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Sun Knowledge DME Billing Services
1.
REVENUE CYCLE MANAGEMENT FOR
DME COMPANIES
2.
SUN KNOWLEDGE OVERVIEW Key
Facts Awards, Affiliations & Certifications 2Sun Knowledge © 2015-16 Private & Confidential ‘Onshore /Offshore’ KPO & BPO Services Serving US healthcare industry since 2007 Robust & scalable infrastructure State-of-the-art technology and systems Highly skilled and trained staff with good communication skills and in-depth knowledge of process Structured training, feedback and coaching HIPAA-HITECH compliant State-of-the-art facility inbuilt with all redundancies – power, infrastructure Sun Knowledge is ISO 27001:2013 and ISO 9001:2008 certified CMMi-SVC implementation in progress under KPMG guidance Member of NASSCOM, the Governing Industry body for IT/ITES in India Awarded ‘Best Emerging BPO Company of the year 2010’ by The Economic Times, India Recognized as one of the foremost 'Emerging companies in Eastern India' by NASSCOM in 2011 Awarded Asia-wide “Healthcare BPO Provider of the Year” at the Asia BPO Excellence Awards ceremony hosted by Asia BPO Summit on 14th February 2013 in Mumbai, India Awarded the prestigious “Outsourcing Service Provider of the Year” award in the Asian Outsourcing Excellence Awards ceremony hosted by CMO Asia on 1st August 2013 in Singapore Awarded “Highest New Job Creator (IT/ITES)” by STPI (Software Technology Parks of India) on 3rd December 2015
3.
SERVICE PORTFOLIO Provider
Support Member Support Member Retention Program Clinical Help Desk Contact Center Utilization Management Medication Therapy Management Hospital Re-admission Management Therapeutic Interchange Formulary Management Clinical Services Revenue Cycle Management Claims Administration Enrollment Processing & Member Fulfillment Credentialing Premium billing and collections Administrative Services Analytics Telemedicine Services Remote Patient Monitoring Application Development & Support Technical Support Technical Documentation IT Services Claims /Drug Utilization Analysis PDE Analysis Payment Reconciliation Medical Records Indexing and Retrieval 3Sun Knowledge © 2015-16 Private & Confidential We provide services to Providers – Physicians, Hospitals, DME, P&O, Home Health Care and Pharmacies Payers – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs
4.
HIPAA COMPLIANCE 4Sun Knowledge
© 2015-16 Private & Confidential SL. COMPLIANCE ASPECT HIGHLIGHTS 1 Physical Access Authorized access only | Bio-metric access | Proximity card system | Photo ID cards | Access log review 2 General Security 24 hour security personnel | Logging of visitor details | Physical register retained for 10 years 3 Monitoring CCTV monitoring (with recording) of production area | Daily review of recording 4 Vendor Access Signing confidentiality agreement before accessing sensitive areas | Accompanied by security personnel/employee during all times 5 Mobile Phones All employees (except managers) are required to deposit mobile phones in the locker box before entering facility 6 Personal Baggage No backpacks or other bags allowed | All baggage to be deposited in locker box before entering facility 7 Network & Application Usage Unique user IDs created using Microsoft Active Directory | Access to storage devices, shared drives, USB/mass storage devices, printers – controlled by Domain Group Policy | No wireless access points 8 Firewall Unified Threat Management System | Internet traffic regulation using multiple filters | Network Address Translation (NAT) | Intrusion Prevention Systems (IPS) | Port-mapping for traffic between Virtual LANs | Default setting to deny all traffic 9 VPN (Virtual Private Network) Site-to-site IPSec VPN tunnels | Authorized access via client-to-site VPN connections | Access authorization controlled by Active Directory's authentication service 10 Redundancy Management Fully redundant network stack | Two ISP links configured in active-active mode | Power backup supplied by 130 KVA UPS and 750 KVA generator | 22 KVA UPS backup for server and network systems 11 Virus & Malware Protection Central anti-malware system | Automatic updates | Extra protection by gateway firewall | Centralized OS patch management system (using Microsoft's WSUS server) 12 Other Measures Fire extinguishers at key areas | Half-yearly fire drills
5.
