This document provides an overview of Sun Knowledge, a company that offers prior authorization and other healthcare services. Sun Knowledge has extensive experience serving the US healthcare industry since 2007. It has robust infrastructure and is HIPAA compliant. The document outlines Sun Knowledge's service portfolio, which includes prior authorization, billing, coding, claims processing and analytics. It also provides details on Sun Knowledge's prior authorization process, sample reports, benefits and positive client testimonials.

1. PRIOR AUTHORIZATION
FOR RADIOLOGY
Presented by
Sun Knowledge 41 Madison Avenue, 25th Floor, New York, NY 10010

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 office inbuilt with all redundancies –
power, infrastructure and others
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
Office at
41 Madison Avenue, 25th Floor,
New York, NY 10010
 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. 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
3Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
We provide services to
PROVIDERS – Physicians, Hospitals, DME, P&O, Home Health Care and Pharmacies
PAYORS – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs

4. SERVICE PORTFOLIO
4Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
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

5. OUR HIPAA COMPLIANCE SUMMARY
5Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
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

6. PRIOR AUTHORIZATION
6Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

7. PRIOR AUTHORIZATION – SERVICE PORTFOLIO
7Sun Knowledge © 2015-16 Private & Confidential
 Full range service, comprising Authorization Request Follow-up Approval
 100% HIPAA-HITECH Compliance
 Low prices with no hidden cost
 Highly streamlined, fast and accurate service
• PET/SPECT scans
• CT
• CTA
• MRI
• MRA
• IMRT
• MEG
• Add-on Procedures, and many more
We handle Prior
Authorization for
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

8. RETRO AUTHORIZATION
8Sun Knowledge © 2015-16 Private & Confidential
 Certain procedures require prior authorization
 Submitting a request does not guarantee approval
 If an authorization was not previously requested, a retro-authorization may be requested for
services already provided
 The same guidelines as for requesting an authorization prior to service are followed
 Dates specific for retro-authorizations are used
 Once the authorization is approved, the bill is resubmitted
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

9. AUTHORIZATION EOB CODES
9Sun Knowledge © 2015-16 Private & Confidential
 EOB code 529 – Case is denied
 EOB code 530 – No authorization on file
 EOB Code 531 – Authorization for claimant, not for provider
 EOB Code 532 – Authorization for claimant and provider, not for dates of service
 EOB Code 533 – Authorization for claimant, provider, and dates of service; not for procedure
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

10. PRIOR AUTHORIZATION – KEY STEPS
10Sun Knowledge © 2015-16 Private & Confidential
Tasks involved in carrying out this Pre Authorization service include the following steps:
 Gathering relevant medical documents from the Providers
 Calling up insurance to find the authorization filing procedure and turnaround time
 Initiation of authorization request (fax/online/calling)
 Follow up with the Payer to check the auth. status as per the TAT set for each Payer
 Acknowledgement of authorization approval/denial
 Updating the authorization details (authorization number / duration / quantity)
in the Provider’s billing system
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

11. SAMPLE REPORTS
11Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

12. SAMPLE REPORT #1
12Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
PRIOR AUTHORIZATION COMPONENTS OF DAILY DETAILED REPORT
INPUT
SL.
Date
Received
Complete/
In Progress
Patient ID Patient Name DOB Dx Codes Name of Process Provider Name Primary Payer Phone #
1 8/18/16 In progress 1234567 Patient 1 1/1/90 71250 CAT scan Provider 1 Aetna Phone 1
2 8/24/16 In progress 1234568 Patient 2 1/2/90 75571 Coronary Calcium Scan Provider 2 Cigna Phone 2
3 8/24/16 In progress 1234569 Patient 3 1/3/90 71270 CAT scan Provider 3 Centene Corp Phone 3
4 8/25/16 In progress 1234570 Patient 4 1/4/90 77080
Bone Densitometry
(DEXA Scan)
Provider 4 Aetna Phone 4
5 8/26/16 In progress 1234571 Patient 5 1/5/90 93307 Echocardiography Provider 5 Cigna Phone 5
7 8/29/16 Complete 1234573 Patient 7 1/6/90 71260 CAT scan Provider 7 Blue Shield Phone 7
8 8/29/16 Complete 1234574 Patient 8 1/7/90 93314 Echocardiography Provider 8 Centene Corp Phone 8
9 8/29/16 Complete 1234575 Patient 9 1/8/90 76815 Perinatal Ultrasound Provider 9 Aetna Phone 9
10 8/29/16 In progress 1234576 Patient 10 1/9/90 37243
Uterine Fibroid Embolization
(UFE)
Provider 10 Blue Shield Phone 10

13. SAMPLE REPORT #2
13Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
PRIOR AUTHORIZATION COMPONENTS OF DAILY DETAILED REPORT (Contd.)
AUTHORIZATION STATUS
Last Worked On Follow Up Date Comments Final Status
Approval /
Denial Date
8/25/2016 8/25/2016
8/25/2016- Got reply from Cigna, triaged back for alt. suggestion
8/18/2016- Notified Triage, since patient requested alternate procedure as copay
was too high.
In Process
8/26/2016 NA
8/26/2016- SK called insurance and s/w Jenny, she informed that a form is to be
filled up and sent back for pre-auth.
8/24/2016- SK called insurance company to provide prior authorization information
verbally.
Procedure Name: Echocardiography
Insurance Co: Aetna | Spoke with: John | Result: Pending
In Process
8/24/2016 NA
S/w Jack, PA is In Progress, Ref# M1*******3, Ade informed that the procedure is
not covered. He also informed that apart from the prescribed procedure, there are
alternatives which are covered. He will fax us the available list of alternatives at ***-
***-****.
In Process

14. SAMPLE REPORT #3
14Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
Month Approved Denied In Process NA Pending for additional information Total
08/17/16 9 2 11
08/18/16 14 1 2 2 19
08/19/16 2 1 3
08/22/16 5 1 1 7
08/23/16 8 1 9
08/24/16 10 2 12
08/25/16 6 2 2 10
08/26/16 8 1 9
08/29/16 7 3 4 14
Total 69 4 11 10 94
PRIOR AUTHORIZATION DAILY SUMMARY REPORT

15. SAMPLE REPORT #4
15Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
PRIOR AUTHORIZATION MONTHLY SUMMARY REPORT
Month Approved Denied In Process NA Pending for additional information Total
Mar-16 71 49 2 122
Apr-16 401 160 5 15 1 582
May-16 418 146 4 69 637
Jun-16 377 151 4 94 1 627
Jul-16 343 128 16 65 6 558
Total 1610 634 29 245 8 2526

16. SUMMARY OF BENEFITS
16Sun Knowledge © 2015-16 Private & Confidential
 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 Time at All Times
 ISO 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

17. TESTIMONIALS
17Sun Knowledge © 2015-16 Private & Confidential
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

18. CLIENTSPEAK
18Sun Knowledge © 2015-16 Private & Confidential
“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
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

19. CLIENTSPEAK
19Sun Knowledge © 2015-16 Private & Confidential
“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
41 Madison Avenue, 25th Floor, New York, NY 10010, USA

20. CLIENTSPEAK
20Sun Knowledge © 2015-16 Private & Confidential
“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 Ave., Suite 2511, 25th Floor
New York, NY 11001, USA
For Additional Information, Please Contact…
41 Madison Avenue, 25th Floor, New York, NY 10010, USA