Prior Authorization Portal · Bright HealthCare

Prior Authorization Portal

Providers submit and track authorizations without a fax, clinicians review them faster, and members get an answer in days

Member search and authorizations dashboard in the Authorization Portal

The tool was bad enough that providers went back to faxing.

Every fax came back to us to be retyped by hand. Nothing was checked on the way in, nothing came back out, and the member waiting on a care decision waited weeks.

Three journeys, and no one owned all three.

A provider submitting, a clinician reviewing, a member waiting on the answer. Each team could see its own step and none could see the path, so I led the experience across all three, working with clinical operations, utilization management, product and engineering.

Faxing in the world of digital experiences can cause providers and their staff added work, frustration, loss of trust in the company, and more importantly time away from caring for members.

So we asked the people sending them.

Interviews with providers and their staff on how an authorization actually got done, and round after round with our own clinical team on what a reviewer needs to see. Then usability tests to find where the flow still caught. Nobody asked for features.

Interview tagging highlight counts and authorization workflow mapping board

They weren't asking for software. They were asking for an answer.

Tell me what’s required before I submit. Tell me where it stands. Don’t make me call to find out.

😟 Pains

Burnout from repetitive admin tasks.
No visibility into status or timelines.
Endless back-and-forth with payers.
Delays hurting patient satisfaction and care.

🌟 Gains

One system, fully integrated with their EHR.
Clear approval requirements, less rework.
Automated status updates and notifications.
Faster turnarounds, more time for patient care.

Empathy map for providers using the portal

A fax is one flat page. A portal needs a structure.

The hard part wasn't the form: it was the rules behind it. With clinical operations I mapped them in, so the form told providers what was required before they submitted, not after.

Two calls came out of that. Submission became a wizard instead of one dense form, a few questions at a time rather than a wall of them. And it saves as a draft, because almost nobody finishes an authorization in one sitting: they stop to chase a chart note and come back.

Then what goes where: the request, what a provider sees after submitting, and a dashboard that grew with them. Status got its own place, the one thing a fax never gave back.

Step 1: Requesting information, provider search

The design system was built for consumers, not for charts.

Bright’s system was made for member-facing products: roomy, friendly, light on data. Prior authorization is dense clinical entry, and it had to white-label across five markets.

So I extended and reshaped the system rather than forking a clinical library beside it. Slower up front, and it left the team one system to maintain instead of two.

Clinician using the authorization portal on a laptop

It replaced the fax machine.

Within weeks of go-live, 15%+ of authorizations had moved to the portal. Providers called it the best tool they'd used; one team put the saving at four hours per provider, per day. And the member at the end of it went from waiting weeks to waiting days.

You have Marie Kondo’d the authorization portal!
Rebecca Schweitz, VP, Clinical Performance

What it saved.

Savings

$1.9m in savings

Scaled monthly usage to 9-10K a month

Clinical review

$800K in savings

7 minutes per case for clinicians reviewing cases

Time saved

4 Hours per day saved

Went down 4 minutes per authorization, per provider

Users

50K authorization submissions

22K providers logged in

The Team

Worked with 5–7 engineers, 1 Product Manager, Director of Product, and 1 Content
Hired and managed 1 designer midway
Worked with clinical teams to understand their workflows and competitors they have used