REVENUE CYCLE MANAGEMENT 5Sun Knowledge
© 2015-16 Private & Confidential
6.
REVENUE CYCLE MANAGEMENT 6Sun
Knowledge © 2015-16 Private & Confidential 360° Revenue Cycle Management Services Eligibility Verification & Authorization Billing Coding Scheduling Payment Posting Accounts Receivable
7.
REVENUE CYCLE MANAGEMENT •
Physicians / Hospitals • DMEPOS • Pharmacy (WC/ PIP) 7Sun Knowledge © 2015-16 Private & Confidential Work with physicians to enroll them with payers, setup billing systems with fee schedules, review clinical notes, code CPT/ICD, submit claims, payment posting and follow-up with payers and patients Setup DME companies in DME billing system, receive orders, generate claims, payment posting and follow-up with payers and patients Setup billing systems for submission of WC/PIP claims, code and apply correct modifiers, check eligibility with adjusters, generate claims, payment posting and follow-up Sun Knowledge provides medical billing & coding services - prompt, perfect and professional. We are HIPAA compliant.
8.
REVENUE CYCLE MANAGEMENT
SERVICES End-to-End Billing Services: Hospitals/ Physicians DMEPOS Pharmacy (WC/PIP) Stand Alone Billing Services: AR Follow-up & Collection Eligibility & Auth Verification Pre-Auth Service Credentialing Patient Collection Coding 8Sun Knowledge © 2015-16 Private & Confidential
9.
PRACTICE MANAGEMENT &
BILLING SYSTEM Sun Knowledge billing executives have experience in working on several industry standard practice management and billing software: 9Sun Knowledge © 2015-16 Private & Confidential Sun Knowledge can provide medical billing & coding services using customer’s billing system or can setup customer’s practice in a billing system managed by Sun Knowledge. Kareo SOS Emdeon / Capario One Meditech Brightree Alpha Collector Fastrack OPIE CPR+ HME Futura DME Works PrimeRx Team DME
10.
Assignment of adequate
staff Completion of secondary verification Rigorous audit Time consuming with limited staff Documentation collection requires continuous follow-up Increased TAT Time consuming with limited staff Secondary verification not carried out Checking Authorization requirement and obtaining Auth Eligibility verification Patient Demographics / Insurance / Charge Entry Transaction audit to minimize error that will reduce denial due to missing patient information TASK DESCRIPTION CHALLENGES APPROACH Missing information / Key-in errors Increased denial rate Increased TAT Assignment of adequate staff Systematic and regular follow-up with physicians’ offices and payers to collect documentation, obtain authorization Proper tracking mechanism 10Sun Knowledge © 2015-16 Private & Confidential MEDICAL BILLING – CHALLENGES VS. APPROACH
11.
Defining KPI
for rejection management process and assigning responsibility Claims reconciliation and exception report generation Unapplied balance Accumulation of backlog Manual posting Denials not posted Payment reconciliation issue Delayed correction and resubmission Possible loss of payment Payment Posting Rejection management Paper claim submission Proper tracking of every submission of paper claims Moving to EDI based submission whenever possible will reduce cost of manual work and faster payment cycle TASK DESCRIPTION CHALLENGES APPROACH Additional work for printing and faxing/mailing Delayed filing leading to denials Lack of information about the actual status Defining guidelines Review of patient payments Define KPI – TAT & Accuracy Denial posting and review MEDICAL BILLING – CHALLENGES VS. APPROACH 11Sun Knowledge © 2015-16 Private & Confidential
12.
