Streamlining Insurance Compliance for Mental Health Practices.
fulcrum GT
fulcrum GT
Streamlining Insurance Compliance for Mental Health Practices.
Streamlining Insurance Compliance for Mental Health Practices.
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 minutes
4 months
4 months
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:
Product Designer
Founding Designer
Product Designer
1 Product Designer (Me!)
1 Product Designer (Me!)
1 Product Designer (Me!)
1 Product Manager
1 Product Manager
1 Product Manager
1 Data Scientist
1 Data Scientist
1 Data Scientist
3 Developers
3 Developers
3 Developers
2 Business Strategists
2 Business Strategists
2 Business Strategists
Results:
Result:
Result:
Expected to reduced documentation time by
Expected to reduce 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
12 Hour decrease in monthly clinical documentation time
Case Study Outline:
The Problem:
The Problem:
Therapists Face Insurance Denials and Tedious Documentation.
Therapists Face Insurance Denials and Tedious Documentation.
The Problem:
The Problem:
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 Initial Patient-Focused Insurance Compliance Approach Met Negative Feedback.
Our Initial Patient-Focused Insurance Compliance Approach Met Negative Feedback.
*I built this website using an AI tool (Lovable) for quick feedback: link
*I built this website using an AI tool (Lovable) for quick feedback: link
Our Initial Problem Framing →
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.
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.
The Problem with Our Approach →
The Problem with Our Approach →
User testing showed that fighting billing errors was unrealistic for patients, which led us to pivot to therapists' pain points.
User testing showed that fighting billing errors was unrealistic for patients, which led us to pivot to therapists' pain points.
Research:
Research:
Therapists Face Insurance Compliance Hurdles: Excessive Time, Complexity, and Cost.
Therapists Face Insurance Compliance Hurdles: Excessive Time, Complexity, and Cost.
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→
User Personas→
Understanding Our Users→
User interviews (11) and secondary research →
User interviews (11) and secondary research →
Admin work stole an average of 8 hours a week with clients.
Admin work stole an average of 8 hours a week 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.
>34% of claims were denied, rejected, and "clawbacked" which undermined the financial stability of practices.
>34% of claims were denied, rejected, and "clawbacked" which 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
Understanding Our Users →
Small Practice Therapist
Age: 32-60+
Spends a long time on billing and payroll management.
Wants more time to spend with clients.
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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
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
Finding the Gaps in the Market →
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
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.
How might we make administrative processes easier for therapists without sacrificing billing/documenting accuracy?
Our Direction →
Initial MVP Design Journey:
Initial MVP Design Journey:
Streamlining Billing Complexity to Design Therapist Friendly Solutions
Streamlining Billing Complexity to Design Therapist Friendly Solutions
Prioritizing efficiency over immediate learnability →
Prioritizing efficiency over immediate learnability →
I mapped this flow to include all the necessary elements for insurance documentation. The flow is designed to retain insurance requirements, improve claim acceptance and reduce documentation time.
I mapped this flow to include all the necessary elements for insurance documentation. The flow is designed to retain insurance requirements, improve claim acceptance and reduce documentation time.
*Platform onboarding left out for simplicity
Ideating more efficient claims features →
Ideating more efficient claims features →
I began wire-framing on how I could make the process of filing insurance claims simpler and less time consuming using a mix of auto-populating fields and leveraging LLM technology.
I began wire-framing on how I could make the process of filing insurance claims simpler and less time consuming using a mix of auto-populating fields and leveraging LLM technology.
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
Iteration with developer input→
How might we increase documentation efficiency for therapists?→
I iterated on my initial idea for LLM assisted documentation to ensure my design met insurance standards, fit within therapists' mental models, and was technically achievable.
I iterated on my initial idea for LLM assisted documentation to ensure my design met insurance standards, fit within therapists' mental models, and was technically achievable.
V1 Progress Notes Feature
Changes:
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 to prevent errors
Used the existing BIRP framework to structure the flow
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03
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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:
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.
Initial User Testing:
Initial User Testing:
Refining Our Progress Notes Feature.
Refining Our Progress Notes Feature.
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 →
Adjustments to Progress Notes →
Based on 8 user tests, 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 card sorting with therapists.
Based on 8 user tests, 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 card sorting with therapists.
Testing LLM Behavior With Real Users →
User testing revealed a preference for real-time text streaming, which helped manage the wait time during generation. To safeguard against AI inconsistencies users expressed issues with, my team and I integrated a regeneration feature.
Testing LLM Behavior With Users →
User testing revealed a preference for real-time text streaming, which helped manage the wait time during generation. To safeguard against AI inconsistencies users expressed issues with, my team and I integrated a regeneration feature.
Testing LLM Behavior With Real Users →
User testing revealed a preference for real-time text streaming, which helped manage the wait time during generation. To safeguard against AI inconsistencies users expressed issues with, my team and I integrated a regeneration feature.
Testing LLM Behavior With Real Users →
User testing revealed a preference for real-time text streaming, which helped manage the wait time during generation. To safeguard against AI inconsistencies users expressed issues with, my team and I integrated a regeneration feature.
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:
A comprehensive insurance claim and document management platform for therapists.
A comprehensive insurance claim and document management platform for therapists.
Clear Claim management→
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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More Comprehensive and Quicker Documentation→
More Comprehensive and Quicker Documentation→
Our patented "Practinotes" feature guides users through writing documentation based on a database of over 1,000 options personalized to their particular client. Instead of manually writing out documentation, therapists just have to click, and our AI model fills in the rest.
Our patented "Practinotes" feature guides users through writing documentation based on a database of over 1,000 options personalized to their particular client. Instead of manually writing out documentation, therapists just have to click, and our AI model fills in the rest.
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Cleaner and Quicker Claim Filing→
Cleaner and Quicker Claim Filing→
Our system auto-populates confusing and lengthy insurance forms from our database and therapist documentation. Instead of selecting from over 11,000 CPT code options, therapists can just accept or deny CPT code suggestions.
Our system auto-populates confusing and lengthy insurance forms from our database and therapist documentation. Instead of selecting from over 11,000 CPT code options, therapists can just accept or deny CPT code suggestions.
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The Results →
The Results →
Following a successful pitch, we secured continued funding from Fulcrum GT investors.
We have secured a provisional patent for our documentation feature called "practinotes".
We expect to reduce clinical documentation time by 12 hours a 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.
*In user tests, our progress notes feature had an average task completion time of 3 minutes.
12
12
hours saved each month with our progress notes feature, based on user testing
monthly hours saved 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.
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"!
Final Thoughts:
Final Thoughts:
Key Takeaways and Next Steps.
Key Takeaways and Next Steps.
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.
Next Steps →
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.
Getting HIPAA audited to ensure compliance.
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
Final Design →
Documenting the session:
Completing a claim:
My LinkedIn profile
@ Will Ingersoll 2026
About Me
@ Will Ingersoll 2026