Concept study · self-initiated · 2026
A work queue for revenue-cycle teams that turns payer rejections and denials into a clear next action — instead of a code to look up.
This is a self-initiated concept. The product, organisations and data are fictional; the design problems are real.
Context
Billing specialists work thousands of claims a month across a dozen insurers. Denials arrive as reason codes (CO-197, N54) spread across portals and reports, so triage depends on tribal knowledge and spreadsheets — and money is lost to deadlines nobody saw coming.
If every claim told you what to do next — and why — specialists would spend their day fixing claims instead of finding them.
Shadow 3–5 billing specialists during a denial-work session, then test the queue and the explainer with a clickable prototype against their current tools.
Journey
Numbers refer to the chapters below. 05 — the command palette — works across every step. 03 feeds back into how claims are built, so fewer are denied in the first place.
Get a specialist from login to the most urgent fix in one click.
Most claims need nothing from a person. Opening on everything buries the few that do, so the default view is the actionable subset, with counts on every tab.
Considered insteadStatus-only tabs — rejected: a status doesn’t say what to do.
Each row answers “what do I do now?” without opening it. Codes stay in the detail view for experts who search by them.
Considered insteadShowing the denial code in the list — precise, but needs a lookup every time.
Money lost to a missed deadline can’t be recovered, so urgency beats age or amount. The deadline is the only red text in the row.
Considered insteadSort by amount — the biggest claim isn’t always the most urgent.
Explain a denial in plain language and turn it into a guided fix.
The explainer leads with cause and consequence; reason codes sit alongside as tags, so experts lose nothing and newcomers aren’t lost.
Considered insteadA tooltip on the code — hides the answer behind an interaction.
“2 days left — then it becomes a write-off” makes the priority self-evident without a separate priority field.
Most disputes are “who had it last?” — clinic, clearinghouse or insurer. A visible timeline settles it in seconds.
Considered insteadA separate activity-log tab — accurate but rarely opened.
Help billing leads fix the causes, not just the claims.
Fixable, appeal or write-off: leads see where effort pays back before assigning work.
Patterns are insurer-specific. A matrix makes “one insurer drives most auth denials” visible at a glance.
Considered insteadStacked bars per insurer — hard to compare one reason across insurers.
Dashboards rarely change behaviour unless the next step is one click away. Each suggestion shows the money it would have saved.
Let specialists fix dozens of claims without creating new rejections.
Resubmitting a broken claim triggers a second rejection and wastes days. Every claim is checked first and the result is summarised.
Partial success beats all-or-nothing. Blocked claims stay in the queue with the reason attached.
Considered insteadDisabling the whole action until every claim is valid — blocks good work.
The button states the real outcome (“Resubmit 10 claims”) and a 30-second undo replaces a confirmation people click through.
Make expert, keyboard-first work fast without adding UI.
Specialists work in the tool all day. Typing intent is faster than navigating menus.
Power users build their own queues from plain language — no filter builder to learn.
Considered insteadA dedicated advanced-filter screen — powerful but slow for everyday use.
Hints next to each result are learned through use, not from a help page.
Turn a strong case into a complete appeal on the first try.
Claim data fills the letter and is highlighted, so the author checks the generated parts instead of retyping them.
Missing documentation is the most common reason appeals fail. The checklist comes from the insurer’s policy, not a generic template.
People see exactly what blocks them. Sending with a warning was rejected: a weak appeal can’t be redone.
Considered insteadAllow sending with a warning.
Empty, loading, outage and partial failure are where a work tool earns or loses trust. Each one says what happened, whose problem it is and whether action is needed.
Small, explicit rules keep a dense interface consistent as it grows.
Every status pill pairs a tone with a dot and a label (WCAG 1.4.1).
Denied · Rejected · Pending · PaidClaim IDs, member IDs and codes are easy to compare and copy.
CLM-26-08812Red is reserved for what costs money if ignored — deadlines and denials — so it keeps its meaning.
2d leftAs a concept, this has no live numbers — so here is what I would measure and test first.