ACCOUNTS RECEIVABLE FOLLOW-UP
&
DENIAL MANAGEMENT SERVICES
FOR NURSING HOMES
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
Phone: (646) 661-7853 | E-mail: [email protected]
WHY SUNKNOWLEDGE
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 2
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SUNKNOWLEDGE OVERVIEW
Key Facts
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
Office at
41 Madison Avenue, 25th Floor,
New York, NY 10010
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 3
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SERVICE PORTFOLIO BILLING & PAYER SERVICES TELEMEDICINE
COLLECTIONS
PRACTICE Claims Telemedicine
MANAGEMENT Coding Adjudication Remote Patient
Charge Posting Credentialing
Scheduling Claims Submission Utilization Monitoring
Payment Posting Management
Eligibility & Customer Care
Authorization
Verification
Prior Authorization
Customer Care
Denial Management
Accounts Receivable
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 4
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
A UNIQUE EDGE PROVIDERS SERVED BY US
PAYERS SERVED BY US Serving since 2007!
Serving since 2009!
Sun Knowledge is the only Practice Management / Revenue Cycle Management company
with a very own Telemedicine platform to be working for both major Payers like HealthCare
Partners and Heritage Provider Network and Providers like Hospitals, Orthotics-Prosthetics
& DME companies, Nursing Homes, Urgent Care Centers and more, across the US, with
equal success!
We help our clients leverage this dual exposure and get a unique edge in making their
business more successful in a much shorter time.
This is just a small selection from the list of hospitals and other healthcare organizations served by us currently
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 5
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
OUR 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 & Unique user IDs created using Microsoft Active Directory | Access to storage devices, shared drives, USB/mass
Application Usage 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 Site-to-site IPSec VPN tunnels | Authorized access via client-to-site VPN connections | Access authorization
Private Network) controlled by Active Directory's authentication service
10 Redundancy Fully redundant network stack | Two ISP links configured in active-active mode | Power backup supplied by 130 KVA UPS
Management and 750 KVA generator | 22 KVA UPS backup for server and network systems
11 Virus & Malware Central anti-malware system | Automatic updates | Extra protection by gateway firewall |
Protection Centralized OS patch management system (using Microsoft's WSUS server)
12 Other Measures Fire extinguishers at key areas | Half-yearly fire drills
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 6
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
ACCOUNTS RECEIVABLE
MANAGEMENT
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 7
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
ACCOUNTS RECEIVABLE IN THE REVENUE CYCLE
Eligibility & Patient
Authorization Information
Verification
Entry
Reporting
Denial 360° Coding
Management Charge Entry
Revenue Cycle
Accounts Management
Receivable
Services
Payment Claim
Posting Submission
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
ACCOUNTS RECEIVABLE MGMT. PROCESS OVERVIEW
Our A/R follow-up service is designed to increase the Revenue Collection for
our clients.
The process begins after the Provider creates and sends Health Insurance
Claims (Electronic/Paper claims or Manual HCFA forms) to various Insurance
Companies.
Depending on the transmission type and length of time since submission,
we begin our follow-ups.
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 9
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
FOLLOW-UP
2 types of Claims Follow-ups
No Remark Claims: 1
Any claim in which absolutely no status is known for the claim.
Last Remark Claims:
2Claims which remain unpaid for various reasons. These claims are
routinely followed up on a monthly basis.
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
STEPS IN ACCOUNTS RECEIVABLE FOLLOW-UP
A/R Analysis
• 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed
or written off by providers
• 50% of denied claims are never re-filed
• 50-70% of denied claims have higher chance of being recovered
Follow-up with Payer
• Aggressive follow up with the insurance company's on all accounts at any stage of the
aging bucket plays an important part in A/R follow up activities
Closure of claim
Reducing days in A/R, claims submission and improving collection ratio
with an increase in the probability of payment through timely follow-up is
the responsibility of the A/R team
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 11
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
STEPS IN ACCOUNTS RECEIVABLE FOLLOW-UP
1 Online Claims Follow-Up
Using various insurance company websites and Internet payer portals, we
check on the status of outstanding claims.
2 Automated Claims Follow-Up (IVR)
By calling insurance companies directly, an Interactive Voice Response (IVR)
system will provide the status of unpaid claims.
3 Insurance Company Representative
If necessary, calling a ‘live’ insurance company representative will give us a
more detailed reason for claim denials when such information is not available
by the first 2 methods.
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 12
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
AR FOLLOW-UP/DENIAL
MANAGEMENT PROCESS
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 13
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
REASONS FOR DENIAL Inclusive Procedures
Partial Payments
Authorization Issues Out-of-network claim status and
Referral Issues
Medical Necessity and Medical deductibles
EDI Rejections
Records requests No status and No claim on File
Non-Participation with Insurance PIP cases
Network
Terminated Insurance
Coordination of benefits
Wrong Diagnosis
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
STEPS IN DENIAL MANAGEMENT
2 Categories of Denial Management
1 Claim Correction and Resubmission
These are the claims which are corrected, modified, and resubmitted as a corrected
claim to Insurance companies.
