Case study · Healthcare workflow design
Making electronic prior authorization understandable at every step.
A multi-release UX effort that helped healthcare teams configure, identify, act on, and document electronic prior authorization work across acute and ambulatory workflows.
The challenge
Prior authorization is not one task.
It is a chain of decisions spread across dictionary configuration, worklists, clinical context, payer responses, claim submission, and audit history.
Authorization specialists needed to determine when electronic processing applied, understand a payer response, resolve missing information, and document their next action—without losing the context of the patient, coverage, or authorization. Administrators also needed a faster way to maintain the rules behind that workflow.
The design challenge was to make that chain feel like one coherent experience while respecting the distinct needs of acute and ambulatory teams, existing configurations, and the safety constraints of a regulated healthcare environment.
Design approach
Design the system, then make each moment legible.
I organized the work around five connected moments in the authorization lifecycle. This created a shared structure for requirements, UI decisions, and handoff across a broad set of stories.
- 01
Configure
Set default behavior and targeted overrides without repetitive maintenance.
- 02
Recognize
Make electronic processing and status reasons visible in the worklists people already use.
- 03
Understand
Present coverage, payer response, claim, and questionnaire information in a clear hierarchy.
- 04
Act
Guide users through documentation, payer follow-up, and claim submission with appropriate safeguards.
- 05
Account
Capture the context behind user actions so workflows remain traceable.
01 · Configure at scale
Replace one-at-a-time maintenance with intentional bulk editing.
The Authorization/Referral Requirements Dictionary gained a Multi-Select Edit routine for appointments, surgical procedures, orders, facilities, financial classes, and insurances. Users could select groups of related items, add or remove them through familiar lookup patterns, and apply shared defaults or targeted overrides.
To keep complex selection states understandable, group hierarchies retained expand/collapse behavior and counts. The same structural pattern carried across appointment, procedure, and order tabs—reducing cognitive overhead for administrators moving between workflows.
02 · Recognize what needs attention
Put ePA context where specialists make decisions.
Status Reason was added across standard Account, Appointment, and Procedure worklists so users could see why an authorization was in its current state without opening another screen.
A small green target indicator made electronic processing visible in relevant worklists. An accompanying key explained the icon, and the Process field was made available to eligible custom worklist formats. The solution handled real-world complexity: primary insurance behavior, multiple authorizations, and drill-in states were all accounted for.
03 · Make payer responses usable
Turn dense API data into a decision-ready view.
Electronic prior authorization responses contained coverage details, documentation requirements, contacts, questionnaire links, and later claim-response data. Instead of presenting this as one undifferentiated screen, the experience separated Coverage Info from Claim Response and preserved a consistent information hierarchy across Acute, Ambulatory, and Clinical Chart.
Coverage opens by answering the immediate questions—insurance, date, coverage, prior-auth need, and documentation need—then progresses to supporting details, contacts, and required documentation. When responses are long, the UI signals truncation and provides a way to view complete content.
04 · Guide the next action
Make follow-up and submission deliberate.
When additional information was needed, users could move from the authorization to a focused Clinical Chart experience where the relevant ePA response accordion opened directly. Questionnaires, coverage, and embedded payer follow-up were kept within the clinical workflow.
Manual claim submission and re-submission became state-aware. Labels and confirmation language changed according to whether a claim had already been sent and whether edits needed saving. The action stayed unavailable when no ePA authorization was present, helping prevent invalid submissions.
05 · Create accountable actions
Standardize the “why,” without erasing local practice.
The Status Reason Dictionary became a broader Reason Dictionary with two purpose-specific types: Auth Status and Claim Submission. Existing entries retained their behavior through migration and initialization safeguards, while standard Claim Submission reasons provided a consistent starting point.
On a manual ePA submission, a required Reason field surfaced only the relevant options. This decision links an intentional user action to an explicit rationale, stores a reason for each manual claim attempt, and supports audit and reporting needs without forcing a one-size-fits-all workflow.
What this work enabled
A connected ePA experience built for clarity, control, and traceability.
Administrators can update related authorization requirements through one purposeful routine.
Teams can recognize electronic authorizations and the reason behind a status from their worklists.
Coverage, claim, contact, and questionnaire information have a more useful hierarchy.
Manual claims capture the reason for submission and preserve a per-attempt record.
Reflection
The work was never just about adding an ePA flag.
It was about helping people understand an automated process well enough to trust it, intervene when necessary, and maintain it over time. The most valuable design decisions connected small moments—an icon, a default, a required field—to the larger authorization workflow around them.
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