Proper documentation –
process manual, guidelines & checklists Defining proper tracking mechanism through various reports -Ageing, Status, Daily, Exception Generate exception reports and regular audit of every process tasks Defining KPIs and assigning responsibility Lack of clarity of claims volume and current status affects management decision making process Impact on overall billing process performance and improvement Decreased productive efficiency Process administration and reporting AR Follow-up & Denial Management Regular analysis, follow-up and review Transaction audit TASK DESCRIPTION CHALLENGES APPROACH Accumulation of backlog Denials not posted Claims reconciliation issue MEDICAL BILLING – CHALLENGES VS. APPROACH 12Sun Knowledge © 2015-16 Private & Confidential
13.
GENERAL HIGHLIGHTS 13Sun Knowledge
© 2015-16 Private & Confidential FREE Billing Software FREE EMR FREE Setup, upgrades and support Up to 97% Collection Rate Claims Submission within 48 hours max. Error-free Patient Entry Over 99.9% Coding Accuracy Real-time Audits Methodical and Proactive AR Follow-up 100% HIPAA Compliance Custom Reporting
14.
DME BILLING SERVICES 14Sun Knowledge
© 2015-16 Private & Confidential
15.
DME BILLING –
KEY FACTS Secure Information & Data Flow between Sunknowledge and our partners enabled with reliable networking software & hardware (includes secured Virtual Private Networks and FTP sites) All low pay and no pays reports are sent to the client Work on re-processing of the denied claims starts immediately after receipt of ERA ERAs are posted to the respective patients’ accounts Quality check is conducted at all stages of process Turn Around Time for this process is 24 - 48 hours 15Sun Knowledge © 2015-16 Private & Confidential
16.
ORDER ENTRY –
SAMPLE REPORT 16Sun Knowledge © 2015-16 Private & Confidential INVENTORY RECEIVED Category Breast Pump CPAP Nebulizer Closet Nebulizer Integra Month Jun-15 330 114 34 45 0 Jul-15 664 265 0 55 447 Aug-15 957 278 0 49 552 Sep-15 867 248 0 35 400 Oct-15 835 303 0 74 722 Nov-15 923 244 0 105 632 Dec-15 947 299 0 133 637 Jan-16 779 230 0 142 655 INVENTORY COMPLETED Category Breast Pump CPAP Nebulizer Closet Nebulizer Integra Month Jun-15 330 114 33 45 0 Jul-15 664 265 0 55 447 Aug-15 957 278 0 49 552 Sep-15 867 248 0 35 400 Oct-15 835 303 0 72 690 Nov-15 923 241 0 105 592 Dec-15 946 290 0 127 637 Jan-16 752 209 0 134 655 0 100 200 300 400 500 600 700 800 900 1000 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 INVENTORY RECEIVED Breast Pump CPAP Nebulizer Closet Nebulizer Integra 0 100 200 300 400 500 600 700 800 900 1000 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 INVENTORY COMPLETED Breast Pump CPAP Nebulizer Closet Nebulizer Integra
17.
ELIGIBILITY & AUTHORIZATION
VERIFICATION – SAMPLE REPORT 17Sun Knowledge © 2015-16 Private & Confidential SUN KNOWLEDGE ELIGIBILITY VERIFICATION & AUTHORIZATION DETAILED FOR ABC - (7/10/2015) Sl. No. Patient # Equipment Category Eligibility Checked Primary Checked Secondary Checked Auth Required Auth Obtained Fax sent Auth Pending Comment 1 221359 Beds / Mattress Yes Yes No Yes No Yes Yes Pending Auth# Ak-098651 Follow-up : 07/15/2015 2 328547 Beds / Mattress Yes Yes No Yes No Yes Yes Follow-up : 07/14/2015 3 190398 CPAP - Machine Yes Yes No Yes No No Yes Sleep study report missing. Dr.'s office contacted Follow-up : 07/13/2015 4 215604 Diabetic Supplies Yes Yes Yes No Yes Yes No Follow-up : 07/14/2015 5 218219 CPAP - Machine Yes Yes No Yes No Yes No Follow-up : 07/17/2015 EIGIBILITY VERIFICATION & AUTHORIZATION SUMMARY REPORT FOR ABC - 07/10/2015 Equipment Category Number of New Patients Patients Brought Forward Total Patients Primary Checked Secondary Checked Auth Required Auth Obtained Fax sent Auth Pending Beds / Mattress 25 0 25 25 4 19 2 2 17 CPAP (Supplies) 44 3 47 47 12 9 7 6 2 CPAP (Machine) 15 0 15 15 3 11 3 3 8 Other DME 50 12 62 61 18 23 5 21 18 Diabetic Supplies 27 0 27 27 6 8 6 8 2 Total 161 15 176 175 43 70 23 40 47
18.
