HIPAA-Compliant Answering Services are Available 24/7

CALL CENTER SERVICES FOR
HEALTHCARE PROVIDERS
xxx-xxx-xxxx yourmail@something.com

COMPANY 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
 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
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
Office at
41 Madison Avenue, 25th Floor,
New York, NY 10010

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, Urgent Care, 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

CALL CENTER SERVICES

CONTACT CENTER – INTRODUCTION
Sun Knowledge’s HIPAA-compliant answering services are available 24/7.
We provide both after-hours answering services and overflow calls support on days
when you are experiencing a sudden surge in calls or staff shortages.
In addition to answering calls, Sun Knowledge also provides:
 Appointment Scheduling
 Appointment Reminder
 Patient Inquiries
 Order Taking
 Patient Satisfaction Survey
Reduce your no-show rates and last-minute cancellations and
improve the overall efficiency of your healthcare practice.

CONTACT CENTER – TYPICAL ROLES
Member
Experience
Lead
Generation
Enrollment
Inquiries
Member
Enrollment
&
Orientation
Customer
Care
Member
Satisfaction
&
Retention

CONTACT CENTER – OVERVIEW
SERVICES OFFERED BY SUN KNOWLEDGE
 Inbound Customer Support
 Outbound Call Center Services
 Email Response
 Multilingual Support
 Live Web Chat Support
Supported By:
 Project & Operation Management Best
Practices
 Rigorous Quality Assurance Program
 Real-Time Queue Monitoring through
Dashboard
 Defined Communication & Reporting
Protocol
 Structured Performance Metrics
Management
 Established Compliance Framework
 State-of-the-Art Technology Infrastructure
 BCP and Disaster Management Mechanisms
with 100% Redundancy

CONTACT CENTER – SERVICES
 Prior Authorization Inquiry Support
 Member Eligibility Inquiry Support
 Coverage Related Inquiry Support
 Plan Benefit Inquiry Support
 Claims status Inquiry and Follow-up
 Patient/Provider Outreach and Education Service
 Appeals and Grievances Handling Service
 Billing, Payment Support and Troubleshooting

PRIOR AUTHORIZATION INQUIRY SUPPORT
Our Contact Center provides the following services to the providers
in Prior Authorization:
 Inquiry handling regarding authorization request
 Providing details of authorization to be raised via Fax
 Providing information regarding authorization status
 Providing information related to Appeal Rights
 Providing assistance related to formulary / drug coverage
Our Contact Center representatives are adequately trained on:
 Formulary and benefit plan design
 Interpretation of Authorization guidelines
 Appeal process / procedure
 Client guidelines w.r.t. to Authorization requirement related advise
offered during the call
 HIPAA, FWA and related rules & regulations

MEMBER ELIGIBILITY INQUIRY SUPPORT
Our Contact Center provides the following services to the providers and members
for Eligibility:
 Inquiry handling regarding eligibility of a member
 Providing the current & past eligibility of the members
 Checking the Co-ordination of Benefits for the patient
 Resolve queries related to disputes regarding the coverage of the member
 Providing assistance in regards to the correcting the member demographics
 Benefit plan design for the current & the last year
 Medicare eligibility guidelines
 Verifying the authentication of the person calling on behalf of the member
 Policies & guidelines to correct any errors in the member’s
demographic information

PLAN BENEFITS INQUIRY SUPPORT
for Benefits Plan:
 Inquiry handling for type of plan the patient has
 Providing the benefits coverage information for different services
 Checking the deductibles & out-of-pocket met information
 Providing vendor information for the services carved out to other vendors
 Benefit Plan Design for the current & the last year
 Interpretation of co-pay, coinsurance, deductible & out-of-pocket
information for different services
 Vendors contracted & services provided by them
 Any kind of terms or conditions under which the services would be covered

