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HIPAA-Compliant Answering Services are Available 24/7

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Veröffentlicht am

Sun Knowledge – A Practice Management and Revenue Cycle Management Company.
Contact Details:
New York Office - 41 Madison Avenue, 25th Floor, NY 10010

Phone - +1 212-400-6100, Email - contact@sunknowledge.com

Website - www.sunknowledge.com

Facebook - https://www.facebook.com/SunKnowledge

Twitter - https://twitter.com/sunknowledge

LinkedIn - https://www.linkedin.com/company/sun-knowledge

Google plus - https://plus.google.com/+SunknowledgeInc

Our clients prefer us for:

~ Powerful references from major healthcare providers and health insurance payers
~ Instant reduction of billing costs by 70%
~ Managing high volume claims with robust processes
~ Collections of up to 97%
~ 99% medical billing & coding accuracy

Sun Knowledge is a revenue cycle management company and expert in various practice management software. We also provide services for following medical billings, medical coding, account receivable, denial managements, claims adjudications, claim processing, authorization and verification, insurance follow up, and many more.

We are specialize in Hospitals, urgent care centers, DME, orthotics, prosthetics, Nursing home, physician office and many more billing industry.

Veröffentlicht in: Gesundheitswesen
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HIPAA-Compliant Answering Services are Available 24/7

  1. 1. CALL CENTER SERVICES FOR HEALTHCARE PROVIDERS xxx-xxx-xxxx yourmail@something.com
  2. 2. 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
  3. 3. SERVICE PORTFOLIO  Provider Support  Member Support  Member Retention Program  Clinical Help Desk Contact Center  Utilization Management  Medication Therapy Management  Hospital Re-admission Management  Therapeutic Interchange  Formulary Management Clinical Services  Medical Coding & Billing  Claims Administration  Enrollment Processing & Member Fulfillment  Credentialing  Premium billing and collections Administrative Services Analytics  Telemedicine Services  Remote Patient Monitoring  Application Development & Support  Technical Support  Technical Documentation IT Services  Claims /Drug Utilization Analysis  PDE Analysis  RAF Analysis  Payment Reconciliation We provide services to Providers – Physicians, Hospitals, DME, P&O, Urgent Care, Home Health Care and Pharmacies Payers – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs 3Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
  4. 4. SUMMARY OF SERVICES 4Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA PRACTICE MANAGEMENT Scheduling Eligibility & Authorization Verification Prior Authorization Customer Care BILLING & COLLECTIONS Coding Charge Posting Claims Submission Payment Posting Denial Management Accounts Receivable PAYER SERVICES Claims Adjudication Credentialing Utilization Management Customer Care TELEMEDICINE Telemedicine Remote Patient Monitoring
  5. 5. HIPAA COMPLIANCE SUMMARY 5Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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
  6. 6. 6Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA CALL CENTER SERVICES
  7. 7. CONTACT CENTER – INTRODUCTION 7Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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.
  8. 8. CONTACT CENTER – TYPICAL ROLES 8Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA Member Experience Lead Generation Enrollment Inquiries Member Enrollment & Orientation Customer Care Member Satisfaction & Retention
  9. 9. CONTACT CENTER – OVERVIEW 9Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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
  10. 10. CONTACT CENTER – SERVICES 10Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA  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
  11. 11. PRIOR AUTHORIZATION INQUIRY SUPPORT 11Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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
  12. 12. MEMBER ELIGIBILITY INQUIRY SUPPORT 12Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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
  13. 13. PLAN BENEFITS INQUIRY SUPPORT 13Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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
  14. 14. CLAIMS STATUS INQUIRY & FOLLOW-UP SUPPORT 14Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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
  15. 15. PATIENT/PROVIDER OUTREACH & EDUCATION SERVICE 15Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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
  16. 16. APPEALS & GRIEVANCES HANDLING SERVICES 16Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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
  17. 17. PERFORMANCE METRICS 17Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA  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
  18. 18. CALL AUDIT PROCESS 18Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA  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
  19. 19. COMPLIANCE 19Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA  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
  20. 20. SERVICE HIGHLIGHTS 20Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA  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
  21. 21. 21Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA TESTIMONIALS
  22. 22. CLIENTSPEAK 22Sun Knowledge © 2015-16 Private & Confidential “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 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
  23. 23. CLIENTSPEAK 23Sun Knowledge © 2015-16 Private & Confidential “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 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
  24. 24. CLIENTSPEAK 24Sun Knowledge © 2015-16 Private & Confidential “I was always against the idea of outsourcing our back end claims processing work but I was wrong. Sun Knowledge provided extraordinary deliverables on a timely basis which led to cost cutting considerably for us.” CEO of a leading MA-PD Plan Your name here Phone: Email: Sun Knowledge 41 Madison Ave., Suite 2511, 25th Floor New York, NY 11001, USA For additional information, please contact… 41 Madison Avenue, 25th Floor, New York, NY 10010, USA

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