For such claims, every effort is made to resolve the denial to avoid billing the patient.
2 Patients' Responsibility
These are claims which cannot be further worked upon and the final bill is sent to the
patient for payment collection.
The reasons for sending the patient a bill generally include In-Network deductibles and
non-covered benefits as per the insurance plan. Patients receive a statement with a
clear explanation for the balance due.
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
IDENTIFY THE OUTSTANDING BALANCE
Identify O/S Balance Identify Reason for
Non Payment
follow-up with payer
Document the
comments
accordingly
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 16
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
BILL THE CLAIMS (PAID)
Bill the Claims Check for
Rejections
Work on the
Identified Rejections
Resubmit the claims
Follow-up with the
Payer
Receive Payment
Confirmation
Post the Payment
Document the
Applicable
Comments
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 17
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
BILL THE CLAIMS (UNDERPAID/DENIED)
Bill the Claims Check for
Rejections
Work on the
Identified Rejections
Resubmit the claims
Follow-up with the
Payer
Denied/ Underpaid
Follow the Appeal
Process
Document the
Applicable
Comments
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 18
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
GUIDELINES
Payer/Provider contracts
State Specific Laws
Payer specific guidelines
Provider exceptions
Billing Guidelines
Dos Don'ts
• Regular follow-ups on the claim in a span Untimely follow-up on claims
of 30 days Untimely submission of claims
• Proper Data Management/Reporting of
Work
Follow-up Mechanism
Higher $ value claims & Oldest DOS must be worked as priority
Account level work
Oldest DOS must be worked first
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 19
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SALIENT ASPECTS
Level of Care
Skilled Care:
• Patient requires various therapies, ventilator, and additional care
• Physician’s assessment is usually required along with authorization
• Usually this will be inclusive in the room & board charges but reimbursement will be at a higher
rate
• This is usually short term in nature and is covered under Medicare and by Commercial payers
Non Skilled / Custodial Care:
• Usually involves elderly who are unable to take care of themselves and does not include therapies
• Only room & board charges are billed and cannot be billed with therapies
• Such cases are generally long term in nature and is covered by Medicaid or paid privately
There may be instances where a patient is shifted from an SKF to a hospice and in such cases if the patient
has a Medicare Advantage plan the plan will not reimburse and this has to be billed directly to Medicare
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 20
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SALIENT ASPECTS – AR FOLLOW-UP
Secondary to Medicare
It is important to contact the payer to ensure that the claim was crossed over to avoid the
possibility of TF denials
Several payers require the claim to be billed again even if Medicare crossed over the claim
If Medicare does not pay on the claim the the secondary payer will not pick up any
reimbursement on the claim
It is therefore for imperative to first follow-up on the Medicare claim and get payment and
then follow-up with the secondary payer as a Medicare denial will result in an automatic
denial from the secondary payer
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SALIENT ASPECTS – AR FOLLOW-UP
Medicare Criteria for SNF Coverage
Benefit period: refers to the days covered by Medicare
QHS: Qualifying Hospital Stay for 3 or more days prior to SNF level of care
SNF coverage: only 100 days (custodial care is not covered) per benefit period which is
limited to a maximum of 3 per calendar year
Each benefit period follows a 60 day period of non-skilled care
Medicare Reimbursement
Depends on the RUG (resource utilization groups)score which is an assessment of the level
of care needed based on the LTC Minimum Data Set. It is a PPS method of reimbursement.
First 20 days of SNF care is covered at 100% (subject to 2% sequestration)
21st day to 100th day was payable at $164.50 in 2017. The balance is then picked up by:
• Secondary / Medigap
• Medicaid
• Private pay
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 22
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
CHALLENGES
Understanding the revenue codes along with modifiers
Proper coding of the claim based on the contract provisions: is addressed with timely intervention of the
coding department
Untimely follow-up: is avoided by proper tracking of next follow-date
Indentifying / Understanding the different trends like denial, payment, and claims processing
Understanding the proper applications to be used for claims follow-up
Obtaining required information needs extensive research which is time consuming
Medicare EOB not available: AR follow-up can still be worked based on coinsurance amount from value code
09, Medicare paid amount from the transaction history and Medicare paid date from payment posting date
Ensuring patient has Medicaid coverage: Sun Knowledge also carries our Medicaid eligibility checks for clients
who offer Medicaid enrollment support as their service. The services involve:
Communicating with physicians’ offices for medical notes/clinical documentation
Communicating with local govt. offices to verify eligibility
Verification of eligibility for patients via state online database
Downloading patients files from state website (where applicable) and uploading to clients’ systems for
processing
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 23
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
CHALLENGES - MEASURES
Key Initiatives Required
Need to know about the exceptions on the claim billing
All the claims must be followed up / touched every 30 days
Need to check on the older inventories to identify the trends
Timely follow-up on the claim to avoid nonpayment of claims
Best Practices & Pro-active Steps
Continuous approach in trying to gather the claims processing information specific to payers helps in determining
the further steps on the claims
Timely follow-up on the claims helps to reduce the outstanding AR balances (collection or valid denial
adjustments )
Proper share of knowledge specific to the claims follow-up based on the provider-payer contract
Follow-up Mechanism
Claims follow-up must be payer specific
Necessary post review actions should be taken simultaneously to avoid any delay
in resolving the claim balance
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 24
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
PAYER SPECIFIC CHALLENGES
Payer Challenges
BCBS
BCBS has separate guidelines for claims processing specific to the states and
the Home & Host plan for MSP. BCBS usually pays out the claims in the first attempt. The challenge is
to get the status update from BCBS on the claims for older dates of service. Although BCBS usually
pays out the claims in the first attempt, payments might get recouped against any over-payment
recovery as the plan benefits are not considered primarily.
