Enviar búsqueda
Cargar
Prior Authorization for Dermatology Practices (Sun Knowledge)
•
Descargar como PPTX, PDF
•
1 recomendación
•
125 vistas
Saikat Mukherjee
Seguir
Denunciar
Compartir
Denunciar
Compartir
1 de 28
Descargar ahora
Recomendados
Prior authorization by sun knowledge
Prior authorization by sun knowledge
Ronnie Hastings
Accounts Receivable Management By Sun Knowledge
Accounts Receivable Management By Sun Knowledge
Ronnie Hastings
Step by Step Anesthesiology Billing, Coding, Revenue Cycle Management and Pra...
Step by Step Anesthesiology Billing, Coding, Revenue Cycle Management and Pra...
Michael Smith
Practice Management & Revenue Cycle Management for Radiology
Practice Management & Revenue Cycle Management for Radiology
Saikat Mukherjee
Prior authorization services by Sun Knowledge
Prior authorization services by Sun Knowledge
Supriyo Bhowmick (Thomas)
Prior Authorization for Sleep Medicine
Prior Authorization for Sleep Medicine
Michael Smith
Revenue cycle management by sun knowledge (labs)
Revenue cycle management by sun knowledge (labs)
NATALIE SIMPSON
Eligibility & Authorization Verification by sun knowledge
Eligibility & Authorization Verification by sun knowledge
Ronnie Hastings
Recomendados
Prior authorization by sun knowledge
Prior authorization by sun knowledge
Ronnie Hastings
Accounts Receivable Management By Sun Knowledge
Accounts Receivable Management By Sun Knowledge
Ronnie Hastings
Step by Step Anesthesiology Billing, Coding, Revenue Cycle Management and Pra...
Step by Step Anesthesiology Billing, Coding, Revenue Cycle Management and Pra...
Michael Smith
Practice Management & Revenue Cycle Management for Radiology
Practice Management & Revenue Cycle Management for Radiology
Saikat Mukherjee
Prior authorization services by Sun Knowledge
Prior authorization services by Sun Knowledge
Supriyo Bhowmick (Thomas)
Prior Authorization for Sleep Medicine
Prior Authorization for Sleep Medicine
Michael Smith
Revenue cycle management by sun knowledge (labs)
Revenue cycle management by sun knowledge (labs)
NATALIE SIMPSON
Eligibility & Authorization Verification by sun knowledge
Eligibility & Authorization Verification by sun knowledge
Ronnie Hastings
MEDICAL BILLING SERVICESFOR ORTHOTICS & PROSTHETICS
MEDICAL BILLING SERVICESFOR ORTHOTICS & PROSTHETICS
Michael Smith
Revenue Cycle Management for Oncology by Sun Knowledge
Revenue Cycle Management for Oncology by Sun Knowledge
Michael Smith
Medical billing services for urgent care centers by Sunknowledge
Medical billing services for urgent care centers by Sunknowledge
Zeeshanul Kader
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Zeeshanul Kader
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
AYAN DUTTA
Medical Billing Services For Urgent Care Centers And Emergency Dept
Medical Billing Services For Urgent Care Centers And Emergency Dept
Ronnie Hastings
Revenue Cycle Management by Sun Knowledge
Revenue Cycle Management by Sun Knowledge
Sayantan Mukherjee (Josh)
Prior Authorization For Radiology By SunKnowledge
Prior Authorization For Radiology By SunKnowledge
Ronnie Hastings
Complete Durable Medical Equipment (DME) Billing Guide | Sun Knowledge
Complete Durable Medical Equipment (DME) Billing Guide | Sun Knowledge
Michael Smith
Revenue cycle management for orthotics & prosthetics by sun knowledge
Revenue cycle management for orthotics & prosthetics by sun knowledge
Ronnie Hastings
HIPAA-Compliant Answering Services are Available 24/7
HIPAA-Compliant Answering Services are Available 24/7
Michael Smith
lity&AuthorizationVerificationbySunKnowledgeSep_14_2016
lity&AuthorizationVerificationbySunKnowledgeSep_14_2016
Sammya Sen
Telehealth and Medical Billing both Franchise Opportunity together at Low Cost
Telehealth and Medical Billing both Franchise Opportunity together at Low Cost
Michael Smith
AccountsReceivableManagementbySunKnowledgeSep_14_2016
AccountsReceivableManagementbySunKnowledgeSep_14_2016
Rahul Bhattacharya
Prior Authorization for Specialty Pharmacy by Sun Knowledge
Prior Authorization for Specialty Pharmacy by Sun Knowledge
Saikat Mukherjee
Revenue cycle management by sun knowledge (labs)
Revenue cycle management by sun knowledge (labs)
Nibedita Sen
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Souvik Ghosh / Neil
Medical Billing Services for Urgent Care Centers by Sun Knowledge (compressed)
Medical Billing Services for Urgent Care Centers by Sun Knowledge (compressed)
Bodhayan Sen
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Su...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Su...
