Casechek
Transforming Healthcare Billing Workflows with No-Touch PO
Eliminating 8 days of manual reconciliation – one touchless PO at a time.
Overview
Casechek is a cloud-based surgical supply chain platform that automates the lifecycle of Bill-Only implants – patient-specific devices procured by vendor sales reps during surgery. These aren't standard inventory items. They're customized for individual patients, used in orthopedic, cardiovascular, and neurosurgical procedures, and historically managed through a tangle of texts, emails, and manual reconciliation that consumed weeks of staff time per month. I joined to redesign the end-to-end billing workflow and ship NoTouchPO™ – the industry's first fully automated, zero-touch Bill-Only purchase order system. The platform validates vendor bills against five data sources simultaneously: the EHR implant log, the hospital Item Master, negotiated contract pricing, the incoming vendor bill, and FDA's GUDID device registry. When all sources align, a purchase order is issued within minutes – without a human ever touching it. The work touched every layer of the hospital: OR coordinators, sterile processing teams, billing staff, supply chain managers, and medical device reps. Getting all of them to trust an automated system meant designing for auditability, exception clarity, and graceful failure – not just for speed.
Problem Space
Understanding the challenge.
Business Challenge
Casechek had built a strong procurement product but needed to close the loop on billing. Hospitals processing $100M in Bill-Only transactions were spending 17,000+ hours annually on manual reconciliation. The business case was clear: automate PO generation and hospitals could redeploy 1.5+ FTEs, reduce overpayments, and capture hundreds of millions in misdocumented charges. The challenge was getting hospital finance teams – trained to distrust automation in a regulatory environment – to hand off control.
User Pain Points
OR coordinators were spending 2+ hours a day chasing vendors by text and phone. Billing staff were manually reconciling vendor invoices against EMR records, contracts, and FDA device data – a process requiring up to 8 staff members across departments and averaging 8 days per PO. Neither group had a shared dashboard, an audit trail, or any way to identify which vendors were chronically late or off-contract. They were flying blind on one of the hospital's largest, most risk-sensitive expense categories.
Constraints
Healthcare is not a forgiving design environment. Every workflow touched HIPAA-protected patient data and FDA-regulated device records. Integration with legacy EHR and ERP systems was non-negotiable – we couldn't ask hospitals to replace their infrastructure. The design had to accommodate deeply varied technical literacy across user groups: sterile processing technicians working on OR floors had fundamentally different needs from finance directors reviewing spend dashboards.
Research
How we listened.
Key Insights
- 1The 8-day PO timeline wasn't inefficiency – it was the result of 8 departments each waiting on the previous one with no shared visibility
- 2OR coordinators were the critical path: every vendor communication delay started with manual outreach, and every case change rippled back through the entire chain
- 3Billing staff didn't trust automation; they needed to see every validation step to build confidence and take ownership of exceptions
- 4Misdocumented implant data in the EMR wasn't seen as a billing problem – it was invisible until a patient recall or revision surgery exposed it years later
- 5Vendor reps were simultaneously the most unreliable and most important node in the workflow – the design had to make compliance easy, not just mandatory
“Before Casechek, I would send multiple texts and place multiple calls informing vendors about upcoming cases, case changes, cancellations. A very time consuming and tedious process. Now with Casechek, a couple clicks of a mouse and I'm done. I've saved hours upon hours of time.
Strategy
How we framed the opportunity.
Research synthesis revealed a clear through-line: the core issue wasn't functional – it was relational. The product wasn't failing to provide information; it was failing to establish trust, set expectations, and create the conditions for confident action.
We organized the design work around three strategic bets: (1) progressive disclosure to reduce cognitive load at each step, (2) transparency as a feature – making the system's behavior predictable and legible, and (3) emotional tone calibration to match the level of stakes users brought to the experience.
Process
How we got there.
Workflow Archaeology
Mapped the complete Bill-Only lifecycle across five hospitals – from the moment a case was scheduled to the moment a PO was issued. Discovered an average of 11 manual handoffs per case, each introducing delay and error risk. Built a shared service blueprint that let clinical, financial, and product stakeholders see the full chain for the first time – and align on where automation could safely replace human decision-making.
Service Blueprint
11 Manual Handoffs – 8 Departments – 8 Days per PO
Avg. 11 handoffs per case · each department waiting on the previous with no shared visibility. Every delay compounded invisibly until the 8th day.
Exception Taxonomy & Trust Architecture
Identified 23 distinct exception types that prevented touchless completion – off-contract pricing, quantity mismatches, missing GUDID data, late vendor bills, EMR documentation gaps. Designed an exception management system that classified each by severity, routed it to the right user, and provided enough context for fast resolution without escalation. This became the trust layer that made automation acceptable to skeptical finance teams.
