CORPORATE OVERVIEW & SERVICES
CORPORATE OVERVIEW & SERVICES
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 Offices located in US & India
• New York City, US – Situated in Manhattan (facility inbuilt with all redundancies – power, infrastructure)
• Kolkata, India – Situated in the IT Hub(facility inbuilt with all redundancies – power, infrastructure)
Sun Knowledge, our contracted company, is ISO 27001:2013 and ISO 9001:2008 certified company.
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
SUN KNOWLEDGE SERVICE PORTFOLIO
Provider SupportMember SupportMember Retention ProgramClinical Help Desk
Contact Center
Utilization ManagementMedication Therapy ManagementHospital Re-admission
ManagementTherapeutic InterchangeFormulary Management
Clinical Services
Revenue Cycle ManagementClaims AdministrationEnrollment Processing &
MemberFulfillmentCredentialing Premium billing and collections
Administrative Services
Analytics
Telemedicine ServicesRemote Patient MonitoringApplication Development & SupportTechnical SupportTechnical Documentation
IT Services
Claims /Drug Utilization AnalysisPDE AnalysisPayment 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
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REVENUE CYCLE MANAGEMENT
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REVENUE CYCLE MANAGEMENT
• Physicians / Hospitals
• DMEPOS
• Pharmacy (WC/ PIP)
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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/ PhysiciansDMEPOSPharmacy (WC/PIP)
Stand Alone Billing Services:
AR Follow-up & Collection Eligibility & Auth Verification Pre-Auth Service Credentialing Patient CollectionCoding
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PRACTICE MANAGEMENT & BILLING SYSTEM
Sun Knowledge billing executives have experience in working on several industry standard practice management and billing software:
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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
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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 resubmissionPossible loss of payment
Payment Posting
Rejection management
Paper claim submission
Proper tracking of every submission of paper claimsMoving to EDI based submission whenever possible will reduce cost of manual work and faster payment cycle
TASK DESCRIPTION CHALLENGES APPROACH
Additional work for printing and faxing/mailing
Delayed filing leading to denials Lack of information about the actual
status
Defining guidelinesReview of patient payments Define KPI – TAT & Accuracy Denial posting and review
MEDICAL BILLING – CHALLENGES VS. APPROACH
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Proper documentation – process manual, guidelines & checklistsDefining proper tracking mechanism through various reports -Ageing, Status, Daily, ExceptionGenerate exception reports and regular audit of every process tasksDefining 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
TASK DESCRIPTION CHALLENGES APPROACH
Accumulation of backlogDenials not postedClaims reconciliation issue
MEDICAL BILLING – CHALLENGES VS. APPROACH
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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
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Order Entry – Sample Report
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INVENTORY RECEIVED
Category Breast Pump CPAP Nebulizer Closet
Nebulizer IntegraMonth
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 IntegraMonth
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
Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16
0
100
200
300
400
500
600
700
800
900
1000
INVENTORY RECEIVED
Breast PumpCPAPNebulizerCloset NebulizerIntegra
Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16
0
100
200
300
400
500
600
700
800
900
1000
INVENTORY COMPLETED
Breast PumpCPAPNebulizerCloset NebulizerIntegra
Eligibility Verification & Authorization– Sample Report
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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-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
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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
PatientsNo. of Patients
Compliant based on best 30 days
90th day Compliance Report 5 3 0 0 0 2
60th day Compliance Report 4 1 3 0 0 0
30th day Compliance Report 7 3 0 2 1 1
15th day Compliance Report 0 0 0 0 0 0
5th day Compliance Report 1 1 0 0 0 0
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
Day30th Day
60th Day
90th Day Patient # Patient Name Doctor System Status
Therapy Report Imaged
Report Faxed to Dr.
Email /Faxed Sales
personPayer 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
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Payer>120 Days 91 – 120 Days 61 – 90 Days 31 – 60 Days
Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining Claims Completed RemainingAARP HEALTH CARE OPTIONS 26 23 3 17 16 1 44 41 3 37 32 5AMERICAN 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 2MAGNACARE 13 12 1 9 9 0 23 22 1 11 10 1HIP_PALLADIAN HEALTH 6 6 0 12 9 3 12 10 2 15 15 0MANAGED PHYSICAL NETWORK 12 10 2 8 7 1 10 10 0 10 8 2MAGNACARE 7 7 0 2 11 -9 5 5 0 8 3 5OXFORD 12 9 3 17 12 5 23 22 1 22 16 6STATE FARM INSURANCE 7 6 1 4 4 0 5 5 0 4 4 0TOUCHSTONE HEALTH 5 5 0 8 6 2 6 4 2 16 12 4UNITED 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 PaidCalled 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 PaidCalled 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 Process Per 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 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
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Auth Related14%
Coding Error5%
OON Issue8%
COB Issues10%
Patient info missing6%
Exceeds Timely Fil-ing8%
Duplicate Claim5%
Service Not Covered
6%
Primary Paid Max7%
Pre-Existing Con-dition
5%
Others26%
Distribution of Denied Claims
DENIAL MANAGEMENT – SAMPLE REPORT
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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
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PAYER SERVICES – ADMINISTRATION & VOICE BASED
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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
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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
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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
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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
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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
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100% call recordingsReal time call barging facility
Daily call audit – audit facilitated through call audit softwareOperation Dashboard & Performance reporting – Daily/Weekly/Monthly
TELEHEALTH & REMOTE PATIENT MONITORING SERVICES
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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
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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
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TRANSITION, OPERATIONS AND COMPLIANCE
FRAMEWORK
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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
WeekEnd
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/Reports 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 W + 3 W + 4 Onshore activity at ABC
5. Validation of solution customization requirements W + 3 W + 4 Onshore activity at ABC
6. Finalize SLA & reporting requirements W + 4 W + 4 Onshore activity at ABC
7. Staffing & Training W + 4 W + 78. 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
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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
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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
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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
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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
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• 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
PlanningConduct Training
Training Evaluation
TRAINING METHODOLOGY
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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.
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COMPLIANCE - ESCALATION STRUCTURE
Service DeliveryService Delivery Mgr
(Service Delivery POC)
Head of Operations
(1st Level Escalation POC)
Operations
CEO & MD
(Final Escalation POC)
Executive Board
Board of Directors
ComplianceCompliance Mgr
(Compliance Escalation POC)
Head of ComplianceCompliance
Team LeadProcess Team Lead
(Service Delivery POC)
TechnologyTechnology Mgr
QualityQuality Mgr
HR/TrainingHR/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
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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
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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
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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 OfficerNew 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 OperationsLeading MSO
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