For many payers, mundane tasks such as claim adjustments, recoupments, and retroactive changes are relegated to SQL scripts for the perceived benefit of freeing up more time in their examiner’s day.
While this seems like an efficient practice that allows staff to focus their attention on more complex tasks, many organizations are unaware that while SQL scripts may seem like an easy fix, this practice could be putting their organization at risk.
What is a SQL script?
SQL (Structured Query Language) is a domain-specific language used in programming and designed for managing data held in a relational database management system (RDBMS) or for stream processing in a relational data stream management system (RDSMS).
A SQL script is a series of commands or a sequence of instructions that can be written and saved as a stored procedure, allowing the designated user to run the script to complete the defined task.
SQL Scripts include the following commands:
UPDATE – editing records in a database to modify certain fields in specified table(s)
INSERT INTO – add specified records in a table
DELETE – delete selected records from a table
There are also commands for creating a table, modifying a table structure, creating a database, modifying a database, and removing a table from a database.
Running scripts has become a common solution many small to midsize payer organizations lean on to automate their manual processes and save time and resources.
What are the drawbacks to running SQL scripts?
While this may seem like a convenient solution, SQL scripts can have significant drawbacks. The scripts are generally created by someone in the organization’s IT team who is relying on specifications from the operations team. Writing SQL scripts requires a high level of expertise; qualified individuals generally have at least 5–7 years of experience. Because of the expertise required, even a small gap in communication between the teams can result in unintentional errors that could very easily compromise or corrupt claims data.
The core issue with SQL scripts is they make data changes to the back end of the claims system and, in most cases, do not track the changes that have been made to the data. This means that anytime a SQL script is run, it can potentially corrupt the data in the system. Errors from something as simple as running the wrong script, deleting the wrong data, updating data fields (i.e., “find and replace”), or unintentionally applying changes to claim lines that weren’t intended to be altered, could all have a significant impact on operations.
While it is possible to write a script that includes logging actions taken, many do not take that extra step. Without this important tracking, there is no audit trail, making it nearly impossible to track what the values were in claim lines before the changes were made by the script. This not only creates a compliance risk but would be problematic if the action needed to be undone due to a programming error.
Even if a user can immediately catch a mistake, they likely will have no way of knowing which lines were accidentally compromised unless they are logging which records are changed. Most organizations rely on database backups as their fallback solution when something goes wrong, but this option also has its flaws. Restoring a previous version means starting from scratch, and undoing all changes that were made. In a worst-case scenario, if the change is made during production hours, all the work of the claim examiners would also be undone in an attempt to undo the change. Database comparison is a lengthy and complicated process, so manually identifying inconsistencies requires substantial resources.
Another issue with scripts is it is impossible to identify the end user that applied the changes to the data, and because SQL scripts bypass all built-in application security, they do not account for whether that user had the skill or authority to make those changes in the first place.
What all this uncertainty means is that, at any given time, a company’s data can be compromised by its use of SQL scripts. This could jeopardize the organization and result in a failed audit.
Are SQL scripts really a compliance issue?
Healthcare Data Governance (DG) is vital to an organization’s success and a key component of any audit. Ensuring data quality is a fundamental responsibility of all operations professionals, not just those who manage compliance. AHIMA defines Data Quality and Integrity as “the extent to which healthcare data are complete, accurate, consistent and timely throughout its lifecycle including collection, application (including aggregation), warehousing, and analysis.”
From an audit perspective, it is crucial to have an accurate and complete audit trail of any data changes or updates. The log should provide all key information, with sequential user and system activities including a timestamp when changes to system records occur. When running a SQL script, the log of actions taken may be incomplete or skipped altogether. From claims data to eligibility to authorizations, there are a myriad of requirements and policies passed down from government agencies. When violated, they could result in lawsuits or penalties that will severely impact the organization.
How can I automate processes while still preserving data integrity?
Fortunately, this does not mean claims processing needs to be a painful, manual process simply to protect your data. There is a way to have all the time-saving benefits of SQL scripts without the associated risks.
SymKey, HCIM’s tried-and-true solution, can automate manual processes without compromising data integrity. SymKey software leverages IntelliRPA® robotic process automation to process claims more efficiently and securely than SQL scripts.
SymKey can process claims up to 8x faster than a claims examiner and with 100% accuracy, eliminating the chance of human error and freeing up your staff for more complex tasks.
Since it runs entirely through the front-end of your claims system, just like a claims examiner would, your operations and IT departments can rest easy knowing all processes are secure and there is no direct writing to the database tables.
SQL Script
SymKey
Protects data integrity by making changes from the user interface, not on the back end
Logs every action
Sometimes/Rarely
Bypasses system edits and messages that potentially would automatically pend a claim
Never
Requires high level of experience
Bypasses all built in application security and security assigned to user profiles
Automatic tracking to easily identify claims that were updated
Compliant and audit friendly
The benefits of SymKey.
Aside from security and data integrity, SymKey has many other benefits to help optimize your company’s operations.
SymKey delivers:
Greater Efficiency — Our robots can complete months’ worth of work in a fraction of the time, letting you focus on the complex tasks that help your business grow.
Increased Accuracy — SymKey consistently applies business rules and ensures complete and thorough documentation on each and every claim, ensuring accuracy and compliance.
Cost Savings — SymKey is an affordable solution that delivers an immediate return on investment by increasing productivity and reducing manual processes.
SymKey can touch and edit virtually any claim header or detail line field in your claims system. With this powerful tool, users can automate an unending list of manual workflows with claims, provider, and authorizations modules. Some examples include reprocessing paid claims, retroactively adjusting or denying claims, duplicating claim logic, matching authorizations, providers data updates, and so much more. SymKey robots provide unique flexibility and control using customized scenarios based on your business rules.
How can my company optimize operations with SymKey?
HCIM has been helping streamline payer operations for over 23 years. We are dedicated to partnering with our clients to deliver automation solutions that meet the demands of the ever-evolving market.
Whether you’re looking to improve your data management processes, enhance the accuracy of your claims processing, or streamline your workflows, HCIM’s SymKey solution can help you achieve your goals and deliver value.
Reach out today to speak to one of our health plan operations experts and learn more about how we can help you turn your complexity into simplicity and drive better results for your organization.