HIPAA-Compliant Answering Services are Available 24/7

CALL CENTER SERVICES FOR HEALTHCARE PROVIDERS

xxx-xxx-xxxx [email protected]

COMPANY OVERVIEW

Key Facts Awards, Affiliations & Certifications

2Sun Knowledge © 2015-16 Private & Confidential

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

communication skills and in-depth knowledge of process

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

power, infrastructure and others

ISO 27001:2013 and ISO 9001:2008 certified CMMi-SVC implementation in progress under KPMG

guidance Member of NASSCOM, the Governing Industry body for

IT/ITES in India Awarded ‘Best Emerging BPO Company of the year 2010’

by The Economic Times, India Recognized as one of the foremost 'Emerging companies in

Eastern India' by NASSCOM in 2011 Awarded Asia-wide “Healthcare BPO Provider of the Year”

at the Asia BPO Excellence Awards ceremony hosted by Asia BPO Summit on 14th February 2013 in Mumbai, India

Awarded the prestigious “Outsourcing Service Provider of the Year” award in the Asian Outsourcing Excellence Awards ceremony hosted by CMO Asia on 1st August 2013 in Singapore

Awarded “Highest New Job Creator (IT/ITES)” by STPI (Software Technology Parks of India) on 3rd December 2015

41 Madison Avenue, 25th Floor, New York, NY 10010, USA

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

SERVICE PORTFOLIO

Provider SupportMember SupportMember Retention ProgramClinical Help Desk

Contact Center

Utilization ManagementMedication Therapy ManagementHospital Re-admission

ManagementTherapeutic InterchangeFormulary Management

Clinical Services

Medical Coding & BillingClaims AdministrationEnrollment Processing &

MemberFulfillmentCredentialing Premium billing and collections

Administrative Services

Analytics

Telemedicine ServicesRemote Patient MonitoringApplication Development & SupportTechnical SupportTechnical Documentation

IT Services

Claims /Drug Utilization AnalysisPDE AnalysisRAF AnalysisPayment Reconciliation

We provide services to

Providers – Physicians, Hospitals, DME, P&O, Urgent Care, Home Health Care and Pharmacies

Payers – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs

3Sun Knowledge © 2015-16 Private & Confidential41 Madison Avenue, 25th Floor, New York, NY 10010, USA

SUMMARY OF SERVICES


PRACTICE MANAGEMENT

Scheduling

Eligibility & Authorization Verification

Prior Authorization

Customer Care

HIPAA COMPLIANCE SUMMARY


SL. COMPLIANCE ASPECT HIGHLIGHTS

1 Physical Access Authorized access only | Bio-metric access | Proximity card system | Photo ID cards | Access log review

2 General Security 24 hour security personnel | Logging of visitor details | Physical register retained for 10 years

3 Monitoring CCTV monitoring (with recording) of production area | Daily review of recording

4 Vendor Access Signing confidentiality agreement before accessing sensitive areas | Accompanied by security personnel/employee during all times

5 Mobile Phones All employees (except managers) are required to deposit mobile phones in the locker box before entering facility

6 Personal Baggage No backpacks or other bags allowed | All baggage to be deposited in locker box before entering facility

7 Network & Application Usage

Unique user IDs created using Microsoft Active Directory | Access to storage devices, shared drives, USB/mass storage devices, printers – controlled by Domain Group Policy | No wireless access points

8 Firewall Unified Threat Management System | Internet traffic regulation using multiple filters | Network Address Translation (NAT) | Intrusion Prevention Systems (IPS) | Port-mapping for traffic between Virtual LANs | Default setting to deny all traffic

9 VPN (Virtual Private Network)

Site-to-site IPSec VPN tunnels | Authorized access via client-to-site VPN connections | Access authorization controlled by Active Directory's authentication service

10 Redundancy Management

Fully redundant network stack | Two ISP links configured in active-active mode | Power backup supplied by 130 KVA UPS and 750 KVA generator | 22 KVA UPS backup for server and network systems

11 Virus & Malware Protection

Central anti-malware system | Automatic updates | Extra protection by gateway firewall | Centralized OS patch management system (using Microsoft's WSUS server)

12 Other Measures Fire extinguishers at key areas | Half-yearly fire drills


CALL CENTER SERVICES

CONTACT CENTER – INTRODUCTION


Sun Knowledge’s HIPAA-compliant answering services are available 24/7.

We provide both after-hours answering services and overflow calls support on days when you are experiencing a sudden surge in calls or staff shortages.