CPAP USER COMPLIANCE
& TRACKING – SAMPLE REPORT 18Sun Knowledge © 2015-16 Private & Confidential CPAP USER COMPLIANCE TRACKING SUMMARY REPORT FOR ABC - 07/10/2015 Day No. of Patients Compliant Patients No. of Non- Compliant Patients No. of Patients with No Data Available PendingNo. of Compliant Patients No. of Patients Compliant based on best 30 days 90th day Compliance Report 5 3 0 0 0 2 60th day Compliance Report 4 1 3 0 0 0 30th day Compliance Report 7 3 0 2 1 1 15th day Compliance Report 0 0 0 0 0 0 5th day Compliance Report 1 1 0 0 0 0 TOTAL 17 11 2 1 3 SUN KNOWLEDGE CPAP USER COMPLIANCE TRACKING STATUS REPORT - 07/10/2015 S No. Set Up Date 5th Day 15th Day 30th Day 60th Day 90th Day Patient # Patient Name Doctor System Status Therapy Report Imaged Report Faxed to Dr. Email /Faxed Sales person Payer Name Comment / Notes 1 4/8/2015 N/A N/A N/A N/A 83.45% 213765 DOE, JOHN Paez Encore Complete Yes Yes No OXFORD HEALTH PLANS 2 4/8/2015 N/A N/A N/A N/A 65.60% 218619 DOE, DAVID Smith Resmed Complete Yes Yes No OXFORD HEALTH PLANS Best of 30 days- 73.3% 3 6/6/2015 N/A N/A 100% N/A N/A 125354 DAY, JULIE Ricardo Encore Complete Yes Yes No MEDICARE 4 6/5/2015 N/A N/A 96.70% N/A N/A 295695 ROE, JANE Paez Encore Complete Yes Yes No HEALTH FIRST NY 5 6/30/2015 80% N/A N/A N/A N/A 233432 DOE, JULIE Paez Encore Complete N/A N/A N/A HEALTH FIRST NY 6 5/27/2015 N/A N/A 100% N/A N/A 196476 SMITH, JOE Jones Resmed Complete Yes Yes No MEDICARE 7 5/23/2015 N/A N/A 73% N/A N/A 215604 BLOGGS, JOE Jones ICODE Complete Yes Yes No AETNA HEALTH PLAN 8 6/3/2015 N/A N/A 57% N/A N/A 217849 SMITH, JULIE Smith Resmed Complete Yes Yes No MEDICARE 9 6/27/2015 100% N/A N/A N/A N/A 168488 ROE, JOHN Jones ICODE Complete N/A N/A N/A MEDICARE 10 5/1/2015 N/A N/A N/A 67.00% N/A 214535 RODRIGUEZ, P Jones Encore Complete Yes Yes No HEALTH FIRST NY
19.
