sun knowledge - corporate overview & services

CORPORATE OVERVIEW & SERVICES

SUN KNOWLEDGE OVERVIEW

2Sun Knowledge © 2015-16 Private & Confidential

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

PROVIDER SERVICESREVENUE 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)

Standalone 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 networkingsoftware & 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 sentAuth

PendingComment

1 221359 Beds / Mattress Yes Yes No Yes No Yes YesPending Auth# Ak-098651Follow-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 YesSleep study report missing. Dr.'s office contactedFollow-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 PatientsNo. 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





TOTAL 17 11 2 1 3

SUN KNOWLEDGE CPAP USER COMPLIANCE TRACKING STATUS REPORT - 07/10/2015

S No.Set Up

Date5th Day

15th

Day

30th

Day

60th

Day

90th

DayPatient # Patient Name Doctor System Status

Therapy

Report

Imaged

Report

Faxed to Dr.

Email

/Faxed

Sales

person

Payer NameComment /

Notes

1 4/8/2015 N/A N/A N/A N/A 83.45% 213765ADODO, JULIE

EPaez 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 PLANSBest of 30 days-

73.3%

3 6/6/2015 N/A N/A 100% N/A N/A 125354SCULLY,

JOANNERicardo 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 233432NELSON,

PATRICKPaez 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 217849SMITH, AUDREY

CSmith Resmed Complete Yes Yes No MEDICARE

9 6/27/2015 100% N/A N/A N/A N/A 168488PETERS, MARC

JJones ICODE Complete N/A N/A N/A MEDICARE

10 5/1/2015 N/A N/A N/A 67.00% N/A 214535RODRIGUEZ,

AMYJones 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 PayerPatient Name

DOB DOS Claim No.Charge

AmountStatus 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 PaidPer 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 ProcessPer Ashley - Rep stated that claim received on 07/06/15 and still in process

CL8765541

5 7/29/2015Health Republic Insurance of New York

Bokhari, Shahid

3/4/1958 6/19/2015 16478355-01 $100.00 AllowedPer 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 PlanSein, Stephanie

4/25/002 6/8/2015 5184T02894 $59.62 PaidPer 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

16

Auth Related14%

Coding Error5%

OON Issue8%

COB Issues10%

Patient info missing6%

Exceeds Timely Filing8%

Duplicate Claim5%

Service Not Covered6%

Primary Paid Max7%

Pre-Existing Condition5%

Others26%

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 pharmaco-economics 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

TELEMEDICINE & REMOTE PATIENT MONITORING

SERVICES


TELEMEDICINE SOLUTION

Our proprietary Telemedicine 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 Telemedicine 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 telemedicine 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 telemedicine 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 telemedicine platform

BENEFITS

Telemedicine 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


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

WeekRemarks

1. Project Initiation W + 0 W + 0

2.Transition Planning and Solution

IdentificationW + 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 MappingW + 2 W + 3 Onshore activity at ABC

4.Validation of process mapping

document / SOPs / training materialsW + 3 W + 4 Onshore activity at ABC

5.Validation of solution customization

requirementsW + 3 W + 4 Onshore activity at ABC

6.Finalize SLA & reporting

requirementsW + 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

ReadinessW + 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 parametersW + 9 W + 9

12.Handover to Operations & start “Go

Live”W + 10

Transition work ends and

operations ramp-up

TYPICAL TRANSITION SCHEDULE

Sun Knowledge © 2015-16 Private & Confidential 28

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 TrainingTraining

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 leading 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 SunKnowledge. They provide superior service at a very attractiverate and have demonstrated to us their commitment to thispartnership. Their expertise across various process areas inthe PDP/MAPD domain and unique cost structure puts themin an incredible position to work with plans throughout thehealthcare industry“

Chairman, President and Chief Executive OfficerNew York based Health Plan

“Our company is very pleased with the administrative, andbusiness analytical solutions which Sun Knowledge delivers toour company from a quality & cost perspective. They havebeen a true partner in bringing industry expertise, andinnovative solutions to the table. Their ability to grow withour evolving needs for higher end services such as clinicalservices is a significant differentiator among healthcarebusiness process outsourcing firms.”

Executive Vice President of OperationsLeading MSO

Sun Knowledge41 Madison Avenue, Suite 2511, New York, NY 10010 Phone: +1 212.400.6100E-mail: [email protected]

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