SunKnowledgeServicesSep_14_2016

CORPORATE OVERVIEW &
SERVICES
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

REVENUE CYCLE
MANAGEMENT

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.

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

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

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

 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
 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

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

Order Entry – Sample Report
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

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

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
30th
15th
5th
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

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

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

 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

PAYER SERVICES –
ADMINISTRATION & VOICE BASED

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.

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.

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.

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.

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

TELEHEALTH & REMOTE
PATIENT MONITORING
SERVICES

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.

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

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!

TRANSITION, OPERATIONS
AND COMPLIANCE
FRAMEWORK

 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
5.
Validation of solution customization
requirements
6.
Finalize SLA & reporting
requirements
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

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!

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

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

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

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

• 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

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.

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

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

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

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
(646) 661-7853
Email: ronnie.hastings@sunknowledge.com
Sun Knowledge
41 Madison Avenue, 25th Floor,
New York, NY 10010
For Additional Information, Please Contact…

SunKnowledgeServicesSep_14_2016

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