1. CORPORATE OVERVIEW &
SERVICES
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
2. Private & Confidential 2Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SUN KNOWLEDGE OVERVIEW
Key Facts Awards, Affiliations & Certifications
‘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 office inbuilt with all redundancies –
power, infrastructure and others
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
Office at
41 Madison Avenue, 25th Floor,
New York, NY 10010
3. SUN KNOWLEDGE 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
Medical Coding & Billing
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
RAF Analysis
Payment Reconciliation
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
Private & Confidential 3Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
4. REVENUE CYCLE
MANAGEMENT
Private & Confidential 4Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
5. REVENUE CYCLE MANAGEMENT
• Physicians / Hospitals
• DMEPOS
• Pharmacy (WC/ PIP)
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.
Private & Confidential 5Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
6. 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
Private & Confidential 6Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
7. PRACTICE MANAGEMENT & BILLING SYSTEM
Sun Knowledge billing executives have experience in working on several industry
standard practice management and billing software:
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
Private & Confidential 7Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
8. 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
MEDICAL BILLING – CHALLENGES VS. APPROACH
Private & Confidential 8Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
9. 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
Private & Confidential 9Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
10. 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
Private & Confidential 10Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
11. 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
Private & Confidential 11Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
13. Eligibility Verification & Authorization– Sample Report
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
Private & Confidential 13Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
14. CPAP User Compliance & Tracking – Sample Report
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
ADODO, JULIE
E
Paez Encore Complete Yes Yes No OXFORD HEALTH PLANS
2 4/8/2015 N/A N/A N/A N/A 65.60% 218619 STEN, LIN L 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
SCULLY,
JOANNE
Ricardo Encore Complete Yes Yes No MEDICARE
4 6/5/2015 N/A N/A 96.70% N/A N/A 295695 GONELL, DAVID Paez Encore Complete Yes Yes No HEALTH FIRST NY
5 6/30/2015 80% N/A N/A N/A N/A 233432
NELSON,
PATRICK
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 REITER, ROBIN Jones Resmed Complete Yes Yes No MEDICARE
7 5/23/2015 N/A N/A 73% N/A N/A 215604 DUTT, BINOY Jones ICODE Complete Yes Yes No AETNA HEALTH PLAN
8 6/3/2015 N/A N/A 57% N/A N/A 217849
SMITH, AUDREY
C
Smith Resmed Complete Yes Yes No MEDICARE
9 6/27/2015 100% N/A N/A N/A N/A 168488
PETERS, MARC
J
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,
AMY
Jones Encore Complete Yes Yes No HEALTH FIRST NY
Private & Confidential 14Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
15. AR & AR Calling – Sample Report
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 Valera, Mary 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 Jerez, Patricia 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) Davis, Mary 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) David, Darcy 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
Sein,
Stephanie
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
Private & Confidential 15Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
16. 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
Private & Confidential 16Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
17. Increased revenue – reduced collection Time (95% + 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
Private & Confidential 17Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
18. PAYER SERVICES –
ADMINISTRATION & VOICE BASED
Private & Confidential 18Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
19. CLAIMS ADMINISTRATION – KEY FACTS
Uploading, validation and correction of claims and authorization files received through EDI
Running bi-weekly “check run process”
Adjudication of outpatient and inpatient claims (CMS 1500 and UB 04)
Maintenance of provider data
Claims services covers claims form (CMS 1500 and UB04) entry, re-pricing, first-pass processing,
adjustment/appeals processing and provider maintenance (demographic changes)
Consistently maintaining high level of quality – Financial (> 99%) , payment (> 98%) and processing accuracy (>
97%)
More than 90% of clean claims are processed within 5 - 10 days from receipt
Processing timelines comply with CMS guidelines
Sun Knowledge claims processing associates are trained in several industry standard claims adjudication
software (EZ-Cap & IKA) and can adapt to any claims adjudication system within a short period.
Private & Confidential 19Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
20. ENROLLMENT PROCESS
Consistently achieved 100% LIS match rate
4Rx transmission for auto & facilitated enrollees within 72 hours of receipt of TRR file
Processing of enrollment files from CMS/SPAP/OEC/EGWP groups on the same day of receipt of the file
Enrollment processing based on real time eligibility verification against Medicare Beneficiary database through
Infocrossing
Daily creation and transmission of transaction data file to CMS through automatic job scheduler
Beneficiary enrollment data update as per CMS’ transaction response file
Scheduled daily creation and transmission of beneficiary eligibility data to PBM system
Generation of exception reports at every stages of enrollment processing which in turn reduces errors and
triggers corrective action
Defined manual process for analysis, investigation and resolution based on various exception reports prepared
from eligibility data
Strict adherence to CMS compliance requirements and timeliness
Our proprietary software PDP Manager is used to support enrollment functions.