AR & AR
CALLING – SAMPLE REPORT 19Sun Knowledge © 2015-16 Private & Confidential Payer >120 Days 91 – 120 Days 61 – 90 Days 31 – 60 Days Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining AARP HEALTH CARE OPTIONS 26 23 3 17 16 1 44 41 3 37 32 5 AMERICAN TRANSIT INSURANCE COMPANY 12 11 1 6 5 1 15 15 0 10 10 0 BCBCS 28 24 4 16 13 3 41 37 4 32 30 2 MAGNACARE 13 12 1 9 9 0 23 22 1 11 10 1 HIP_PALLADIAN HEALTH 6 6 0 12 9 3 12 10 2 15 15 0 MANAGED PHYSICAL NETWORK 12 10 2 8 7 1 10 10 0 10 8 2 MAGNACARE 7 7 0 2 11 -9 5 5 0 8 3 5 OXFORD 12 9 3 17 12 5 23 22 1 22 16 6 STATE FARM INSURANCE 7 6 1 4 4 0 5 5 0 4 4 0 TOUCHSTONE HEALTH 5 5 0 8 6 2 6 4 2 16 12 4 UNITED HEALTHCARE 31 28 3 23 20 3 49 43 6 41 39 2 S No. Date Payer Patient Name DOB DOS Claim No. Charge Amount Status Comments Ref # 1 7/21/2015 Healthfirst Doe, John 8/29/1974 6/26/2015 1063051526 $195.00 Paid Called Healthfirst spoke with Gary - Rep stated that claim received on 06/30/15 and processed on 07/17/15. Per rep ins paid $173.47 on check# 3023659 having bulk amount $11909.23. Check was issued on 07/17/15 and is not cashed yet. 1063051526 2 7/21/2015 Healthfirst Roe, Julie 5/3/1983 6/16/2015 1091527510 $195.00 Paid Called Healthfirst spoke with Gary - Rep stated that claim received on 06/19/15 and processed on 07/10/15. Per rep ins paid $173.47 on check# 3019387 having bulk amount $25091.99. Check was issued on 07/10/15 and is not cashed yet. 1061915510 3 7/24/2015 Magna Care (Oscar) Roe, David 8/11/1942 5/26/2015 P0449302 $3,800.00 Paid Per Ashley- rep stated that claim received on 06/05/15 and ins applied $292.60 towards pt as coins and paid 2633.40 by ck# 69783. Check issued on 07/10/15 and not yet cashed. CL725541 4 7/24/2015 Magna Care (Oscar) Bloggs, Joe 8/10/1952 6/17/2015 Q0487598 $252.11 In Process Per Ashley - Rep stated that claim received on 07/06/15 and still in process CL8765541 5 7/29/2015 Health Republic Insurance of New York Bokhari, Shahid 3/4/1958 6/19/2015 16478355-01 $100.00 Allowed Per Andriya stated that claim processed on 07/08/15 and ins applied $82.89 towards in-network deductible, Per rep the annual in-network deductible is $2000. 18441664 6 7/31/2015 Oxford Health Plan Smith, P 4/25/002 6/8/2015 5184T02894 $59.62 Paid Per Kelly stated that claim paid $42.58 on ck# 13357299 having bulk amount $221.32 issued on 07/28/15 and not cashed yet. 15298601
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20 Auth Related 14% Coding Error 5% OON
Issue 8% COB Issues 10% Patient info missing 6% Exceeds Timely Filing 8% Duplicate Claim 5% Service Not Covered 6% Primary Paid Max 7% Pre-Existing Condition 5% Others 26% Distribution of Denied Claims DENIAL MANAGEMENT – SAMPLE REPORT 20Sun Knowledge © 2015-16 Private & Confidential
21.
