Streamlining Insurance Compliance for Mental Health Practices.
fulcrum GT
Streamlining Insurance Compliance for Mental Health Practices.
Streamlining Insurance Compliance for Mental Health Practices.
Summary:
Summary:
Summary:
Over the course of the summer, I worked on a new startup at Fulcrum GT's startup program. In this program, my team and I sought to solve the problem of therapists' lengthy and confusing administrative work that I uncovered in user interviews and other research. Armed with the research, my team and I landed on our solution: an AI-powered platform that simplifies insurance compliance for small and new mental health practices.
Over the course of the summer, I worked on a new startup at Fulcrum GT's startup program. In this program, my team and I sought to solve the problem of therapists' lengthy and confusing administrative work that I uncovered in user interviews and other research. Armed with the research, my team and I landed on our solution: an AI-powered platform that simplifies insurance compliance for small and new mental health practices.
Estimated Reading Time: 3 minutes
Est. Reading Time: 5 mins
Est. Reading Time: 5 minutes
4 months (and counting)
My Role:
Product Designer
1 Product Designer (Me!)
1 Product Manager
1 Data Scientist
3 Developers
2 Business Strategists
My Role:
My Role:
My Role:
My Role:
Product Designer
Product Designer
Product Designer
Product Designer
1 Product Designer (Me!)
1 Product Designer (Me!)
1 Product Designer (Me!)
1 Product Designer (Me!)
1 Product Manager
1 Product Manager
1 Product Manager
1 Product Manager
1 Data Scientist
1 Data Scientist
1 Data Scientist
1 Data Scientist
3 Developers
3 Developers
3 Developers
3 Developers
2 Business Strategists
2 Business Strategists
2 Business Strategists
2 Business Strategists
Results:
Expected to reduced clinical documentation time by
12
hours a month based on initial user testing.
hours a month.
Presented at Iltacon 2025
12 Hour decrease in monthly clinical documentation time
12 Hour decrease in monthly clinical documentation time
Case Study Outline:
The Problem:
The Problem:
The Problem:
Therapists dealing with insurance face high denial rates, tedious documentation, and no cheap solutions.
Therapists dealing with insurance face high denial rates, tedious documentation, and no cheap solutions.
Therapists dealing with insurance face high denial rates, tedious documentation, and no cheap solutions.
For small practices, the choice was either struggle through confusing claims or pay costly coders, leading many to stop accepting insurance altogether. Additionally, documentation adds another heavy burden: therapists must write detailed progress notes after every session, a process that eats into client time and can lead to revoked payments ("clawbacks") if done incorrectly.
For small practices, the choice was either struggle through confusing claims or pay costly coders, leading many to stop accepting insurance altogether. Additionally, documentation adds another heavy burden: therapists must write detailed progress notes after every session, a process that eats into client time and can lead to revoked payments ("clawbacks") if done incorrectly.
Solution Preview→
Sending claim to health insurance
Therapist session with client
Our Core User Flow
Documenting the session (progress notes)
Click to enlarge
Click to enlarge
Completing an insurance claim document
Final Design Preview →
Completing a claim:
Documenting the session:
Our First Major Pivot:
Our First Major Pivot:
Our First Major Pivot:
Before Therapists, We Focused on Solving Insurance Compliance from the Patient's Perspective, But We Encountered Negative Feedback.
Before Therapists, We Focused on Solving Insurance Compliance from the Patient's Perspective, But We Encountered Negative Feedback.
Before Therapists, We Focused on Solving Insurance Compliance from the Patient's Perspective, But We Encountered Negative Feedback.
*I built this website using an AI tool (lovable) for quick feedback: link
Our Initial Problem Framing→
At first, we didn’t set out to solve this problem for therapists; we began by creating a tool for patients to intelligently navigate their medical bill errors. But user testing showed that fighting billing errors was unrealistic for patients, which led us to pivot to therapists' pain points.
At first, we didn’t set out to solve this problem for therapists; we began by creating a tool for patients to intelligently navigate their medical bill errors. But user testing showed that fighting billing errors was unrealistic for patients, which led us to pivot to therapists' pain points.
Research:
Research:
Research:
Therapists Struggle with Time, Complexity, and Costly Options When Dealing With Health Insurance Companies.
Therapists Struggle with Time, Complexity, and Costly Options When Dealing With Health Insurance Companies.
Therapists Struggle with Time, Complexity, and Costly Options When Dealing With Health Insurance Companies.
