Case study · Strategic enterprise partnership
Turning returned eligibility data into a faster, more confident decision.
A direct, accelerated partnership with a major healthcare organization to replace a fragmented, scripted eligibility-response workflow with a governed experience inside the EHR.
The challenge
The customer had valuable payer data, but no durable in-product way to use it.
Important benefits information came back in a dense 271 response, then relied on scripted behavior and separate screens to reach the places staff actually needed it.
That approach could not carry forward in a cloud environment. The partnership focused on a better model: keep people in the EHR, make relevant benefit values understandable, let them choose the right value once, and apply it safely to standard fields, customer-defined questions, or both.
Because the work was tied to an immediate enterprise need, regular customer conversations shaped the direction and release slices. This case study describes the collaboration without naming confidential customer details.
Design strategy
Move from a fragmented handoff to one decision-ready screen.
The key experience change was a more useful Details view inside Process Response: eligibility context first, a compact insurance-specific Custom Data Screen next, and financial information by service directly below.
This preserves familiar workflow structure while bringing questions and returned values into the same decision space. It also makes the consequence of a selection explicit before patient-facing information is changed.
Stay in context
Keep eligibility, prompts, and returned benefits together.
Make mapping visible
Show whether a value updates standard fields, CDS queries, or both.
Reduce repetitive work
Collect selections before one deliberate apply action.
Respect local configuration
Resolve the correct CDS at program, class, or insurance level.
01 · Embedded eligibility prompts
Bring customer-defined questions into the response workflow.
A configured CDS now appears in the Details view rather than requiring staff to navigate to a separate screen. The system chooses the most relevant screen through a hierarchy of default, financial class, and insurance-specific configuration.
In the response workflow, the CDS sits immediately above the financial information it helps interpret. Required questions remain enforced on save, while view-only workflows show saved answers without allowing an accidental change.
02 · Precise response mapping
Let administrators describe which repeated 271 value is the right one.
Response Detail filtering adds qualifier-based rules to the EDI Data Element Dictionary. For example, a mapping can identify the individual, in-network deductible among many repeating EB segments before connecting that amount to a CDS query.
The EDI Program Dictionary then controls the destination: standard fields, CDS queries, or both. The most specific setting—insurance, financial class, then default—wins.
03 · One deliberate apply action
Replace repeated prompts with controlled multi-selection.
Financial Information by Service Type now uses the existing checkboxes as an intentional selection model. A user can choose multiple benefit values, but competing values for the same benefit type are muted until the selection changes.
One Apply Selections action presents a single confirmation grouped by destination and calls out anything ignored because of a data-type conflict. The outcome is faster review without hiding what will happen next.
What this work enabled
A customer-shaped response experience that can scale beyond one customer.
Eligibility context, questions, and benefit values stay together during review.
Repeated payer values can be filtered and connected to the right destination.
Staff choose values in context and confirm their full set once.
Configuration supports customer needs without returning to a scripting dependency.
Reflection
A direct customer partnership can reveal the product’s next durable pattern.
The customer’s urgency made the workflow gaps impossible to ignore, but the design work stayed focused on a reusable solution: a response review model that supports local configuration, gives staff control over what they apply, and can extend through the standard eligibility platform.
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