Increased revenue
– reduced collection Time (up to 97% collection rate) Claim submission within 48 hours of receipt of billing input Adherence to CMS billing requirements Proper records maintenance and visibility through reporting Standardization of billing operations BENEFITS PROPOSITION 21Sun Knowledge © 2015-16 Private & Confidential
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TELEHEALTH & REMOTE PATIENT
MONITORING SERVICES 22Sun Knowledge © 2015-16 Private & Confidential
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TELEHEALTH SOLUTION Our proprietary
Telehealth platform enables patients to have tele-consultation with physicians at remote locations through secured video conference. A Home Healthcare unit can use our vast network of specialist doctors for remote consultation with a patient in need. Our Telehealth solution supports end-to-end workflow for tele-consultation and is bundled with our medical billing services. Patient registration & Appointment scheduling Patient’s health records Alert/Reminder management through mail Secured video conference Electronic payment Reporting services 23Sun Knowledge © 2015-16 Private & Confidential Our telehealth solution is highly customizable and can be tailored to a specific program – hospitals, nursing homes, home healthcare and providers. It brings unparalleled benefits – Improved Access, Highly Convenient, Availability on Demand and Reduction in Supplementary Cost.
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PATIENT REMOTE MONITORING PATIENT
REMOTE MONITORING - KEY FACTS Patient remote monitoring is a modular system which integrates health monitoring devices with the telehealth delivery platform Patient remote monitoring can be used in various scenarios such as, Continual patient health collection for patient suffering from chronic diseases using homecare devices Patient undergoing post-admission/hospitalization Vital health statistics collection for patients visiting outpatient health providers Patient vital statistics are collected and displayed in real-time within telehealth platform BENEFITS Telehealth platform is integrated with advanced patient monitoring system which provides actionable insights to healthcare providers and quality & proactive care for the patients EMR system seamlessly integrates with various types remote patient monitoring devices allowing specialists to monitor need based patient health data and provide individualized care for the patients Patients monitoring system can be used to pull continuous critical vital statistics of patient and store in EMR for physicians and caregivers to monitor the progress of patient health Patient monitoring system enables collection and transmission of health data, and monitors changes in health patterns for patients 24Sun Knowledge © 2015-16 Private & Confidential
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TRANSITION, OPERATIONS AND COMPLIANCE FRAMEWORK 25Sun
Knowledge © 2015-16 Private & Confidential
26.
The key
resources of the customer are available during the transition phase. All documents and process materials like P&Ps and SOPs are available to the Service Provider Transition team before the start of transition. Any change in the Scope of Work will require re-planning. All data files are made available for data migration work. Any other assumptions made in the “Statement of Work” are applicable here. A more accurate plan will be given at the time of transition Transition plan tasks may vary depending on specific project ASSUMPTIONSSr. No. Phase / Task Description Start Week End Week Remarks 1. Project Initiation W + 0 W + 0 2. Transition Planning and Solution Identification W + 1 W + 1 ABC to provide existing SOPs/P&Ps/Flowcharts/Report s before this phase starts. 3. Knowledge transfer and detailed As- Is Process Mapping W + 2 W + 3 Onshore activity at ABC 4. Validation of process mapping document / SOPs / training materials W + 3 W + 4 Onshore activity at ABC 5. Validation of solution customization requirements W + 3 W + 4 Onshore activity at ABC 6. Finalize SLA & reporting requirements W + 4 W + 4 Onshore activity at ABC 7. Staffing & Training W + 4 W + 7 8. Solution customization W + 4 W + 7 9. Solution testing and verify operation Readiness W + 7 W + 8 ABC to provide sample data and participate in testing exercise. 10. Conduct Pilot W + 9 W + 9 11. Evaluate Pilot results and finalize critical Quality parameters W + 9 W + 9 12. Handover to Operations & start “Go Live” W + 10 Transition work ends and operations ramp-up TYPICAL TRANSITION SCHEDULE Sun Knowledge © 2015-16 Private & Confidential 26
27.
