulk actions to the Payer Work Queue that allows users to group related invoices and respond to them at the same time.
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The Bulk Actions component was made to be reusable across work queues, receiving the correct actions as props depending on the user type and bucket.

Impact

Introducing bulk actions enabled users to review and respond to multiple invoices at once, rather than handling them individually. This improvement increased efficiency, boosted customer satisfaction, and led to faster reimbursements totaling $152million to date, with a low 1.5% payer rejection rate compared to a 18% national average.

User Assignment

Allow users to assign invoices, so better delegate and manage when a request is being reviewed.

Users have said that it can be difficult keeping track of when an invoice is already being looked at by a colleague. We decided to give them the ability to assign invoices to users, and give them "In Review" statuses.

Impact

This work reduced duplicate efforts by clearly indicating when an invoice was already under review, streamlining the overall invoice review process. Improving work queue efficiency has been a core focus for driving customer satisfaction and retention, resulting in more accurate reviews and faster referral decisions - with a 98% referral acceptance rate within three days.

WHAT'S NEXT

These work queue designs were intended to be scalable enough for future users including New York as a part of the New York Medicaid 1115 Waiver initiative. The work queue's design is constantly being iterated on for improved efficiency.