Medical billing services for urgent care centers by Sunknowledge

MEDICAL BILLING SERVICES
FOR URGENT CARE
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com

Private & Confidential 2Phone: (646) 661-7853 | E-mail: ronnie.hastings@sunknowledge.com
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

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

SUMMARY OF SERVICES
PRACTICE
MANAGEMENT
Scheduling
Eligibility &
Authorization
Verification
Prior Authorization
Customer Care
BILLING &
COLLECTIONS
Coding
Charge Posting
Claims Submission
Payment Posting
Denial Management
Accounts Receivable
PAYER SERVICES
Claims
Adjudication
Credentialing
Utilization
Management
Customer Care
TELEMEDICINE
Telemedicine
Remote Patient
Monitoring

HIPAA COMPLIANCE SUMMARY
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

REVENUE CYCLE
MANAGEMENT

ACCOUNTS RECEIVABLE IN THE REVENUE CYCLE
360°
Revenue Cycle
Management
Services
Eligibility &
Authorization
Verification
Patient
Information
Entry
Coding
Charge Entry
Claim
Submission
Payment
Posting
Accounts
Receivable
Denial
Management
Reporting

SERVICE HIGHLIGHTS
 Cutting-edge rapid automation technology
 Up to 97% collection rate
 Real-time eligibility checks & fast authorization
 100% HIPAA-HITECH compliance
 Turnaround time less than 48 hours max.
 Low service fees with no hidden cost
 Zero lockup service contract that can be cancelled anytime
 Excellent references from reputed clients across the US
 Real-time audits and custom reporting
 Extensive payer-side experience (in claim adjudication)

SERVICE AREAS
We provide turnkey revenue cycle management services in the following areas:
Prosthetics & Orthotics Durable Medical Equipment Urgent Care
Pathology Emergency Rooms Skilled Nursing Facilities
Wound Care EKG Pharmacies
Cardiology Specialty Clinics Orthopedic Surgery
Anesthesia Family Practice Radiology
Rehab Centers Dermatology Physicians
Healthcare Facilities and more…

ELIGIBILITY &
AUTHORIZATION
VERIFICATION

ELIGIBILITY VERIFICATION – HIGHLIGHTS
 Full range of verification services
 Fast 24-hour turnaround time
 Above 99.9% accuracy
 Detailed documentation
 100% HIPAA compliance
 Experience with national and private carriers
We have the experience, training and resources to complete quick
verification checks, a feature that Urgent Care Centers love us for.
In some cases, such services can even be rendered
in real-time (with the help of rapid database access
through appropriate lookup software applications)

AUTHORIZATION VERIFICATION – HIGHLIGHTS
 Diligent follow-up till resolution and closure
 Uniform importance given to every account irrespective of size, age or claim value
 Fast completion of authorization process
 Periodic follow-ups to maintain authorization validity
Years of experience in working at
claims adjudication for major
insurance companies in the US
have given us a unique
understanding of the
authorization process, allowing
us to complete the process faster
than others!

SAMPLE REPORTS
0
20
40
60
80
100
120
140
4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/2015
96
83
94
98
96
29
11
6
31
32
125
94
100
129
128
41
32
26
30
28
ELIGIBILITY VERIFICATION
Number of New Patient Patient Brought Forward
Primary Checked Secondary Checked (if applicable)
0
5
10
15
20
25
30
35
40
45
50
4/6/2015 4/7/2015 4/8/2015 4/9/2015 4/10/2015
45
25
38
44
46
20
15
26
22 21
25
10
12
22
25
AUTHORIZATION VERIFICATION
Auth Required Auth Obtained Auth Pending

BILLING & CODING

MEDICAL CODING OVERVIEW
Service Offerings
• Place of Service Based Coding – Inpatient, Outpatient Coding
• Provider Specialty Based Coding– E/M, Cardiology, Orthopedics, Physical Medicine etc.
• Review medical notes and clinical documents
• Assign ICD-10 codes for the diagnosis identified by the physician and procedure codes
(CPT/ ICD 10 PCS)
• Assign modifiers as applicable
• Code review and quality assurance
• Communication with Physician’s office for additional medical
documentation and clarification
Key Tasks

MEDICAL CODING – PROCESS
Downloading Allocation
CodingQuality Check
Uploading Feedbacks & Updates
Encrypted reports are
downloaded from SFTP site
Reports are allocated to
coders according to specialty
Quality checked for LCDs,
updates and client specs.
Analysis of reports, allocation
of ICD and Service codes
Analysis of reports, allocation
of ICD and CPT codes
Client reports back with
feedbacks and updates
Medical Coding Process Flow

MEDICAL BILLING SYSTEM
We use some of the premium medical billing software systems for coding and billing services
that cover the complete billing cycle, including:
 SOAP notes review
 Superbill generation and coding
 Claims edit checking and correction
 Claims submission through EDI clearing house at a scheduled time
 Rejection management
 ERA/EOB posting and reconciliation
 Automatic secondary payer billing
 Denial Management
 Patient statement generation and mailing
Sun Knowledge handles medical billing - promptly, perfectly and
professionally – using any billing system as preferred by the
client.