TRANSITION SUCCESS FACTORS
Executive buy-in Foster win-win partnership relationship Strong project leadership for both companies Client’s involvement in approving key deliverables (i.e. project plan, process documents, etc.) Maintain key current subject matter experts until knowledge is transferred and the key processes are stable Availability of key client personnel for training Accurate identification of desk procedures and processes is critical Effective governance structure Communicate, Communicate, Communicate 27Sun Knowledge © 2015-16 Private & Confidential
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OPERATIONAL FRAMEWORK TRANSITION Project
scoping & planning Knowledge transfer – Process training and assessment Process documentation Solution customization Infrastructure set up Pilot/Transition period TRAINING Training Need Identification Customized training program as per client’s requirement Pre-process & process training Voice & accent and cultural training Refresher training PRODUCTION Project management approach Exception handling and reporting Effective coaching & monitoring practices Periodic review and evaluation Service level management and reporting QUALITY Regular audit for process and deliverables Identify and analyze errors to take corrective measures Flowcharting and root cause analysis for process improvement measures Management reporting of quality assurance activities Capacity planning Forecasting, staffing & scheduling Real time reporting Billing and revenue management MIS / WFM Ensure 100% adherence to federal / data protection laws Governance & compliance audits Organization preparedness for client & third party audits HIPAA compliance CONTROL & COMPLIANCE PROJECT MANAGEMENT & OVERSIGHT IT INFRASTRUCTURE– TOOLS & TECHNOLOGY 28Sun Knowledge © 2015-16 Private & Confidential
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Sun Knowledge Governance Structure Steering Committee Program
Management Office Project Delivery Team Executive sponsorship Management oversight Ensure business goals and engagement goals alignment Ensure tangible results and demonstrable value Continuously educate & report executive leadership on the critical success factors of engagement Plan and implement change; define, establish performance, metrics aligned to goal Review project scope, timeline and budget and monitor project progress Communication, status reporting & escalation to steering committee Manage cross team dependencies Identify, initiate & institutionalize process improvements Oversee knowledge repository building Project Management Scope Management Knowledge Management Change Management Ensure successful engagement startup Quality Management Resource Management Communication & Status Reporting Issue Management Monitor & measure knowledge transfer process Incorporate industry best practices 29Sun Knowledge © 2015-16 Private & Confidential GOVERNANCE MODEL
30.
QUALITY ASSURANCE &
CONTROL Quality Control & Assurance processes at Sun Knowledge help us meet our client’s expectations and SLA target. We use Quality Assurance program to set production and quality goals. Our daily quality audit activities ensure that we evaluate our agents’ work on all relevant criteria. We ensure quality by carrying out rigorous quality assurance and control activities. Periodic process review Process audit Testing deliverables and root cause analysis Process improvement / re-engineering Incorporating customer feedback N% internal quality audit of client deliverables & review reporting Weekly/monthly monitoring of productivity reports 30Sun Knowledge © 2015-16 Private & Confidential
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• Process training
and refreshers • Availability of training documents in ‘Knowledge Net’ portal • V&A, Soft skills training • Post-training assessment • Training feedback • Review of training program • Preparation of training Modules • Preparation of training Plan in ‘Knowledge Net’ training module • Regular process test and appraisals • Work in-sync with Operations & QA Training Need Identification Training Program Planning Conduct Training Training Evaluation TRAINING METHODOLOGY 31Sun Knowledge © 2015-16 Private & Confidential
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COMPLIANCE – KEY
FACTS Well defined policies to cover compliance aspects Written procedures covering compliance aspects Proactive compliance reporting and issue escalation Action list for changes in rules and regulations by regulatory authorities Compliance evaluation framework Periodical training on compliance issues and update Periodic audit and review mechanism to address potential compliance risks Implementation of data privacy and security standards like HIPAA-HITECH and ISO 27001 Incident reporting for data security violation Compliance awareness among the employees and reward on compliance reporting Compliance violation by employees leads to employee retraining and reassessment Sun Knowledge has defined and established a process and system to avoid compliance risks while carrying out operations and encourage employees to proactively report compliance issues to the higher management Sun Knowledge has defined and established a process and system to avoid compliance risks while carrying out operations and encourages employees to proactively report compliance issues to the higher management. 32Sun Knowledge © 2015-16 Private & Confidential