Saikat Mukherjee
Eligibility & Authorization Verification By Sun Knowledge
Eligibility & Authorization Verification By Sun Knowledge
Saikat Mukherjee
Revenue Cycle Management by Sun Knowledge
Revenue Cycle Management by Sun Knowledge
Sayantan Mukherjee (Josh)
Complete Prior Authorization Services | Prior Authorization Process Guideline
Complete Prior Authorization Services | Prior Authorization Process Guideline
Michael Smith
Más contenido relacionado
La actualidad más candente
MEDICAL BILLING SERVICESFOR ORTHOTICS & PROSTHETICS
MEDICAL BILLING SERVICESFOR ORTHOTICS & PROSTHETICS
Michael Smith
Revenue Cycle Management for Oncology by Sun Knowledge
Revenue Cycle Management for Oncology by Sun Knowledge
Michael Smith
Medical billing services for urgent care centers by Sunknowledge
Medical billing services for urgent care centers by Sunknowledge
Zeeshanul Kader
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Zeeshanul Kader
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
AYAN DUTTA
Medical Billing Services For Urgent Care Centers And Emergency Dept
Medical Billing Services For Urgent Care Centers And Emergency Dept
Ronnie Hastings
Revenue Cycle Management by Sun Knowledge
Revenue Cycle Management by Sun Knowledge
Sayantan Mukherjee (Josh)
Prior Authorization For Radiology By SunKnowledge
Prior Authorization For Radiology By SunKnowledge
Ronnie Hastings
Complete Durable Medical Equipment (DME) Billing Guide | Sun Knowledge
Complete Durable Medical Equipment (DME) Billing Guide | Sun Knowledge
Michael Smith
Revenue cycle management for orthotics & prosthetics by sun knowledge
Revenue cycle management for orthotics & prosthetics by sun knowledge
Ronnie Hastings
HIPAA-Compliant Answering Services are Available 24/7
HIPAA-Compliant Answering Services are Available 24/7
Michael Smith
lity&AuthorizationVerificationbySunKnowledgeSep_14_2016
lity&AuthorizationVerificationbySunKnowledgeSep_14_2016
Sammya Sen
Telehealth and Medical Billing both Franchise Opportunity together at Low Cost
Telehealth and Medical Billing both Franchise Opportunity together at Low Cost
Michael Smith
AccountsReceivableManagementbySunKnowledgeSep_14_2016
AccountsReceivableManagementbySunKnowledgeSep_14_2016
Rahul Bhattacharya
La actualidad más candente
(14)
MEDICAL BILLING SERVICESFOR ORTHOTICS & PROSTHETICS
MEDICAL BILLING SERVICESFOR ORTHOTICS & PROSTHETICS
Revenue Cycle Management for Oncology by Sun Knowledge
Revenue Cycle Management for Oncology by Sun Knowledge
Medical billing services for urgent care centers by Sunknowledge
Medical billing services for urgent care centers by Sunknowledge
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services For Urgent Care Centers And Emergency Dept
Medical Billing Services For Urgent Care Centers And Emergency Dept
Revenue Cycle Management by Sun Knowledge
Revenue Cycle Management by Sun Knowledge
Prior Authorization For Radiology By SunKnowledge
Prior Authorization For Radiology By SunKnowledge
Complete Durable Medical Equipment (DME) Billing Guide | Sun Knowledge
Complete Durable Medical Equipment (DME) Billing Guide | Sun Knowledge
Revenue cycle management for orthotics & prosthetics by sun knowledge
Revenue cycle management for orthotics & prosthetics by sun knowledge
HIPAA-Compliant Answering Services are Available 24/7
HIPAA-Compliant Answering Services are Available 24/7