Exception Taxonomy
23 Exception Types Blocking Touchless Automation
Off-contract pricing
→ Supply Chain31Quantity mismatch
→ Billing18Missing GUDID data
→ Compliance9Late vendor bill
→ Billing22EMR documentation gap
→ OR Coordinator14Duplicate line item
→ Billing7Item not in Item Master
→ Supply Chain11PO already issued
→ Finance4Outcome: Each exception type routed to the right user with full context – building trust by making automation explainable, not just fast. Finance teams moved from skepticism to 80%+ touchless rates in 90 days.
5-Way Bill Match UX
Designed the validation interface for NoTouchPO™ – a system that compares vendor bills against EHR records, Item Master, contract pricing, and FDA GUDID data simultaneously. The challenge was making complex multi-source validation legible to billing staff who needed to audit exceptions without a data science background. Used progressive disclosure: a summary pass/fail view with drill-down into source-level detail on demand.
5-Source Validation
NoTouchPO™ – Simultaneous Multi-Source Bill Match
Bill Line Under Validation
42-5320-075-02
Impl Knee Sz F Persona Tibia Stemmed Rht
Vendor: Zimmer Biomet · Qty: 1
$600.00
EHR Implant Log
Implant documented in patient's surgical record
Item Master
SKU exists in the hospital catalog
Contract Pricing
Unit price matches negotiated contract
Vendor Bill
Line received on the incoming vendor bill
FDA GUDID
Device UDI registered in FDA's device database
NoTouchPO™ Issued
All 5 sources matched · PO generated in 7 min · Zero human intervention required
Mobile-First Vendor Coordination
Redesigned the vendor-facing Tray App to reduce the coordination friction that caused most pre-PO delays. Introduced automated push notifications for case scheduling, tray status, and change alerts – replacing the manual text chains that consumed OR coordinator time. Designed for one-tap vendor acceptance and streamlined loaner tray check-in/check-out workflows.
Mobile-First Vendor Coordination
Replacing Manual Text Chains with Automated Push Notifications
Before
OR Coordinator texts vendor rep
No reply – follows up by phone
Rep confirms verbally, no record
Case changes – coordinator texts again
Rep misses update, wrong tray arrives
Emergency re-coordination day-of surgery
2+ hrs/day · no audit trail
After
EHR scheduling feed triggers Auto-Assign™
Push notification sent to vendor rep
Rep confirms with one tap – logged
Case change auto-notifies all parties
SPD alerted 48h in advance
Day-of: no calls, no surprises
Fully logged · zero follow-up calls
Casechek
now
Case confirmed: Dr. Chandler · Northwestern Memorial · Knee Arthroplasty · Fri 08:00 AM
Spend Visibility Dashboard
Designed the hospital leadership dashboard – real-time visibility into Bill-Only spend, vendor performance, automation rates, and flagged exceptions. For the first time, supply chain directors could see which vendors submitted late bills, which surgeons drove off-contract spend, and what their actual-vs-contracted pricing variance looked like across the full implant portfolio.
Spend Visibility Dashboard
Real-Time Bill-Only Spend · Vendor Performance · Automation Rate
Bill-Only spend processed
$104.2M
+12%YTD across 3 facilities
NoTouchPO™ automation
82%
+38 ptsof all Bill-Only POs
Avg. time to PO
7 min
−99%down from 8 days
Misdocumented spend caught
$131M
flagged for charge capture
Vendor Scorecard
Zimmer Biomet
96%
+0.4%
Stryker
93%
+1.1%
Boston Scientific
95%
+0.6%
Medtronic
88%
+2.3%
Johnson & Johnson
74%
+4.8%
Pilot Rollout & Automation Ramp
Supported the NoTouchPO™ pilot with in-product guidance flows and exception coaching tools designed to move hospitals from partial to full automation over 90 days. Built confidence by surfacing automation rates climbing week-over-week within the product itself. By Q4, customers exceeded 80% NoTouchPO™ automation – issuing POs in minutes rather than days, and processing 146,000 purchase orders with dramatically reduced manual intervention.
Automation Ramp
12-Week NoTouchPO™ Rollout – 18% → 82% Touchless
Rollout Milestones
146K
POs Processed
82%
Automation Rate
7 min
Avg. Time to PO
Solution
What we built.
We shipped NoTouchPO™ – the industry's first fully automated, zero-touch Bill-Only purchase order system. The platform validates vendor bills against five data sources simultaneously and issues a PO within minutes when all sources align. No human ever has to touch it.
