Sun knowledge dme billing services

REVENUE CYCLE MANAGEMENT FOR DME COMPANIES

SUN KNOWLEDGE OVERVIEW

Key Facts Awards, Affiliations & Certifications

2Sun Knowledge © 2015-16 Private & Confidential

‘Onshore /Offshore’ KPO & BPO Services Serving US healthcare industry since 2007 Robust & scalable infrastructure State-of-the-art technology and systems Highly skilled and trained staff with good

communication skills and in-depth knowledge of process

Structured training, feedback and coaching HIPAA-HITECH compliant State-of-the-art facility inbuilt with all redundancies –

power, infrastructure

Sun Knowledge is 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

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

Medical Records Indexing and Retrieval


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

HIPAA COMPLIANCE


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

REVENUE CYCLE MANAGEMENT




360° Revenue Cycle Management

Services


• 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 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


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



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


Accumulation of backlogDenials not postedClaims reconciliation issue



GENERAL HIGHLIGHTS


FREE Billing Software FREE EMR FREE Setup, upgrades and support Up to 97% Collection Rate Claims Submission within 48 hours max. Error-free Patient Entry Over 99.9% Coding Accuracy Real-time Audits Methodical and Proactive AR Follow-up 100% HIPAA Compliance Custom Reporting

DME BILLINGSERVICES


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 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 & AUTHORIZATION VERIFICATION – 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-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

PatientsNo. 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 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 DOE, JOHN Paez Encore Complete Yes Yes No OXFORD HEALTH PLANS

2 4/8/2015 N/A N/A N/A N/A 65.60% 218619 DOE, DAVID 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 DAY, JULIE Ricardo Encore Complete Yes Yes No MEDICARE

4 6/5/2015 N/A N/A 96.70% N/A N/A 295695 ROE, JANE Paez Encore Complete Yes Yes No HEALTH FIRST NY

5 6/30/2015 80% N/A N/A N/A N/A 233432 DOE, JULIE 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 SMITH, JOE Jones Resmed Complete Yes Yes No MEDICARE

7 5/23/2015 N/A N/A 73% N/A N/A 215604 BLOGGS, JOE Jones ICODE Complete Yes Yes No AETNA HEALTH PLAN

8 6/3/2015 N/A N/A 57% N/A N/A 217849 SMITH, JULIE Smith Resmed Complete Yes Yes No MEDICARE

9 6/27/2015 100% N/A N/A N/A N/A 168488 ROE, JOHN 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, P 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 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 Doe, John 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 Roe, Julie 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) Roe, David 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) Bloggs, Joe 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 Smith, P 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

20

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


Increased revenue – reduced collection Time (up to 97% 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


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


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

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

Sun Knowledge © 2015-16 Private & Confidential 26

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

PlanningConduct 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 encourages employees to proactively report compliance issues to the

higher management.


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


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 27001:2013 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 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

RONNIE HASTINGSSun Knowledge 41 Madison Avenue, Suite 2511, New York, NY 10010 Phone: (646)-661-7853E-mail: [email protected]

For Additional Information, Please Contact


mailto:[email protected]