lity&AuthorizationVerificationbySunKnowledgeSep_14_2016
lity&AuthorizationVerificationbySunKnowledgeSep_14_2016
Telehealth and Medical Billing both Franchise Opportunity together at Low Cost
Telehealth and Medical Billing both Franchise Opportunity together at Low Cost
AccountsReceivableManagementbySunKnowledgeSep_14_2016
AccountsReceivableManagementbySunKnowledgeSep_14_2016
Similar a Prior Authorization for Dermatology Practices (Sun Knowledge)
Prior Authorization for Specialty Pharmacy by Sun Knowledge
Prior Authorization for Specialty Pharmacy by Sun Knowledge
Saikat Mukherjee
Revenue cycle management by sun knowledge (labs)
Revenue cycle management by sun knowledge (labs)
Nibedita Sen
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Souvik Ghosh / Neil
Medical Billing Services for Urgent Care Centers by Sun Knowledge (compressed)
Medical Billing Services for Urgent Care Centers by Sun Knowledge (compressed)
Bodhayan Sen
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Su...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Su...
Saikat Mukherjee
Eligibility & Authorization Verification By Sun Knowledge
Eligibility & Authorization Verification By Sun Knowledge
Saikat Mukherjee
Revenue Cycle Management by Sun Knowledge
Revenue Cycle Management by Sun Knowledge
Sayantan Mukherjee (Josh)
Complete Prior Authorization Services | Prior Authorization Process Guideline
Complete Prior Authorization Services | Prior Authorization Process Guideline
Michael Smith
Accounts Receivable Management by Sun Knowledge
Accounts Receivable Management by Sun Knowledge
Ronnie Hastings
Accounts Receivable Management for Hospitals | Accounts Receivable Services
Accounts Receivable Management for Hospitals | Accounts Receivable Services
Michael Smith
Prior authorization for dermatology practices by Sun Knowledge
Prior authorization for dermatology practices by Sun Knowledge
Michael Smith
PRACTICE MANAGEMENT & REVENUE CYCLE MANAGEMENTFOR RADIOLOGY PRACTICES
PRACTICE MANAGEMENT & REVENUE CYCLE MANAGEMENTFOR RADIOLOGY PRACTICES
Michael Smith
GoTelecare - Corporate Overview & Service Catalog 2016
GoTelecare - Corporate Overview & Service Catalog 2016
Jeff Brown
Practice Management & Claims Administration
Practice Management & Claims Administration
Judd Trump
DMEBillingServicesbySunKnowledgeSep_14_2016
DMEBillingServicesbySunKnowledgeSep_14_2016
Sammya Sen
DMEBillingServicesbySunKnowledgeSep_14_2016
DMEBillingServicesbySunKnowledgeSep_14_2016
Rahul Bhattacharya
Sun Knowledge - Practice Management and Revenue Cycle Management Services PPT
Sun Knowledge - Practice Management and Revenue Cycle Management Services PPT
Michael Smith
DME Billing & Coding Services
DME Billing & Coding Services
Ronnie Hastings
Similar a Prior Authorization for Dermatology Practices (Sun Knowledge)
(18)
Prior Authorization for Specialty Pharmacy by Sun Knowledge
Prior Authorization for Specialty Pharmacy by Sun Knowledge
Revenue cycle management by sun knowledge (labs)
Revenue cycle management by sun knowledge (labs)
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Sun Kno...
Medical Billing Services for Urgent Care Centers by Sun Knowledge (compressed)
Medical Billing Services for Urgent Care Centers by Sun Knowledge (compressed)
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Su...
Medical Billing Services for Urgent Care Centers & Emergency Dept. by Su...
