ERA Reporting Dashboard

Understand the claim life cycle

Providers

Claim Creation and Transmission

An automated function that generates dental claims once the treatments are completed. These claims contain all the essential information about the treatments and are created on behalf of the providers. Once the dental claims are created, they are automatically sent to a clearinghouse via our Retrace system.

Clearing House

Claim Check

The clearinghouse serves as an intermediary, checking if the claims meet all the required standards and criteria before forwarding them to the insurance payer.

Payers

Claim Processing

The insurance payer receives the claims from the clearinghouse and then initiates their internal claim processing mechanism. If the claim passes through all their checks, it successfully follows what we call the 'happy path'. After the claim has been processed, the payer generates an ERA, which they send back to the provider.

ERAs

Clinics

Admin Users

Tracking Electronic Remittance Advice

Now, let's imagine being a admin user to manage their clinics, this complex process. They're juggling a tremendous number of clinics, often beyond a hundred, each receiving multiple ERAs. Imagine the scale, the magnitude of the task at hand. It's massive.

Problem

The vast and complex ERA data, which complicates tracking ERAs and verifying that all claims have matching ERAs. This lack of transparency in tracking impacts financial operations by hindering the confirmation of owed reimbursements to clinics.

Outcome

Improvement in the efficiency of ERA management by 28%
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Increase the efficiency of decision-making due to the organized presentation of data by 15%
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The efficiency of identifying clinics with issues has been enhanced by 32%

Final Design Quick Look

We addressed their issues by simplifying and enhancing their efficiency through a dashboard. This visual tool transforms ERAs from various clinics into comprehensible data, optimizing decision-making speed and effectiveness. It's a game-changing tool.

Project Goal

Simplify the process of tracking ERAs across different clinics.

Visualize ERA data to facilitate quick understanding and decision-making.

Highlight clinics facing significant issues for immediate action.

Create an intuitive, user-friendly interface that caters to the needs of admin users.

Proposed Solutions

Data Visualization

The cornerstone of our solution is to leverage data visualization techniques.

Empower Admin Users

Our solution aims to allow admin users to swiftly understand the status and trajectory of ERAs across all clinics.

Organized Data

Organize data based on critical factors such as payer, clinic, and time.

Design Challenges

Data Overwhelm

Difficulty understanding the vast array of ERA data.

Insufficient Issue Highlighting

Lack of clear indicators to highlight clinics with significant issues.

Workflow Inefficiency

Inefficient workflow due to the complex nature of the ERA tracking system.

Decision-Making Challenges

Difficulty making quick decisions due to the unorganized presentation of data.

AntV G2

To truly deliver on our promise of clear, actionable insights, we realized that the choice of charting tool was paramount. That's when we discovered AntV G2, a highly customizable and feature-rich data visualization library.

Design Explorations

Bridging Proposed Solutions with Effective Interactions

Option 1

View by Time

In the "View by Time" section, we assess performance changes. The Donut Chart for ERA Files Distribution uses color coding—green indicating healthy conditions and red suggesting attention is required—to swiftly evaluate the health of ERAs across all clinics. We also utilize a Vertical Stacked Bar Chart for ERA Files Received, perfect for a 12-month view. This shows the amount and status of ERAs over time, transforming complex data for rapid comprehension and immediate action.

Option 2.1

View by Payer

Horizontal Stacked Bar Chart, showcasing top ERAs received along with their status breakdown. It ensures easy readability of payer names and provides an overview of ERA statuses such as unassigned, confirmed, unconfirmed assignment, and closed. This helps identify problem payers for efficient issue resolution.

Option 2.2

View by Payer

Vertical Stacked Bar Chart to display Top ERAs Received by Payer Over Time. The consistency of color coding for each payer across our system aids intuitive understanding, helping to identify payers with the highest ERAs and address performance issues.

Doughnut Chart simplifies the task of identifying unpaid claim values, spotlighting areas needing attention. It's designed to ease ERA tracking complexity and fast-track resolution of unpaid claims.

Option 3

View by Clinics

We've created specific charts for Top ERAs Received by Payers and Claims Amount Without ERAs Received by Payers. They help identify clinics with high ERAs volumes or significant claim amounts without matching ERAs, guiding effective attention. We've also added a List for Top ERAs Received by Payer, offering data in a straightforward, easy-to-digest format.

In this view, we display two distributions - 'ERA Files Distribution by Payer' and 'ERA Amount Distribution by Payer'. For example, 'Delta Dental of California - CA00' accounts for 60% of total ERA files received and 40% of claim value in total distribution. This straightforward data presentation aids in making strategic decisions.

Option 4

View by payer - Final

Facing an unexpected twist, stakeholder and project manager feedback led us to pivot our focus exclusively to 'View by Payer'. Recognizing that all claims and ERAs trace back to the payer, addressing payer issues became our priority. This strategic transformation, from broad visibility to targeted problem-solving, demonstrates the importance of iterative feedback and adaptability.

In the final design, a bar-inside-a-bar chart was chosen to represent ERAs Received by Payer, juxtaposing Claims Submitted and ERAs Received. The juxtaposition of the bars could have helped frame the comparison between Claims Submitted and ERAs Received. Adding sorting capabilities, as it could help users focus on the beginning and end of the sorted list, where they are more likely to remember the information.

The color-coded payer list the colors could help the different payers stand out in the user's memory. It’s color code the top 20% mid Tier and Bottom 20%

In this dashboard, our Stack Bar logic diverges from other dashboards where values add up to a total. Here, the relationship is unique to avoid confusion, emphasizing each value's individual significance rather than their cumulative total.

Expandable Table

Flow 1

Which payer has the most Claim Submitted?

Admins can easily identify the payer with the most claims submitted through a visual comparison: light green bars represent submitted claims, dark green bars signify ERAs received. If they align, it signifies efficiency. Any light green bar not entirely filled indicates a delay.A sortable payer list, based on the volume of submitted claims, allows quick identification of payers possibly causing reimbursement delays, enabling swift and informed action.

Flow 2

Which payer has the most ERAs received?

Admin users can determine which payer has the most ERAs received. The ERAs received are represented by the dark green bars, providing a clear visual representation of payer performance. By sorting the payer list based on ERAs received, admins can readily identify the most active or efficient payers. This information aids admins in resource allocation, allowing them to prioritize and tackle the areas most impactful to the reimbursement process.

Flow 3

Which payer has most claims not received ERAs?

Taking it one step further, our solution empowers admin users to find out which payer has the most claims that have not received ERAs. This is done by sorting the payer list based on ERAs received from low to high. The unfilled part of the bar chart, representing claims not matched with ERAs, is a clear indication of potential issues. With this feature, admins can quickly spot and prioritize payers that may need immediate attention or intervention. This capability to spotlight problem areas enhances the efficiency of the overall reimbursement process.

Success Metrics

Improved the efficiency of ERA management

Improved the speed of decision-making

Reduced time spent identifying clinics with issues

Key Takeaways

Apply experience on other dashboard modules

Even though we focused on 'View by Payer' based on stakeholder feedback, the exploration journey we took was invaluable. Like a rough diamond polished to reveal its brilliance, our process refined our thinking, our approach, and our design skills.This is not the end. It's just the beginning. We've gleaned experiences and insights that are directly applicable to other areas of our work. Think claims submission, think other dashboard projects. The wisdom we've gained from the ERA Reporting - Dashboard project will illuminate our path forward.