In addition to answering calls, Sun Knowledge also provides:

Appointment Scheduling

Appointment Reminder

Patient Inquiries

Order Taking

Patient Satisfaction Survey

Reduce your no-show rates and last-minute cancellations and improve the overall efficiency of your healthcare practice.

CONTACT CENTER – TYPICAL ROLES


Member Experience

Lead Generation

Enrollment Inquiries

Member Enrollment & Orientation

Customer Care

Member Satisfaction & Retention

CONTACT CENTER – OVERVIEW


SERVICES OFFERED BY SUN KNOWLEDGE Inbound Customer Support

Outbound Call Center Services

Email Response

Multilingual Support

Live Web Chat Support

Supported By: Project & Operation Management Best

Practices Rigorous Quality Assurance Program Real-Time Queue Monitoring through

Dashboard Defined Communication & Reporting

Protocol Structured Performance Metrics

Management Established Compliance Framework State-of-the-Art Technology Infrastructure BCP and Disaster Management Mechanisms

with 100% Redundancy

CONTACT CENTER – SERVICES


Prior Authorization Inquiry Support

Member Eligibility Inquiry Support

Coverage Related Inquiry Support

Plan Benefit Inquiry Support

Claims status Inquiry and Follow-up

Patient/Provider Outreach and Education Service

Appeals and Grievances Handling Service

Billing, Payment Support and Troubleshooting

PRIOR AUTHORIZATION INQUIRY SUPPORT


Our Contact Center provides the following services to the providers in Prior Authorization:

Inquiry handling regarding authorization request Providing details of authorization to be raised via Fax Providing information regarding authorization status Providing information related to Appeal Rights Providing assistance related to formulary / drug coverage

Our Contact Center representatives are adequately trained on: Formulary and benefit plan design Interpretation of Authorization guidelines Appeal process / procedure Client guidelines w.r.t. to Authorization requirement related advise

offered during the call HIPAA, FWA and related rules & regulations

MEMBER ELIGIBILITY INQUIRY SUPPORT


Our Contact Center provides the following services to the providers and members for Eligibility:

Inquiry handling regarding eligibility of a member Providing the current & past eligibility of the members Checking the Co-ordination of Benefits for the patient Resolve queries related to disputes regarding the coverage of the member Providing assistance in regards to the correcting the member demographics

Our Contact Center representatives are adequately trained on: Benefit plan design for the current & the last year Medicare eligibility guidelines Verifying the authentication of the person calling on behalf of the member HIPAA, FWA and related rules & regulations Policies & guidelines to correct any errors in the member’s

demographic information

PLAN BENEFITS INQUIRY SUPPORT


Our Contact Center provides the following services to the providers and members for Benefits Plan:

Inquiry handling for type of plan the patient has Providing the benefits coverage information for different services Checking the deductibles & out-of-pocket met information Providing vendor information for the services carved out to other vendors

Our Contact Center representatives are adequately trained on: Benefit Plan Design for the current & the last year Interpretation of co-pay, coinsurance, deductible & out-of-pocket

information for different services Vendors contracted & services provided by them Any kind of terms or conditions under which the services would be covered HIPAA, FWA and related rules & regulations

CLAIMS STATUS INQUIRY & FOLLOW-UP SUPPORT


Our Contact Center provides the following services to the providers and members for Claims:

Inquiry handling timelines for filing a claim Providing the status of the claims Researching on the denied claims Providing methods for reconsidering incorrectly processed claims Providing assistance in regards to the reconsiderations sent

Our Contact Center representatives are adequately trained on: Provide complete detail on the processing of the claim Interpretation of claim processing guidelines Reconsideration process/procedure Clients reimbursement policies and procedures with respect to claims

processing and the steps to be taken in the future HIPAA, FWA and related rules & regulations

PATIENT/PROVIDER OUTREACH & EDUCATION SERVICE


Our Contact Center provides the following patient/provider outreach services: Booking & reminder calls for ANOC seminars Medicare ‘Star Rating’ related member awareness Member/provider surveys Provider demographics verification Appointment setting and reservation for members Welcome calls to members and providers Member retention

Our Contact Center representatives are adequately trained on: Process specific rules and guidelines Member/Provider verification process HIPAA, FWA and related rules & regulations

APPEALS & GRIEVANCES HANDLING SERVICES


Our Contact Center provides the following appeals services to the providers and members:

Manage claims and authorization denial appeals Process member cost sharing appeals like co-pay and coinsurance Non covered services related appeals processing Process appeals from OON Providers related to denial of claims Documentation and processing of 2nd level appeals to IRE

Our Contact Center provides the following grievance handling services: Inappropriate treatment or misdiagnosis Member having to wait prior to receiving service Cleanliness/condition of provider’s office Resolution of issue/requests requiring multiple calls Member not getting appointments with providers Coverage discontinuation Inconvenience due to poor quality of service

PERFORMANCE METRICS


Consistently achieving <2% abandonment rate for existing processes

Consistently achieving a very high rate of ASA (ASA <= 30 seconds: 90%);

CALL ABANDONMENT RATE

AVERAGE SPEED OF ANSWER

AVERAGE HANDLING TIME

FIRST CALL RESOLUTION

SCHEDULE ADHERENCE

The metrics are defined at the time of process transition and vary from process to process

CALL AUDIT PROCESS


Audit sample size: 2 calls per agent daily

All audits findings are recorded and classified on the basis of severity

All observations are recorded in the audit tracker until resolution and closure

All identified samples are audited on the same business day

Gauge customer service representatives in terms of call opening/verification, customer focus, documentation and call closing

Roles and responsibilities of supervisors, auditors and CSRs are defined for every task

Preventive actions are identified to reduce potential problems based on repeat audit analysis and proactive management.

Known errors identified through root-cause analysis, Fish Bone and/or Pareto analysis are available in the knowledge database and form an input to TNI, refreshers, etc.

Corrective actions are controlled through proper documentation and process guidelines

Audit findings are shared with the client

COMPLIANCE


All agents undergo HIPAA standard and compliance training during process induction

100% calls are recorded and reported for compliance, quality and training purposes

Call center agents follow established policies and procedures to mitigate risks of non-compliance

Calls are subjected to strict verification process by call center agents for all healthcare related calls

Data Security and Privacy policies ensure compliance with HIPAA and other regulatory requirements

Periodic compliance audit ensures fulfillment of compliance requirement in call center operation

SERVICE HIGHLIGHTS


Proven Call Center Performance Abandonment Rate < 2%;ASA within 30 Seconds for 90% of calls; High CSAT

Highly-trained personnel Highly skilled staff trained in process, product & communication skills; staff competency built on structured training, feedback and coaching

Highly scalable and flexible services State-of-the-Art Technology Solutions;service continuity supported by BCP and disaster management mechanisms;service 24 hours a day, 7 days a week, 365 days a year; call patching and paging

Best Management Project management best practices for process migration and operation; knowledge management by effective use of software tools and system; Monitor, Measure & Manage process through use technology and automated tools

Compliance & Transparency No canned responses; scripts are customized with you in mind; full HIPAA compliance


TESTIMONIALS

CLIENTSPEAK


“We have had the pleasure of working with the Sun Knowledge team throughout the few months utilizing their services for patient data entry and eligibility verification. They are a devoted and responsible team that is highly experience in what they do. They are always concerned about the client’s needs and are always there to help. I highly recommend the services offered by Sun Knowledge.”

COO of a leading medical billing and credentialing company in New York

“Your team amazed me with the manual and the amount of info you provided with that short training session.”

Practice Manager of a major Dermatology group in New York and New Jersey


CLIENTSPEAK


“My firm has evaluated an outsourcing transaction with Sun Knowledge. They provide superior service at a very attractive rate and have demonstrated to us their commitment to this partnership. Their expertise across various process areas in the PDP/MAPD domain and unique cost structure puts them in an incredible position to work with plans throughout the healthcare industry.”

Chairman, President and CEO of a major New York based Health Plan

“Our company is very pleased with the administrative, and business analytical solutions which Sun Knowledge delivers to our company from a quality & cost perspective. They have been a true partner in bringing industry expertise, and innovative solutions to the table. Their ability to grow with our evolving needs for higher end services such as clinical services is a significant differentiator among healthcare business process outsourcing firms.”

Executive Vice President of Operations of a leading MSO


CLIENTSPEAK


“I was always against the idea of outsourcing our back end claims processing work but I was wrong. Sun Knowledge provided extraordinary deliverables on a timely basis which led to cost cutting considerably for us.”

CEO of a leading MA-PD Plan

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Sun Knowledge41 Madison Ave., Suite 2511, 25th Floor

New York, NY 11001, USA

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HIPAA-Compliant Answering Services are Available 24/7

Healthcare

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