OTHER SERVICES

PAYMENT/DENIAL POSTING PROCESS
Payment posting is crucial to the billing process. Due to the sensitivity of this process,
accurate and efficient payment posting process is indispensable.
Our billers are known to be highly efficient and analytical in the payment posting process.
Payment Entry Process
Select Patient Account
Select EncounterSelect Encounter
If not found
Refer Client SpecifiesDenial
Denial Code
Hold Transfer BalanceTransfer BalanceWrite-off
Post Payment
Payment

PRODUCTIVITY EFFICIENCY TRACKING
Employee Name Note Count Days Worked Hours Worked Notes Per Hour Max Note Time Avg. Note Time
John Smith 977 23 203.55 4.8 1:29:52 0:07:15
Jane Doe 1025 23 214.97 4.77 0:55:14 0:04:56
Rick Williams 913 21 207.07 4.06 1:27:08 0:07:14
Robert Frost 870 21 187.35 4.64 0:42:54 0:04:05
Dan Chesser 910 23 216.47 4.2 3:50:55 0:06:18
Derek Malia 823 23 210.37 3.91 7:01:30 0:04:37
Our clients depend on transparency.
We provide our clients with the ability to maintain detailed tracking for increased productivity
and efficiency.
Sample Report

TELEMEDICINE
 Our customizable telemedicine platform (offered through our telemedicine partner GoTelecare Inc.)
connects patients, healthcare providers and ancillary staff members to complete face-to-face
consultations
o Reduces healthcare costs
o Decreases patient wait times for patient appointments
o Increases patient satisfaction
o Simple, easy to use user interface
 Diabetic Verification Form
o Expedites the process to receive the returned, signed Diabetic Verification Form from the
primary care physician
 Prescription Refills
o For rental devices; decreases the time associated with
obtaining a prescription refill

ACCOUNTS RECEIVABLE
MANAGEMENT

ACCOUNTS RECEIVABLE FOLLOW-UP
Our A/R follow-up service is designed to increase the Revenue Collection for our
clients.
The process begins after the Provider creates and sends Health Insurance Claims
(Electronic/Paper claims or Manual HCFA forms) to various Insurance Companies.
Depending on the transmission type and length of time since submission, we
begin our follow-ups.

THE SUN KNOWLEDGE EDGE
Sun Knowledge’s trained and highly-skilled billing and AR follow up
personnel can help Providers submit claims to the correct Payer(s) and
follow up with them to realize the maximum payment fast!
When claims need
to be chased,
we know
whom to ask,
when to ask
and
how to ask!

STEPS IN A/R FOLLOW-UP
 A/R Analysis
 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed
or written off by providers
 50% of denied claims are never re-filed
 50-70% of denied claims have higher chance of being recovered
 Follow-up with payer
 Aggressive follow up with the insurance company's on all accounts at any
stage of the aging bucket plays an important part in A/R follow up activities.
 Closure of claim
Reducing days in A/R, claims submission and
improving collection ratio with an increase in the
probability of payment through timely follow-up is
what we excel in!

SAMPLE OF AGENT-WISE A/R REPORT
User ID
Touched
Accounts
Note
Count
Days Worked
Hours
Worked
Notes Per
Hour
Max Note Time
Average
Note Time
XX12_GT 37 37 1 8.22 4.5 0:20:06 0:02:00
XX13_GT 50 51 1 8.83 5.77 0:35:44 0:05:45
XX14_GT 37 37 1 8.9 4.16 0:15:26 0:02:19
XX15_GT 41 41 1 8.65 4.74 0:38:47 0:09:48
XX16_GT 34 48 1 9.32 5.15 0:23:57 0:03:45
XX17_GT 83 83 1 9.63 8.62 0:42:35 0:02:37
XX18_GT 50 50 1 9.3 5.38 0:35:14 0:05:18
XX19_GT 45 46 1 9.65 4.77 0:24:11 0:05:05
XX20_GT 53 53 1 8.87 5.98 0:33:47 0:04:01
XX21_GT 14 14 1 9.93 1.41 0:37:20 0:08:23
Total Touched 444 460 Total time 91.30 5.04
Average Touched 44 46 Average time 9.13

SAMPLE OF A/R AGING REPORT
SUN KNOWLEDGE WEEKLY AR AGEING REPORT FOR Client X Inc. - 07/06/2015 through 07/12/2015
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
BCBS 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 11 9 2 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

BENEFIT HIGHLIGHTS
Reduction in
accounts receivable
by up to 30%
within 1 month
Accounts Receivable
recovery cost starts from
1%
of collections
Expert handling of accounts
receivable by highly
experienced staff
Same attention to every
cash amount regardless of
its size or source
Demonstrated expertise in
working on difficult-to-
recover aging A/R
Over 7 years’ experience
in claim adjudication for
major US insurance plans

