DHCS State of California

Revolutionizing California’s Medi-Cal Provider Experience

Transforming Eligibility Verification & Claims Processing for Efficiency & Compliance

Role

UX Designer

Team

Medi-Cal Digital Services

Timeline

Jan 2024 - Dec 2024

Overview

Business Context

The California Department of Health Care Services (DHCS) operates the Medi-Cal Provider Portal, a critical system supporting millions of healthcare professionals in verifying patient eligibility, processing claims, and managing reimbursements.

The California Department of Health Care Services (DHCS) operates the Medi-Cal Provider Portal, a critical system supporting millions of healthcare professionals in verifying patient eligibility, processing claims, and managing reimbursements.

However, inefficient workflows, poor error messaging, and accessibility gaps created frustrating user experiences, leading to:

01

Slow task completion and processing delays

02

Compliance risks due to accessibility gaps

03

High support dependency, increasing operational costs

My Role & Collaboration

As a Senior UX Designer, I led the end-to-end transformation of key workflows for the State of California’s Medi-Cal provider portal, focusing on two critical divisions: Eligibility and Advanced Provider Services. My goal was to enhance usability, efficiency, and compliance, ensuring that both healthcare providers and users could seamlessly interact with the portal to complete their tasks accurately.

As a Senior UX Designer, I led the end-to-end transformation of key workflows for the State of California’s Medi-Cal provider portal, focusing on two critical divisions: Eligibility and Advanced Provider Services. My goal was to enhance usability, efficiency, and compliance, ensuring that both healthcare providers and users could seamlessly interact with the portal to complete their tasks accurately.

This resulted in:

Increase in task completion rates

Reduction in error resolution time.

Improved self-service adoption

Reduction in support calls.

Additionally, I worked on the Global User Messaging (G.U.M.) system, designing multiple iterations of an admin-controlled messaging feature that allowed for alerts, announcements, and targeted communication across different organizations, user types, and provider categories.

Additionally, I worked on the Global User Messaging (G.U.M.) system, designing multiple iterations of an admin-controlled messaging feature that allowed for alerts, announcements, and targeted communication across different organizations, user types, and provider categories.

The Challenge

Simplifying Healthcare Access for Providers & Users

How can the Medi-Cal Provider Portal be optimized to improve eligibility verification, claim processing, and provider workflows, ensuring a seamless and efficient experience for healthcare professionals?

The Medi-Cal Provider Portal serves millions of healthcare providers and users but complex navigation, inefficient workflows, and accessibility gaps made it difficult to complete critical tasks. These issues resulted in:

01

User frustration

Due to slow, error-prone processes.

02

Increased call center dependency

Driving up operational costs.

03

Prolonged processing times

Delaying payments and reimbursements.

To address these challenges, I led the enhancement of key workflows for Eligibility Verification, Advanced Provider Services workflows , and the Global User Messaging system. These improvements boosted task completion rates, increased self-service adoption, and improved real-time communication.

Process & Approach

Enhancing Provider Portal Efficiency

Phase 01 | Research & Discovery

Conducted a heuristic evaluation to identify usability pain points.

Analyzed drop-off rates, error logs, and call center support data to uncover major friction points.

Interviewed healthcare providers and admins to understand workflow challenges and communication gaps.

Phase 02 | Wireframing & Prototyping

Redesigned eligibility verification workflows with real-time validation & clearer error messaging.

Built intuitive APS dashboards for claim status tracking & checkwrite inquiries.

Enhanced search & filtering for faster provider access to critical data.

Developed G.U.M. (Global User Messaging) to allow admins to send messages, alerts, and updates across multiple organizations, user types, and provider groups.