CLAIMS STATUS INQUIRY & FOLLOW-UP SUPPORT
for Claims:
 Inquiry handling timelines for filing a claim
 Providing the status of the claims
 Researching on the denied claims
 Providing methods for reconsidering incorrectly processed claims
 Providing assistance in regards to the reconsiderations sent
 Provide complete detail on the processing of the claim
 Interpretation of claim processing guidelines
 Reconsideration process/procedure
 Clients reimbursement policies and procedures with respect to claims
processing and the steps to be taken in the future

PATIENT/PROVIDER OUTREACH & EDUCATION SERVICE
Our Contact Center provides the following patient/provider outreach services:
 Booking & reminder calls for ANOC seminars
 Medicare ‘Star Rating’ related member awareness
 Member/provider surveys
 Provider demographics verification
 Appointment setting and reservation for members
 Welcome calls to members and providers
 Member retention
 Process specific rules and guidelines
 Member/Provider verification process

APPEALS & GRIEVANCES HANDLING SERVICES
Our Contact Center provides the following appeals services to the providers and
members:
 Manage claims and authorization denial appeals
 Process member cost sharing appeals like co-pay and coinsurance
 Non covered services related appeals processing
 Process appeals from OON Providers related to denial of claims
 Documentation and processing of 2nd level appeals to IRE
Our Contact Center provides the following grievance handling services:
 Inappropriate treatment or misdiagnosis
 Member having to wait prior to receiving service
 Cleanliness/condition of provider’s office
 Resolution of issue/requests requiring multiple calls
 Member not getting appointments with providers
 Coverage discontinuation
 Inconvenience due to poor quality of service

PERFORMANCE METRICS
 Consistently achieving <2%
abandonment rate for existing
processes
 Consistently achieving a very high
rate of ASA (ASA <= 30 seconds:
90%);
CALL ABANDONMENT RATE
AVERAGE SPEED OF ANSWER
AVERAGE HANDLING TIME
FIRST CALL RESOLUTION
SCHEDULE ADHERENCE
The metrics are defined at the time of process transition and vary from process to process

CALL AUDIT PROCESS
 Audit sample size: 2 calls per agent daily
 All audits findings are recorded and classified on the basis of severity
 All observations are recorded in the audit tracker until resolution and closure
 All identified samples are audited on the same business day
 Gauge customer service representatives in terms of call opening/verification, customer focus,
documentation and call closing
 Roles and responsibilities of supervisors, auditors and CSRs are defined for every task
 Preventive actions are identified to reduce potential problems based on repeat audit analysis
and proactive management.
 Known errors identified through root-cause analysis, Fish Bone and/or Pareto analysis are
available in the knowledge database and form an input to TNI, refreshers, etc.
 Corrective actions are controlled through proper documentation and process guidelines
 Audit findings are shared with the client

COMPLIANCE
 All agents undergo HIPAA standard and compliance training during process induction
 100% calls are recorded and reported for compliance, quality and training purposes
 Call center agents follow established policies and procedures to mitigate risks of
non-compliance
 Calls are subjected to strict verification process by call center agents for all healthcare
related calls
 Data Security and Privacy policies ensure compliance with HIPAA and other regulatory
requirements
 Periodic compliance audit ensures fulfillment of compliance requirement in call center
operation

SERVICE HIGHLIGHTS
 Proven Call Center Performance Abandonment Rate < 2%;
ASA within 30 Seconds for 90% of calls; High CSAT
 Highly-trained personnel Highly skilled staff trained in process,
product & communication skills; staff competency built on structured
training, feedback and coaching
 Highly scalable and flexible services State-of-the-Art Technology Solutions;
service continuity supported by BCP and disaster management mechanisms;
service 24 hours a day, 7 days a week, 365 days a year; call patching and paging
 Best Management Project management best practices for process migration and
operation; knowledge management by effective use of software tools and system;
Monitor, Measure & Manage process through use technology and automated tools
 Compliance & Transparency No canned responses; scripts are customized with
you in mind; full HIPAA compliance

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
Your name here
Phone:
Email:
Sun Knowledge
41 Madison Ave., Suite 2511, 25th Floor
New York, NY 11001, USA
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