Eligibility & Authorization Verification By Sun Knowledge
Eligibility & Authorization Verification By Sun Knowledge
Revenue Cycle Management by Sun Knowledge
Revenue Cycle Management by Sun Knowledge
Complete Prior Authorization Services | Prior Authorization Process Guideline
Complete Prior Authorization Services | Prior Authorization Process Guideline
Accounts Receivable Management by Sun Knowledge
Accounts Receivable Management by Sun Knowledge
Accounts Receivable Management for Hospitals | Accounts Receivable Services
Accounts Receivable Management for Hospitals | Accounts Receivable Services
Prior authorization for dermatology practices by Sun Knowledge
Prior authorization for dermatology practices by Sun Knowledge
PRACTICE MANAGEMENT & REVENUE CYCLE MANAGEMENTFOR RADIOLOGY PRACTICES
PRACTICE MANAGEMENT & REVENUE CYCLE MANAGEMENTFOR RADIOLOGY PRACTICES
GoTelecare - Corporate Overview & Service Catalog 2016
GoTelecare - Corporate Overview & Service Catalog 2016
Practice Management & Claims Administration
Practice Management & Claims Administration
DMEBillingServicesbySunKnowledgeSep_14_2016
DMEBillingServicesbySunKnowledgeSep_14_2016
DMEBillingServicesbySunKnowledgeSep_14_2016
DMEBillingServicesbySunKnowledgeSep_14_2016
Sun Knowledge - Practice Management and Revenue Cycle Management Services PPT
Sun Knowledge - Practice Management and Revenue Cycle Management Services PPT
DME Billing & Coding Services
DME Billing & Coding Services
Prior Authorization for Dermatology Practices (Sun Knowledge)
1.
PRIOR AUTHORIZATION FOR DERMATOLOGY PRACTICES
2.
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 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.
SUN KNOWLEDGE SERVICE
PORTFOLIO Provider Support Member Support Member Retention Program Clinical Help Desk Contact Center Utilization Management Medication Therapy Management Hospital Re-admission Management Therapeutic Interchange Formulary Management Clinical Services Medical Coding & Billing Claims Administration Enrollment Processing & Member Fulfillment Credentialing Premium Billing and Collections Administrative Services Analytics Telemedicine Services Remote Patient Monitoring Application Development & Support Technical Support Technical Documentation IT Services Claims /Drug Utilization Analysis PDE Analysis RAF Analysis Payment Reconciliation We provide services to Providers – Physicians, Hospitals, DME, P&O, Home Health Care and Pharmacies Payers – Commercial Plans, MA Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs, TPAs, PBMs and RBMs 3Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
4.
SERVICE PORTFOLIO SUMMARY 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.
SERVICE AREAS 5Sun Knowledge
© 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA We provide our services in the following areas: Durable Medical Equipment Prosthetics & Orthotics Urgent Care Pathology Critical Care Skilled Nursing Facilities Wound Care Oncology Pharmacies Cardiology Specialty Clinics Orthopedic Surgery Anesthesia Family Practice Radiology Rehab Centers Dermatology Physicians Healthcare Facilities and more…
6.
SERVICE HIGHLIGHTS 6Sun Knowledge
© 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA High levels of accuracy (>95%) across all services FREE medical billing software, EMR & setup* Real-time eligibility and benefits check 100% HIPAA-HITECH compliance Fast denial management using Rapid Automation Technology® Turnaround time less than 48 hours max. Low service fees with no hidden cost Zero lockup service contracts that can be cancelled anytime Tons of excellent references from current clients Real-time audits and custom reporting * Conditions apply
7.
OUR HIPAA COMPLIANCE
SUMMARY 7Sun 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
8.
8Sun Knowledge ©
2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA PRIOR AUTHORIZATION
9.
PRIOR AUTHORIZATION –
INTRODUCTION 9Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
10.
PRIOR AUTHORIZATION –
INTRODUCTION 10Sun Knowledge © 2015-16 Private & Confidential “It’s a nuisance, time-consuming and often not in the patient’s best interest!” – George G. Ellis, Jr., MD Internal medicine physician & Medical Economics editorial advisor 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
11.
THE SOLUTION! 11Sun Knowledge
© 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA Sun Knowledge provides a comprehensive array of prior authorization services for a wide range of healthcare areas such as: Pharmacies Hospitals Nursing Homes DME Orthotics & Prosthetics Physicians’ Offices Radiology/Imaging Services Dermatology Practices, and many more! Our services are designed to take the pain out of prior authorization and free you from the need to engage your resources or spend precious time in tedious prior authorization tasks. 99.9% accuracy!
