Background
This client has a product that allows insurance companies and diagnostic labs to work together to get billing codes (traditional CPT® codes) assigned to diagnostic lab tests that do not have them yet through traditional billing routes. Usually these are very complex molecular diagnostic tests.
In this process, laboratories need to be able to submit their test directly to the client’s system for review and the assignment of a billing code. This allows the lab to receive timely reimbursement for the test by the insurance company.

Problem
The process for a laboratory to add a test to the client’s system involved a complex spreadsheet that the lab downloaded and completed. They then would send that spreadsheet by email back to the client, where the client would upload the results into a tool that fed the tests into individual records. The client’s administration team had to manually review and correct information on each record. This overtaxed client resources, leading to slow response times to mistakes and requests for more information.

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Solution
Because of the complex nature of the information requested by the client system, a well documented stepwise form was created for laboratories to enter test information. In addition, a downloadable explanation of all fields and worksheet are available, so the lab can gather information before sitting down to enter the information for the test.

On the client end, all tests now only require a quick review, because information is received in the correct fields from laboratory.

Process
Using feedback from the past year from all types of end users of this system, I set out to create a step-wise form that would lead a user through the complexities of giving information required for molecular diagnostic tests.

After working with the development team to determine any technical difficulties, it was straight to wires for a quick proof of concept, because we didn’t have a lot of time, and this was a feature on an existing enterprise application. This allowed me to confirm that I gathered the correct information and the organization of that information was clear and could lead a user through the process.

Once that organization was laid out, I created a prototype that was very close to pixel perfect, so that we could test our work. This allowed us the opportunity to address questions we might not have thought of, tweak the workflow, and get a solid design to the Business Analyst to facilitate acceptance criteria. While I don’t always go straight to pixel perfect, it was a necessary time saving step for this project (and the library I have created for this client helps).

While writing acceptance criteria, the BA would occasionally come back with questions that we hadn’t thought about. The prototype was easy to revise and test, so we were able to answer most questions within 30 minutes to an hour. This allowed her to get the AC on the board (this team uses Kanban to manage project flow) and move the feature through analysis to construction and on to demo.

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Results
This feature has been in production for a little over one year. Turnaround time for our client to get back to their labs has been reduced by over 50% and errors on submission have been reduced by over 30%. I continue to work on ways to get the errors of submission down through education and better form instruction.