Small Practice Therapist
Female, 56 years old
Spends a long time on billing and payroll management
Wants more time to spend with clients
New Therapist
Age: 26-32
Small Practice Therapist
Age: 26-32
Frequently makes coding and documentation mistakes
Wants a way to simplify complicated insurance billing
Spends a long time on billing and payroll management
Wants more time to spend with clients
Small Practice Therapist
Age: 32-60+
Spends a long time on billing and payroll management
Wants more time to spend with clients
Small Practice Therapist
Age: 32-60+
Spends a long time on billing and payroll management
Wants more time to spend with clients
New Therapist
Age: 26-32
Frequently makes coding and documentation mistakes
Wants a way to simplify complicated insurance billing
New Therapist
Age: 26-32
Small Practice Therapist
Age: 26-32
Frequently makes coding and documentation mistakes
Wants a way to simplify complicated insurance billing
Spends a long time on billing and payroll management
Wants more time to spend with clients
User Personas→
Understanding Our Users→
Understanding Our Users→
User interviews (11) →
Over the course of the summer, I led 11 user interviews in order to investigate therapist workflows. I conducted 10 interviews online and 1 interview in person, sourced from online forums and connections, using semistructured interview questions.
Over the course of the summer, I led 11 user interviews in order to investigate therapist workflows. I conducted 10 interviews online and 1 interview in person, sourced from online forums and connections, using semistructured interview questions.
My Main Findings:
Admin work stole valuable time with clients.
Admin work stole valuable time with clients.
Medical coding rules felt confusing and, therefore, led to denied insurance claims.
Medical coding rules felt confusing and, therefore, led to denied insurance claims.
Insurance claim denials, rejections, and clawbacks undermined the financial stability of practices.
Insurance claim denials, rejections, and clawbacks undermined the financial stability of practices.
“I’ve spent nine hours fighting Blue Cross Blue Shield on one denial, and it’s still unresolved." - Therapist Interviewee
Synthesizing Insights →
Small Practice Therapist
Age: 32-60+
Spends a long time on billing and payroll management
Wants more time to spend with clients
1
2
4
5
7
8
10
3
6
9
11
Interviewees
New Therapist
Age: 26-32
Frequently makes coding and documentation mistakes
Wants a way to simplify complicated insurance billing
Our Direction →
How might we make administrative processes easier for therapists without sacrificing billing/documenting accuracy?
Competitor Analysis →
Accurate insurance form filing
Often prohibitively expensive
Can't write up documentation
Medical Coders
Accurate insurance form filing
Often prohibitively expensive
Can't write up documentation
Medical Coders
Affordable
No automatic CPT coding
Slow documenting*
EHR Systems
*Or privacy violating transcriptions
Affordable
No automatic CPT coding
Slow documenting*
EHR Systems
*Or privacy violating transcriptions
Most Accurate Form Filing
Most Expensive
Not Flexible with Demand
RCM vendors
Most Accurate Form Filing
Most Expensive
Not Flexible with Demand
RCM vendors
Competitor Analysis →
I analyzed 13 practice management systems (like Simple Practice and Therapy Notes) to understand how they handled insurance compliance and documentation as well as other options like medical coders and RCM vendors.
Accurate insurance form filing
Often prohibitively expensive
Can't write up documentation
Medical Coders
Affordable
No automatic CPT coding
Slow documenting*
Other EHR Systems
*Or privacy violating transcriptions
Most Accurate Form Filing
Most Expensive
Not Flexible with Demand
RCM vendors
Secondary research →
We did extensive secondary research to understand what therapists have to document for health insurance companies, and we investigated the complexities of completing insurance forms, completing progress notes, and other tasks like intake assessments, treatment plans, and more to inform the design or our product.
Therapists spend an avg. of
8 hours/week*
doing administrative tasks.
*Source: APA (2022)
>34% Rejection rate*
Therapists face a
for insurance claims.
*Source: APA (2023)
Tedious Documentation
Therapists have to complete
after every session and more.
Our Direction →
How might we make administrative processes easier for therapists without sacrificing billing/documenting accuracy?
Competitor Analysis →
Competitors fell into three camps: medical coders (accurate but prohibitively expensive), EHR add-ons (integrated but clunky and designed for hospitals), and RCM vendors (comprehensive but inaccessible to small practices). None combined affordability, ease of use, and transparency. This gap shaped our opportunity: deliver coder-level accuracy through therapist-first, AI-powered workflows.
Competitors fell into three camps: medical coders (accurate but prohibitively expensive), EHR add-ons (integrated but clunky and designed for hospitals), and RCM vendors (comprehensive but inaccessible to small practices). None combined affordability, ease of use, and transparency. This gap shaped our opportunity: deliver coder-level accuracy through therapist-first, AI-powered workflows.