12.
CASE STUDY ON
BOTOX 12Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
13.
SERVICE PORTFOLIO 13Sun Knowledge
© 2015-16 Private & Confidential Full range service, comprising Authorization Request Follow-up Approval 100% HIPAA-HITECH Compliance Highly streamlined, fast and accurate service The best prices… period! • Specialty Pharmacy • Botox • Infusable biologics • Injectable medications for psoriasis and psoriasis arthritis • Hidradenititis suppurative (like Enbrel, Humira, Stelara, Remicade) • Other conditions We cater to 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
14.
PRIOR AUTHORIZATION FOR
MEDICATION 14Sun Knowledge © 2015-16 Private & Confidential Tasks involved in carrying out Prior Authorization for medication include the following steps: Gathering relevant medical documents from the providers Calling up insurance to find the authorization filing procedure and turnaround time Submission of the authorization request (fax/online/calling) Follow up with the Payer to check authorization status as per the TAT set for each Payer Acknowledgement of authorization approval/denial Notifying the Pharmacy Updating the authorization details (authorization number / duration / quantity) in the Provider’s billing system 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
15.
SAMPLE REPORTS 15Sun Knowledge
© 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
16.
SAMPLE REPORT #1 16Sun
Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA PRIOR AUTHORIZATION COMPONENTS OF DAILY DETAILED REPORT INPUT SL. Date Received Complete/ In Progress Patient ID Patient Name DOB Dx Codes Name of Medication Provider Name Primary Payer Phone # 1 8/18/16 In progress 1234567 Patient 1 1/1/90 L40.0 Adapalene 0.3% Gel Provider 1 Caremark Phone 1 2 8/24/16 In progress 1234568 Patient 2 1/2/90 L21.9, L71.8 Elidel 1 % topical cream Provider 2 Envision Rx Phone 2 3 8/24/16 In progress 1234569 Patient 3 1/3/90 L40.0 Clobetasol Prop 0.05% Foam Provider 3 Caremark Phone 3 4 8/25/16 In progress 1234570 Patient 4 1/4/90 L70.0 Sulfacetamide sodium-sulfur 10 %-5 % (w/w) topical cleanser Provider 4 Magellan Rx Phone 4 5 8/26/16 In progress 1234571 Patient 5 1/5/90 L40.0 Desonide 0.05% Cream Provider 5 Cigna Phone 5 7 8/29/16 Complete 1234573 Patient 7 1/6/90 L70.0 Tretinoin 0.025% cream Provider 7 Caremark Phone 7 8 8/29/16 Complete 1234574 Patient 8 1/7/90 L70.0 Tretinoin 0.025% cream Provider 8 Express Scripts Phone 8 9 8/29/16 Complete 1234575 Patient 9 1/8/90 L70.0 Tretinoin 0.025% cream Provider 9 Caremark Phone 9 10 8/29/16 In progress 1234576 Patient 10 1/9/90 L70.0 Tretinoin 0.025% cream Provider 10 Tufts Health Phone 10
17.
SAMPLE REPORT #2 17Sun
Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA PRIOR AUTHORIZATION COMPONENTS OF DAILY DETAILED REPORT (Contd.) Authorization Status Last Worked On Follow Up Date Comments Final Status Approval / Denial Date 8/25/2016 8/25/2016 8/25/2016- Got reply from NEDA, triaged back for alt. medication suggestion 8/18/2016- Notified Triage, since patient requested alternate medication as copay was too high. In Process 8/26/2016 NA 8/26/2016- SK called insurance and s/w Jenny, she informed that a form is to be filled up and sent back for pre-auth. 8/24/2016- SK called insurance company to provide prior authorization information verbally. Medication Name: Elidel 1 % topical cream Insurance Co: Envision Rx | Spoke with: John | Result: Pending In Process 8/24/2016 NA S/w Jack, PA is In Progress, Ref# M1*******3, Ade informed that it is a non formulary drug and the foam is not covered, she also informed that apart from foam there are alternatives like cream and solution which are covered so she will fax us the available list of alternatives at ***-***-****. In Process Pharmacy Status Pharmacy Name Pharmacy Ph # Auth Status Informed Date of communication Comments Schedule Delivery Date CVS Phone 1 No Rite Aid Phone 2 No Walgreens Phone 3 No CVS Phone 4 Yes 8/29/2016 S/w John, informed about the approval CVS Phone 5 Yes 8/29/2016 S/w Vivian, informed about the non-coverage
18.