Private & Confidential 20Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
21. MEMBER FULFILLMENT
Delivery of all printing materials within the timelines specified by CMS
Identification of enrollment / disenrollment events based on CMS response files and generation of appropriate
letters or statements
Generation of enrollment specific letters and enrollment kit after receiving acceptance of enrollment
transaction from CMS
Generation of disenrollment letters after receiving intimation from CMS or acceptance of disenrollment
transaction from CMS
Coordination with the printing and mailing company to send members their welcome kits, ID cards and other
letters or statements on time
Tracking and managing, printing and mailing work to comply with CMS specified timelines
Standardization of member fulfillment process ensuring compliance with CMS regulations and standards
Auditing of mailing reports to verify CMS specified time requirement
Our proprietary software PDP Manager is used to support member fulfillment functions.
Private & Confidential 21Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
22. CLINICAL SERVICES - UTILIZATION MANAGEMENT
Dedicated clinical services team comprising of physicians and pharmacists
Final decision making process involves qualified physicians at US
Plan Benefit design set up and maintenance in client specific PBM system including initial benefit design upload,
plan specific member access set-up and day to day member level rule of authorization decision
Reduces the standard procedure turnover time from 72 hours mandated by CMS to 48 hours.
Expedited procedure to determine authorization within 24 hours
Standardized process and effective application of pharmacoeconomics before rendering any decision
24x7 clinical customer support help desk
Our proprietary software PDP Manager is used to support utilization management functions.
Private & Confidential 22Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
23. CONTACT CENTER SERVICES
Claims status/Prior authorization status inquiry and follow-up
Benefit coverage inquiry
Member eligibility inquiry
Member acquisition and retention calls
Patient/provider outreach and education
Appeals and grievances handling
Billing, payment support and collections
Multilingual support
Quality Assurance through live call barging and recordings
All audit finds are recorded and classified based on severity and quality criteria
100% call recordings
Real time call barging facility
Daily call audit – audit facilitated through call audit software
Operation Dashboard & Performance reporting – Daily/Weekly/Monthly
Private & Confidential 23Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
24. TELEHEALTH & REMOTE
PATIENT MONITORING
SERVICES
Private & Confidential 24Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
25. 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
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.
Private & Confidential 25Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
26. 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
Private & Confidential 26Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
27. SOCIAL MEDIA MARKETING
Private & Confidential 27Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
28. EVEN MORE BENEFITS
Private & Confidential 28Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
ACTIVE BRANDING & VIGOROUS LEAD GENERATION THROUGH SOCIAL MEDIA MARKETING
3.4
Million
Healthcare
Providers
Tap into our massive, and ever-growing, database
of over 3 million healthcare providers from every
corner of the US, and discover your next client!
Active
Multi-
Channel
Marketing
Targeted, high quality lead generation through various
digital channels for B2B marketing such as Email
marketing, SEO (Search Engine Optimization), LinkedIn®
marketing, PPC (Pay Per Click) advertising, and more!
30. 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
Private & Confidential 30Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
31. SOCIAL MEDIA MARKETING
Private & Confidential 31Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
32. EVEN MORE BENEFITS
Private & Confidential 32Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
ACTIVE BRANDING & VIGOROUS LEAD GENERATION THROUGH SOCIAL MEDIA MARKETING
3.4
Million
Healthcare
Providers
Tap into our massive, and ever-growing, database
of over 3 million healthcare providers from every
corner of the US, and discover your next client!
Active
Multi-
Channel
Marketing
Targeted, high quality lead generation through various
digital channels for B2B marketing such as Email
marketing, SEO (Search Engine Optimization), LinkedIn®
marketing, PPC (Pay Per Click) advertising, and more!
33. 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
Private & Confidential 33Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
34. 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
Private & Confidential 34Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
35. 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
GOVERNANCE MODEL
Private & Confidential 35Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
36. 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
Private & Confidential 36Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
37. • 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
Private & Confidential 37Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
38. 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 encourage employees to proactively report compliance issues to the
higher management.
Private & Confidential 38Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
39. 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
Private & Confidential 39Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
40. 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
Private & Confidential 40Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
41. DATA SECURITY AND END USER PRIVACY
Information security management system is aligned with ISO 27001:2005 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
Private & Confidential 41Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
42. 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
Private & Confidential 42Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
Ronnie Hastings
(646) 661-7853
Email: ronnie.hastings@sunknowledge.com
Sun Knowledge
41 Madison Avenue, 25th Floor,
New York, NY 10010
For Additional Information, Please Contact…