How might we make administrative processes easier for therapists without sacrificing billing/documenting accuracy?
Our Direction →
Initial MVP Design Journey:
Initial MVP Design Journey:
Initial MVP Design Journey:
Digging into billing complexity to design therapist-friendly solutions.
Digging into billing complexity to design therapist-friendly solutions.
Digging into billing complexity to design therapist-friendly solutions.
Initial User Flow →
After my research, I began mapping the user flow to ensure all necessary information from insurance claims was covered in the screens. My biggest challenge was integrating all the information from claim forms into a therapist-friendly format that remained insurance-compliant. I drew on my research and additional secondary sources to create a streamlined user flow that addressed key pain points for therapists.
After my research, I began mapping the user flow to ensure all necessary information from insurance claims was covered in the screens. My biggest challenge was integrating all the information from claim forms into a therapist-friendly format that remained insurance-compliant. I drew on my research and additional secondary sources to create a streamlined user flow that addressed key pain points for therapists.
*Platform onboarding left out for simplicity
*Platform onboarding left out for simplicity
*Platform onboarding left out for simplicity
*Platform onboarding left out for simplicity
*Platform onboarding left out for simplicity
Wireframing & Lo-fis →
In the wireframing stage, I mapped how claim form fields would auto-populate while ensuring inputs were complete, intuitive, and not overwhelming for users.
In the wireframing stage, I mapped how claim form fields would auto-populate while ensuring inputs were complete, intuitive, and not overwhelming for users.
Hypothesis: Clicking preselected options will speed up documentation time
Progress Notes Wireframe
Claims Submission Page
Progress bar for the claims submission process
The claims page makes users review claim form before submitting to reduce errors
Options can get fed into an LLM to fill in the details
Hypothesis: Clicking preselected options will speed up documentation time
Progress Notes Wireframe
Progress Notes Wireframe
Claims Submission Page
Claims page makes users review claim form to reduce errors
Options can get fed into an LLM to fill in the details
Progress bar for the claims submission process
Hypothesis: Clicking preselected options will speed up documentation time
Progress Notes Wireframe
Claims Submission Page
Progress bar for the claims submission process
The claims page makes users review claim form before submitting to reduce errors
Claim Progress indicator to remind users of claims
Hypothesis: Clicking preselected options will speed up documentation time
Progress Notes Wireframe
Dashboard Iteration →
I tried several different ways to design the dashboard and got some initial feedback on them from users, fellow designers, and developers. Scroll right to see more of my attempts.
Overemphasized rejection and denial rates
Doesn't consider progress notes documentation
No Easy Access to Clients
Hard to get an at a glance summary
Not enough information on claims and doesn't consider how users will cancel suggested claims
Easy Access to Clients
The progress bar allows for easy summary
Allows users to reject suggested to do's
Easy Access to Clients
Overemphasized rejection and denial rates
Doesn't consider progress notes documentation
No Easy Access to Clients
Hard to get an at a glance summary
Not enough information on claims and doesn't consider how users will cancel suggested claims
Easy Access to Clients
The progress bar allows for easy summary
Allows users to reject suggested to do's
Easy Access to Clients
Overemphasized rejection and denial rates
Doesn't consider progress notes documentation
No Easy Access to Clients
Hard to get an at a glance summary
Not enough information on claims and doesn't consider how users will cancel suggested claims
Easy Access to Clients
The progress bar allows for easy summary
Allows users to reject suggested to do's
Easy Access to Clients
Overemphasized rejection and denial rates
Doesn't consider progress notes documentation
No Easy Access to Clients
Hard to get an at a glance summary
Not enough information on claims and doesn't consider how users will cancel suggested claims
Easy Access to Clients
The progress bar allows for easy summary
Allows users to reject suggested to do's
Easy Access to Clients
Scroll to see more design attempts 👉
How might we increase documentation efficiency and accuracy for therapists?→
How might we increase documentation efficiency for therapists?→
I expanded on my initial hypothesis that selecting predefined options would make writing progress notes quicker and iterated on my initial idea to ensure my design met insurance standards, fit within therapists' mental models, and was technically achievable. This process involved collaboration from the developers on my team, as well as extensive secondary research to understand insurance standards.
I expanded on my initial hypothesis that selecting predefined options would make writing progress notes quicker and iterated on my initial idea to ensure my design met insurance standards, fit within therapists' mental models, and was technically achievable. This process involved collaboration from the developers on my team, as well as extensive secondary research to understand insurance standards.