NoTouchPO™ – Validation in Progress
5-Way Simultaneous Bill Match
Bill Line Under Review
Zimmer Biomet · Case #87429142-5320-075-02
Impl Knee Sz F Persona Tibia Stemmed Rht · Qty 1
$600.00
EHR Implant Log
Documented – Tibia System Sz F, Right
Item Master
SKU 42-5320-075-02 · Active · Orthopedics
Contract Pricing
$600.00 · Zimmer Biomet Contract #ZB-2024
Vendor Bill
Line received · Invoice #ZB-INV-88421
FDA GUDID Registry
UDI 00884146008613 · Class III · Active
NoTouchPO™ Issued – PO #CC-2026-874291
All 5 sources matched · Generated in 6 min 48 sec · Zero human intervention
14:03:22
5-Way Bill Match Validation
NoTouchPO™ validates every vendor bill against five simultaneous data sources – EHR, Item Master, contract pricing, vendor invoice, and FDA GUDID. When all five align, a PO issues automatically with zero human intervention.
Exception Management System
23 Exception Types · Routed to the Right Person, Every Time
Off-Contract Pricing Exception · Case #887312
Vendor
Stryker
Procedure
L4-L5 Spinal Fusion
SKU
ST-499-026
Billed
$3,420.00
Contract
$2,890.00
Variance
+$530.00
Automated Routing Workflow
Exception Detected
Off-contract price: +$530 above negotiated rate
Severity Classified
Moderate · Billing threshold exceeded
Routed to Supply Chain
Assigned to Sarah K. · SLA: 24h · context auto-attached
Resolution Path
Contract override OR vendor credit requested
Design insight: Every exception arrives pre-populated with contract data, vendor context, and a suggested resolution – so the billing team makes decisions, not discoveries.
Exception Management System
When sources don't align, exceptions are classified by severity and routed to the right person with full contract context pre-attached. The trust layer that moved finance teams from skepticism to 80%+ automation in 90 days.
PO #CC-2026-874291
Northwestern Memorial · Jun 3 2026
Vendor
Zimmer Biomet
Ship To
OR-305 · Main Pavilion
Required By
Jun 3 · 07:30 AM
Line Items – 5-Way Match Verified
42-5320-075-02
Persona Knee Tibia Sz F · Stemmed · Right
1
$600.00
$600.00
42-5220-040-00
Persona Knee Femoral Sz F · Cemented
1
$890.00
$890.00
42-5420-010-00
Persona Poly Bearing Sz F · Std
1
$220.00
$220.00
Total
$1,710.00
Validation & Approval Trail
5-Source validation passed
14:03:22
PO auto-generated by NoTouchPO™
14:03:28
Sent to Zimmer Biomet AP portal
14:03:31
ERP integration confirmed
14:03:34
Auto-Generated PO Document
The output: a formal, auditable purchase order generated in under 7 minutes – with a complete validation trail, ERP integration confirmation, and vendor portal notification. Indistinguishable from a manually reviewed PO.
Supply Chain Leadership Dashboard
NoTouchPO™ Automation · Annual Performance
NoTouchPO™ Rate
82%
+38 pts
Avg. Time to PO
7 min
−99%
Spend Processed
$104M
+12%
Flags Caught
$131M
YTD
NoTouchPO™ Automation Rate – Jan to Dec 2025
82% ↑Monthly PO Volume
Automation Rate Dashboard
Supply chain leadership gained real-time visibility into automation rate, PO volume, time-to-PO, and misdocumented spend caught – tracking the 18%→82% ramp week over week across all participating facilities.
NoTouchPO™ Prototype
Explore the platform.
A fully interactive prototype of the Casechek NoTouchPO™ billing workflow – including the bill validation queue, multi-source match interface, and the spend analytics dashboard. Explore a real bill from surgical implant receipt to automated PO issuance.
Launch NoTouchPO™
Bill queue · Validation interface · Spend dashboard
Impact
What changed.
From an average of 8 days to minutes – the industry's first fully automated Bill-Only PO, validated against 5 data sources with zero human intervention.
For $100M in Bill-Only transactions, manual processing hours dropped from 17,000 to 3,000 annually – enabling hospitals to redeploy 1.5+ FTEs to higher-value work.
By Q4, customers exceeded 80% touchless automation – processing 146,000 purchase orders with dramatically reduced manual intervention.
In 2025, Casechek customers identified $131M in misdocumented Bill-Only spend – representing over $500M in potential charge capture and patient record corrections.
Reflection
What I learned.
Healthcare supply chain is one of those domains where the gap between what's technically possible and what's actually trusted is enormous. Hospitals had been managing Bill-Only implants manually for decades – not because they lacked technology, but because the stakes of getting it wrong (patient safety, regulatory compliance, multi-million dollar spend) made trust slow to build. The design challenge wasn't really about workflows. It was about building confidence, step by step, that a machine could do this reliably. What I took away: in regulated, high-stakes environments, auditability isn't a compliance checkbox – it's the primary UX feature. Every automation we shipped needed an equal investment in its exception handling, its audit trail, and its 'why did this happen' explanations. The hospitals that ramped fastest to 80%+ touchless automation were the ones who felt most in control of the system – not least. That's the counterintuitive truth of designing for automation: the more control you give people over the machine, the more they trust it to run without them.