95%
reduction in inbound calls and emails
Case study · Hospitals · TPA
95% drop in inbound calls — claims processed 3× faster.
A US Third-Party Administrator serving 120+ outpatient surgery centers was hitting a scaling wall — the provider support team was buried under phone calls and emails. We shipped an MVP self-service portal in 10 weeks. Claims and referrals now process three times faster; inbound calls dropped 95%.
Case · Hospitals
shippedUnited States · TPA · Provider Network
3×
faster claims and referrals processing
120+
outpatient surgery centers in network
10 wk
to MVP in production
Stack·
CakePHP · Angular · PostgreSQL
95%
reduction in inbound calls and emails
3×
faster claims and referrals processing
120+
outpatient surgery centers in network
10 wk
to MVP in production
The challenge
Three problems — all at once.
The TPA was a market leader in bundled-payment structures — but as their customer base grew, they hit a wall. Insufficient automation was delaying claims and referrals.
The provider support team was buried under phone calls and emails — every question about claim status or referral routing came back to the same overloaded inbox.
Scaling meant either hiring more support staff or building self-service. The economics only worked with the second option — and the leadership team wanted MVP in the field within a quarter.
What we did
Seven specific things.
- 01Research and competitor analysis of existing HCP portal solutions to set the minimum bar
- 02UX/UI design with interactive prototyping and iterative usability testing across two-week Agile sprints
- 03Built provider self-service: submit, track, and manage case referrals, claims, and payments
- 04Provider onboarding online form — eliminated back-and-forth emails and phone calls to bring new providers into the network
- 05Physician look-up module for geography- and network-based specialist discovery during referrals
- 06Claims and referrals automation: rule-based validation against defined parameters, with automatic entry into the EHR; a dashboard surfaces questionable cases for human review
- 07Integrated contextual live chat with conversation history — routed to the correct support department, with full context preserved across conversations
- 08Salesforce CRM integration with the existing organization stack — reduced routine administrative tasks across the entire provider support workflow
Tech stack
CakePHPAngularPostgreSQLAWSSalesforce CRM
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