V1 Progress Notes
Improvements:
The selection feature saves practitioner time
Left bar felt disorganized
Sections of tags weren't based on existing frameworks
Preview progress notes button didn't consider technical limitations
Little consideration for requirements and error prevention
Added structure to tag past selection on sidebar
Replaced the preview notes feature with helpful links to past client documentation
Added error messages and required sections for error prevention
Used the existing BIRP framework to structure the flow
01
03
02
02
Added error messages and required sections for error prevention
Replaced the preview notes feature with helpful links to past client documentation
Added structure to tag past selection on sidebar
Improvements:
01
The selection feature saves practitioner time
Left bar felt disorganized
Little consideration for requirements and error prevention
V1 Progress Notes:
Improvements:
V1 Progress Notes
Added structure to tag past selection on sidebar
Replaced the preview notes feature with helpful links to past client documentation
01
Added error messages and required sections for error prevention
02
The selection feature saves practitioner time
Left bar felt disorganized
Preview progress notes button didn't consider technical limitations
Little consideration for requirements and error prevention
02
Added error messages and required sections for error prevention
Replaced the preview notes feature with helpful links to past client documentation
Added structure to tag past selection on sidebar
Improvements:
01
The selection feature saves practitioner time
Left bar felt disorganized
Little consideration for requirements and error prevention
V1 Progress Notes:
The intake client flow
Supplementary Practice Management Features →
I added features like client intake to make our platform competitive with leading systems like SimplePractice and TherapyNotes, and ensure robust HIPAA compliance.
I added features like client intake to make our platform competitive with leading systems like SimplePractice and TherapyNotes, and ensure robust HIPAA compliance.
Design System →
I developed a comprehensive design system with over 50 components for 60+ unique screens. The system features a clean, medical aesthetic, using green and blue as primary colors to build a unique brand identity associated with healing and calm. Link to design system
I developed a comprehensive design system with over 50 components for 60+ unique screens. The system features a clean, medical aesthetic, using green and blue as primary colors to build a unique brand identity associated with healing and calm. Link to design system
Initial User Testing:
Initial User Testing:
Initial User Testing:
Refining Progress Notes and Expanding the Scope of Our Product.
Refining Progress Notes and Expanding the Scope of Our Product.
Refining Progress Notes and Expanding the Scope of Our Product.
User Testing Methodology→
Over the course of 3 weeks, I led 8 user tests with our target users (new therapists and small practice therapists) to validate our features and my designs. We sourced these participants through cold outreach and from connections.
Over the course of 3 weeks, I led 8 user tests with our target users (new therapists and small practice therapists) to validate our features and my designs. We sourced these participants through cold outreach and from connections.
I tested different ways to adjust our predefined options' extremity in progress notes.
I experimented with different ways to change option extremity
I tested different ways to adjust our predefined options' extremity in progress notes.
I experimented with different ways to change option extremity
Adjustments to Progress Notes →
Based on user testing, I found my earlier method of showing the extremity of the components with color was not intuitive for users. Additionally, I defined 1,000+ adjustable, predefined options to populate the tags based on research and expert input.
Based on user testing, I found my earlier method of showing the extremity of the components with color was not intuitive for users. Additionally, I defined 1,000+ adjustable, predefined options to populate the tags based on research and expert input.
Adjustments to Progress Notes Final Page →
By testing a static loading animation and a text stream animation for the end of our progress notes flow, I discovered that users preferred the text stream. I also added a regeneration feature so users can instantly reword notes from the same prompt to address concerns brought up in user testing.
Adjustments to Progress Notes Final Page →
By testing a static loading animation and a text stream animation for the end of our progress notes flow, I discovered that users preferred the text stream. I also added a regeneration feature so users can instantly reword notes from the same prompt to address concerns brought up in user testing.
Adjustments to Progress Notes Final Page →
By testing a static loading animation and a text stream animation for the end of our progress notes flow, I discovered that users preferred the text stream. I also added a regeneration feature so users can instantly reword notes from the same prompt to address concerns brought up in user testing.
Adjustments to Progress Notes Final Page →
By testing a static loading animation and a text stream animation for the end of our progress notes flow, I discovered that users preferred the text stream. I also added a regeneration feature so users can instantly reword notes from the same prompt to address concerns brought up in user testing.
Adjustments to Progress Notes Final Page →
By testing a static loading animation and a text stream animation for the end of our progress notes flow, I discovered that users preferred the text stream. I also added a regeneration feature so users can instantly reword notes from the same prompt to address concerns brought up in user testing.
A More Comprehensive Platform →
Through getting feedback from target users, I learned therapists would only adopt our platform if it functioned like a full practice-management platform like our competitors. This meant I needed to add more features like treatment plans, intake assessments, and other essential workflows.