DENIAL MANAGEMENT

REASONS FOR DENIAL
 Authorization Issues
 Referral Issues
 Medical Necessity and Medical
Records requests
 Non-Participation with Insurance
Network
 Terminated Insurance
 Coordination of benefits
 Wrong Diagnosis
 Inclusive Procedures
 Partial Payments
 Out-of-network claim status and
deductibles
 EDI Rejections
 No status and No claim on File
 PIP cases

STEPS IN DENIAL MANAGEMENT
Claim Correction and Resubmission
These are the claims which are corrected, modified, and resubmitted as a corrected
claim to Insurance companies.
For such claims, every effort is made to resolve the denial to avoid billing the patient.
Patients' Responsibility
These are claims which cannot be further worked upon and the final bill is sent to the
patient for payment collection.
The reasons for sending the patient a bill generally include In-Network deductibles and
non-covered benefits as per the insurance plan. Patients receive a statement with a
clear explanation for the balance due.
1
2
2 Categories of Denial Management

DISTRIBUTION OF DENIED CLAIMS
24%
11%
3%
35%
17%
10%
Distribution of Denied Claims
Auth Related
Coding Correction Required
OON Issue
Others
Patient info missing
Timely Filing
Claims denied as Others are due to the following reasons:
 Claim denied as duplicate
 Claim previously paid
 Patient not eligible on DOS
 Payer didn’t receive EOB from primary payer
 Provider needs to verify if item billed is rental or purchase
 Bill Primary
 Patient not covered due to pre-existing condition
 Plan doesn’t cover medical services such as DME
 Not covered by member’s plan
 Claim exceed maximum number times it can be billed

TECHNOLOGY, OPERATIONAL &
COMPLIANCE FRAMEWORK

IT INFRASTRUCTURE
 Service continuity supported by BCP and disaster management mechanisms
 100% redundancy in all IT assets, providing high-availability and reliability
 12 Mbps leased line internet connectivity provided by two ISPs in load sharing and automatic
failover configuration
 Data protection and security provided by a leading firewall system combined with other physical
and logical access controls
 Voice telephony infrastructure built using E1 lines provided by two IPLC providers
 Avaya PBX with IVR, ACD and CTI functionalities and 100% call recording & reporting features
 Data center with 13 IBM x3650 rack servers with rack mounted 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

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

GOVERNANCE MODEL
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

QUALITY ASSURANCE & CONTROL
Our Quality Control & Assurance processes 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.
The highest quality is ensured by carrying out rigorous quality assurance and control activities such as,
 Periodic process review
 Process audit
 Testing deliverables and root cause analysis
 Process improvement / re-engineering
 Incorporating customer feedback
 Internal quality audit of client deliverables & review reporting
 Weekly/monthly monitoring of productivity reports

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 encourages employees to proactively report compliance issues to
the higher management.

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

CHALLENGES & RESPONSES

CHALLENGES & OUR APPROACH
 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 Authorization
Eligibility Verification
Patient Demographics /
Insurance / Charge Entry
 Transaction audit to minimize errors;
reduces 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 & payors to collect
documentation and obtain authorization
 Proper tracking mechanism

 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
 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
 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

 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
 Accumulation of backlog
 Denials not posted
 Claims reconciliation issue

SOCIAL MEDIA MARKETING

EVEN MORE BENEFITS
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!

SUMMARY OF BENEFITS
 Very Little Risk
• Proven track record in providing healthcare BPO/KPO services
• Experienced in providing services to both payers and providers
• Experienced working with various software platforms
• Quick and efficient resource for special projects requiring technical and process expertise
 Significant Upside Potential
• Great understanding of the Healthcare Industry. Operation scale-up with a short notice
• Extremely competitive rates, greater productivity, improved quality, increased member and provider
satisfaction
 Proven Process Performance
• Low denial rate  reduced collection time  increase in revenue collection
• Billing & Coding Accuracy > 99.9%; TAT: 24 – 48 hours
• Adherence to CMS billing requirements
 Clear Communication and Quick Response at All Times
 ISO 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection

TESTIMONIALS

CLIENTSPEAK
“We have had the pleasure of working with the Sun Knowledge team
throughout the few months utilizing their services for patient data entry and
eligibility verification. They are a devoted and responsible team that is highly
experience in what they do. They are always concerned about the client’s
needs and are always there to help. I highly recommend the services offered
by Sun Knowledge.”
COO of a leading medical billing and credentialing company in New York
“Your team amazed me with the manual and the amount of info you provided
with that short training session.”
Practice Manager of a major Dermatology group in New York and New Jersey

CLIENTSPEAK
“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 CEO of a major 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 of a leading MSO

CLIENTSPEAK
“I was always against the idea of outsourcing our back end claims processing
work but I was wrong. Sun Knowledge provided extraordinary deliverables
on a timely basis which led to cost cutting considerably for us.”
CEO of a leading MA-PD Plan
Ronnie Hastings
(646) 661-7853
Email: ronnie.hastings@sunknowledge.com
Sun Knowledge
41 Madison Avenue, 25th Floor,
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Medical billing services for urgent care centers by Sunknowledge

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