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COMPLIANCE - ESCALATION
STRUCTURE Service Delivery Service Delivery Mgr (Service Delivery POC) Head of Operations (1st Level Escalation POC) Operations CEO & MD (Final Escalation POC) Executive Board Board of Directors Compliance Compliance Mgr (Compliance Escalation POC) Head of Compliance Compliance Team Lead Process Team Lead (Service Delivery POC) Technology Technology Mgr Quality Quality Mgr HR/Training HR/Training Mgr Compliance Issue Trigger Point Process Team Leader will inform Service Delivery Manager and Compliance Manager immediately after occurrence of the event Compliance Manager/ Service Delivery Manager will assign the severity of the compliance issue Compliance Escalation Path Severe Compliance Escalation Path 33Sun Knowledge © 2015-16 Private & Confidential
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IT INFRASTRUCTURE Service
continuity supported by BCP and disaster management mechanisms 100% redundancy in all IT assets, providing high-availability and reliability 40 Mbps leased line internet connectivity provided by two ISPs in load sharing and automatic failover configuration Data protection and security provided by Fortigate 300D firewall combined with other physical and logical access controls Voice telephony infrastructure built using E1 lines provided by two IPLC providers IP Network-based PBX system with IVR, ACD and CTI functionalities and 100% call recording & reporting features Data center with over 20 IBM servers with dedicated UPS Polycom VSX 7000A video conference system for remote training and client communication 24/7/365 IT-Infrastructure support personnel for user support, using ticket management system 120 KVA on-line UPS power backup systems and additional backup provided by 180 KVA power generator 34Sun Knowledge © 2015-16 Private & Confidential
35.
DATA SECURITY AND
END USER PRIVACY Information security management system is aligned with ISO 27001:2013 standard Implementation of policies and procedures with respect to PHI comply with HIPAA-HITECH regulations Data replication between Sun Knowledge’s servers in NY and India via site-to-site IPsec VPN tunnels helps strong business continuity management Daily off-site backup process to mitigate data loss risk in case of disaster Implementation of physical access control system in office premises restricts access to sensitive areas housing application and database Physical and logical segregation of internal network into VLAN segments to control and protect data storage and transmission between business/process units Implementation of perimeter security devices, like firewall and segregation of sensitive information systems Access to all information systems through two levels of authorization Implementation of two levels of end point malware protection network and system level anti-malware systems Use of secure e-mail system for e-mails with sensitive PHI information Implementation of access restrictions to prevent unauthorized deletion or movement of data using external storage devices like optical discs, pen drives, etc. Security incident monitoring, reporting and resolution system Periodic employee awareness training on data privacy & protection and HIPAA regulations 35Sun Knowledge © 2015-16 Private & Confidential
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CUSTOMER TESTIMONIALS &
ADDITIONAL INFORMATION "My firm has evaluated an outsourcing transaction with Sun Knowledge. They provide superior service at a very attractive rate and have demonstrated to us their commitment to this partnership. Their expertise across various process areas in the PDP/MAPD domain and unique cost structure puts them in an incredible position to work with plans throughout the healthcare industry“ Chairman, President and Chief Executive Officer New York based Health Plan “Our company is very pleased with the administrative, and business analytical solutions which Sun Knowledge delivers to our company from a quality & cost perspective. They have been a true partner in bringing industry expertise, and innovative solutions to the table. Their ability to grow with our evolving needs for higher end services such as clinical services is a significant differentiator among healthcare business process outsourcing firms.” Executive Vice President of Operations Leading MSO RONNIE HASTINGS Sun Knowledge 41 Madison Avenue, Suite 2511, New York, NY 10010 Phone: (646)-661-7853 E-mail: ronnie.hastings@sunknowledge.com For Additional Information, Please Contact 36Sun Knowledge © 2015-16 Private & Confidential