Our Solution:
Our Solution:
Our Solution:
A comprehensive insurance claim and document management platform for therapists.
A comprehensive insurance claim and document management platform for therapists.
A comprehensive insurance claim and document management platform for therapists.
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1
1
1
Clear Claim management→
A centralized dashboard for ease of access to documentation and claims-filing.
Reminders to file claims & complete documentation.
A centralized dashboard for ease of access to documentation and claims-filing.
Reminders to file claims & complete documentation.
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2
2
2
Quicker and More Comprehensive Documentation→
Instead of manually typing, therapists can simply click on personalized tags to document sessions.
Instead of manually typing, therapists can simply click on personalized tags to document sessions.
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3
3
3
Cleaner and Quicker Claim Filing→
Our system auto-populates long insurance forms from our database and therapist documentation.
Our system auto-populates long insurance forms from our database and therapist documentation.
The Results →
Following a successful pitch, we secured continued funding from Fulcrum GT Investors and have a patent pending for our technology.
Expected to reduce clinical documentation time by 12 hours a month based on initial user testing*.
*In user tests, our progress notes feature had an average task completion time of 3 minutes. This is more than 3 times faster than the 10-minute national average for writing manual progress notes, according to the American Psychological Association (APA). For the average therapist, this translates to approximately 12 hours of time savings per month.
*In user tests, our progress notes feature had an average task completion time of 3 minutes. This is more than 3 times faster than the 10-minute national average for writing manual progress notes, according to the American Psychological Association (APA). For the average therapist, this translates to approximately 12 hours of time savings per month.
12
hours saved each month with our progress notes feature, based on user testing
hours saved each month with our progress notes feature, based on user testing*
12
hours saved each month with our progress notes feature, based on user testing
Expected to reduce clinical documentation time by 12 hours a month based on initial user testing.
Reflection and Next Steps:
Reflection and Next Steps:
In complex spaces like mental health documentation, design can be leveraged as a safeguard against costly mistakes.
In complex spaces like mental health documentation, design can be leveraged as a safeguard against costly mistakes.
In complex spaces like mental health documentation, design can be leveraged as a safeguard against costly mistakes.
We even got our logo on "stress brains"!
Here is me presenting & getting feedback at Iltacon 2025
Me presenting Practility at Iltacon 2025
We even got our logo on "stress brains"!
Here is me presenting Practility at Iltacon 2025
Here is me presenting Practility at Iltacon 2025
We even got our logo on "stress brains"!
We even got our logo on "stress brains"!
Here is me presenting Practility at Iltacon 2025
What I learned→
Designing for healthcare billing is about trust as much as speed.
Pivoting early concepts through research was critical to finding the right way to solve problems.
Sometimes it's a sign of strength to say "I don't know" when answering questions about complicated topics like healthcare insurance processes.
Designing for healthcare billing is about trust as much as speed.
Pivoting early concepts through research was critical to finding the right way to solve problems.
Sometimes it's a sign of strength to say "I don't know" when answering questions about complicated topics like healthcare insurance processes.
Next Steps →
Progress Notes Testing: This involves insurance audits and gathering more feedback for the over 1000 predefined options.
CPT Code Generation: This focuses on testing the accuracy of the human-AI teaming flow.
Adding More Features: This includes finalizing the treatment plan and adding new billing and payroll management tools.
Progress Notes Testing: This involves insurance audits and gathering more feedback for the over 1000 predefined options.
CPT Code Generation: This focuses on testing the accuracy of the human-AI teaming flow.
Adding More Features: This includes finalizing the treatment plan and adding new billing and payroll management tools.
Progress Notes Testing: This involves insurance audits and gathering more feedback for the over 1000 predefined options.
CPT Code Generation: This focuses on testing the accuracy of the human-AI teaming flow.
Adding More Features: This includes finalizing the treatment plan and adding new billing and payroll management tools.
Adding more practice management features.
Adding more practice management features.
Getting HIPAA audited to ensure compliance.
Getting HIPAA audited to ensure compliance.
Finishing up development and launching!
Finishing up development and launching!
But Wait, There's More!
But wait, there's more!
But wait, there's more!
Final Design →
Sending claim to health insurance
Therapist session with client
Our Core User Flow
Documenting the session (progress notes)
Click to enlarge
Click to enlarge
Completing an insurance claim document
Sending claim to health insurance
Therapist session with client
Our Core User Flow
Documenting the session (progress notes)
Click to enlarge
Click to enlarge
Completing an insurance claim document
Final Design →
Documenting the session:
Completing a claim:
About Me
@Will Ingersoll 2025
About Me
@Will Ingersoll 2025
About Me
@Will Ingersoll 2025
