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I’m skiing in Park City. There are no statistics involved. Okay! No, I have something serious to go through. One of the good things about the pandemic is working remotely. So I can work from Park City, go skiing for a couple of hours, and still get a whole day of work. I was doing that in Joshua Tree, where I would climb for two hours and then still be able to work for ten hours or something like that. As terrible as all this is, there is some silver lining.

Is analytics challenging?

On a serious note, though, there’s something I want to relay. I think a ridiculous story is emblematic of how difficult it is to do analytics. We frequently recount, and you wonder why more people aren’t doing analytics. We run into these things that are like, “Oh, my God, this is why! Because this is our business, this is all we do, and it’s a nightmare for us to be able to get data sometimes.” So it’s no surprise that providers, billing companies, billing managers, whatever it might be, frequently run into horrible roadblocks and then throw up their hands in frustration and go, “All right! Well, I guess I can’t get what I want. So I give up.”

One of the four big clearinghouses. I won’t tell you which one because, again, we’re not trying to out anybody in particular. The four big ones that come to mind are Waystar, Trizetto, Change, and. I have a brain fart, so forgive me. This is what happens when you go skiing.

Remittances

In one of the big clearinghouses, we spent about a month trying to get access to 835s for a client to do data warehousing and provide analytics for them. After a month, we got access to the portal, and we went in. Of course, you can’t download large quantities of them. It’s capped at some small number that you can manually download. But of course, we needed tens of thousands of remittances. So we requested FTP, secure FTP access. It took a month. They provided secure FTP access. We ran the parser to take all the 835s, and run it through all of our software. Next, we combined it with the claims information to populate the analytics for this client. 

There was a problem; that there was missing information. Further, we spent a couple of weeks trying to fix our software because it wasn’t parsing all the data correctly only to figure out, “No, actually our software is working fine. They didn’t give us all the data.”

Cross-referencing

We know that we didn’t get all the data because we did a QA step where we had manually downloaded remittances from the portal. We also cross-referenced those to the ones we got in the SFTP dump and found that remittances were missing from the twelve months’ worth of data. In addition, we believed that our parser wasn’t working correctly. Then we figured out, “No, it’s not that. Actually, they just didn’t give us all the data” (because we went through and sort of systematically looked at it and figured out exactly which ones were missing).

We then went back to the clearinghouse and said, “Hey, you didn’t give us everything for the year. We wanted a year’s worth of 835s, and you didn’t give all of them.” They came back and said, “No, we gave you everything that we had.” We said, “No, no, no! That doesn’t make any sense. You didn’t.” Then, we sent them a spreadsheet showing, “Hey, here’s a ton of missing ones. These are just examples because we don’t have a complete set, but we know that all of these are missing there.” Then, we showed them a list of 5,000 missing or something. 

They came back and said, “Oh, no, no, no! We’ve given you everything that we have. Those are all for payers that are not enrolled through this clearinghouse.” And I said, “Well, that doesn’t make any sense because we downloaded the remittances from you. So how did they get into your clearinghouse if you don’t have a connection to those payers for that client? That doesn’t make any sense at all. Both of the tabs in the spreadsheet are from you. One is just from the portal, and one’s from the SFTP. I think it doesn’t make any sense what you’re saying.” They came back, and they said, “No, we gave you everything we had.”

You don’t know what you don’t know

This is the most brilliant part. They came back and said, “Give us a list of all the missing 835s that you don’t have. Then, we’ll go find those for you.” I thought to myself, “How the hell are we going to do this? This is like somebody coming to you and saying, “Tell me what you don’t know.” How the hell do we know what we don’t know, what we didn’t get? I mean, we just did the QA step to identify that there are some missing, and there’s a lot. 

So we know there is a problem: They’re not giving everything to us, but we can’t say all of the numbers of all the ones missing. If we knew all of the numbers, we wouldn’t have to manually download every one of them to do that, in which case we wouldn’t need the SFTP anymore. Of course, that would take an insane number of man-hours to do. Of course, we wouldn’t do that.

In conclusion

This is how ludicrous this is, how stupid it is that these clearinghouses come back and say dumb things and put incredible obstacles in your path to get the data you want. That is your data. It’s nuts. It’s no wonder that people throw up their hands in frustration and give up.