SAMPLE REPORT #3 18Sun
Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA Month Approved Denied In Process NA Pending for additional information Total 08/17/16 9 2 11 08/18/16 14 1 2 2 19 08/19/16 2 1 3 08/22/16 5 1 1 7 08/23/16 8 1 9 08/24/16 10 2 12 08/25/16 6 2 2 10 08/26/16 8 1 9 08/29/16 7 3 4 14 Total 69 4 11 10 94 PRIOR AUTHORIZATION DAILY SUMMARY REPORT
19.
SAMPLE REPORT #4 19Sun
Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA PRIOR AUTHORIZATION MONTHLY SUMMARY REPORT Month Approved Denied In Process NA Pending for additional information Total Mar-16 71 49 2 122 Apr-16 401 160 5 15 1 582 May-16 418 146 4 69 637 Jun-16 377 151 4 94 1 627 Jul-16 343 128 16 65 6 558 Total 1610 634 29 245 8 2526
20.
20Sun Knowledge ©
2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA MEETING CHALLENGES WITH EFFECTIVE RESPONSE
21.
CHALLENGES & OUR
APPROACH 21Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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 Authorization Eligibility Verification Patient Demographics / Insurance / Charge Entry Transaction audit to minimize errors; reduces 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 & payers to collect documentation and obtain authorization Proper tracking mechanism
22.
CHALLENGES & OUR
APPROACH 22Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA 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 Delayed correction and resubmission Possible loss of payment Payment Posting Rejection Management Paper Claim Submission Proper tracking of every submission of paper claims Moving to EDI based submission whenever possible will reduce cost of manual work and faster payment cycle TASK DESCRIPTION CHALLENGES APPROACH Additional work for printing and faxing/mailing Delayed filing leading to denials Lack of information about the actual status Defining guidelines Review of patient payments Define KPI – TAT & Accuracy Denial posting and review
23.
CHALLENGES & OUR
APPROACH 23Sun Knowledge © 2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA Proper documentation – process manual, guidelines & checklists Defining proper tracking mechanism through various reports -Ageing, Status, Daily, Exception Generate exception reports and regular audit of every process tasks Defining KPIs and assigning responsibility Lack of clarity of claims volume and current status affects management decision making process Impact on overall billing process performance and improvement Decreased productive efficiency Process Administration and Reporting AR Follow-up & Denial Management Regular analysis, follow-up and review Transaction audit TASK DESCRIPTION CHALLENGES APPROACH Accumulation of backlog Denials not posted Claims reconciliation issue
24.
SUMMARY OF BENEFITS 24Sun
Knowledge © 2015-16 Private & Confidential Very Little Risk • Proven track record in providing healthcare BPO/KPO services • Experienced in providing services to both payers and providers • Experienced working with various software platforms • Quick and efficient resource for special projects requiring technical and process expertise Significant Upside Potential • Great understanding of the Healthcare Industry. Operation scale-up with a short notice • Extremely competitive rates, greater productivity, improved quality, increased member and provider satisfaction Proven Process Performance • Low denial rate reduced collection time increase in revenue collection • High billing & coding accuracy; TAT: 24 – 48 hours • Adherence to CMS billing requirements Clear Communication and Quick Response Time at All Times ISO 27001:2013 & HIPAA Compliance for End-user Data Privacy and Protection 41 Madison Avenue, 25th Floor, New York, NY 10010, USA
25.
25Sun Knowledge ©
2015-16 Private & Confidential 41 Madison Avenue, 25th Floor, New York, NY 10010, USA TESTIMONIALS
26.
CLIENTSPEAK 26Sun 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
27.
CLIENTSPEAK 27Sun 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
28.
CLIENTSPEAK 28Sun 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 Ronnie Hastings (646) 661-7853 Email: ronnie.hastings@sunknowledge.com 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
Descargar ahora