Aetna For Aetna, often it is seen that when claims are priced by a pricing vendor for the out of network
providers, the provider is asked to contact for negotiating the claims based on the member’s plan
benefit for a settlement agreement.
General Web portal access is helpful for resolving claims with better accuracy as most of the payers direct to
their Websites for claims information. It also helps to validate the denials.
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 25
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
OVERALL COMPLEXITIES
Complexities arise due to untimely follow-up on the claims and incorrect approach towards the
denials. The most frequent denial types are re listed below:
Past timely denials:
Untimely submission of claims does not get paid unless there is a valid reason for untimely
submission/follow-up. Most of the times, after the timely filing limit is crossed, re-appeal for
the initial denial of the claims can be made. However, it can be cost consuming in case the
claims do not get approved.
No Authorization / Non Covered services:
During eligibility verification and benefits checks, the authorization requirement based on
the services to be rendered to the member needs to be checked. It also needs to be checked
if the services are covered under the plan benefits. If the auth is not obtained, then it might
be needed to re-appeal, providing the medical records of the member.
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 26
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
STEPS IN DENIAL MANAGEMENT
2 Categories of Denial Management
1 Claim Correction and Resubmission
These are the claims which are corrected, modified, and resubmitted as a
corrected claim to Insurance companies.
For such claims, every effort is made to resolve the denial to avoid billing the
patient.
2 Patients' Responsibility
These are claims which cannot be further worked upon and the final bill is sent
to the patient for payment collection.
The reasons for sending the patient a bill generally include In-Network
deductibles and non-covered benefits as per the insurance plan. Patients receive
a statement with a clear explanation for the balance due.
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 27
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
DISTRIBUTION OF DENIED CLAIMS
Distribution of Denied Claims
10% 24% Auth Related
17% Coding Correction Required
11% OON Issue
35% Others
3% Patient info missing
Timely Filing
Claims denied as Others are due to the following reasons:
Claim denied as duplicate Bill Primary
Claim previously paid Patient not covered due to pre-existing condition
Patient not eligible on DOS Plan doesn’t cover medical services such as DME
Payer didn’t receive EOB from primary payer Not covered by member’s plan
Provider needs to verify if item billed is rental or purchase Claim exceed maximum number times it can be billed
Private & Confidential Phone: (646) 661-7853 | E-mail: [email protected] 28
41 Madison Avenue, 25th Floor, New York, NY 10010, USA
BENEFIT HIGHLIGHTS Demonstrated expertise in
working on difficult-to-
Reduction in
accounts receivable recover aging A/R
by 30% Same attention to every
cash amount regardless of
within 1 month
its size or source
Over 7 years’ experience
in claim adjudication for
major US insurance plans
Expert handling of accounts
receivable by highly
experienced staff
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SAMPLE
REPORTS
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SAMPLE OF AGENT-WISE A/R REPORT
User ID Touched Note Days Worked Hours Notes Per Max Note Time Average
Accounts Count Worked Hour Note Time
XX12_GT 1 4.5 0:20:06
XX13_GT 37 37 1 8.22 5.77 0:35:44 0:02:00
XX14_GT 50 51 1 8.83 4.16 0:15:26 0:05:45
XX15_GT 37 37 1 8.9 4.74 0:38:47 0:02:19
XX16_GT 41 41 1 8.65 5.15 0:23:57 0:09:48
XX17_GT 34 48 1 9.32 8.62 0:42:35 0:03:45
XX18_GT 83 83 1 9.63 5.38 0:35:14 0:02:37
XX19_GT 50 50 1 9.3 4.77 0:24:11 0:05:18
XX20_GT 45 46 1 9.65 5.98 0:33:47 0:05:05
XX21_GT 53 53 1 8.87 1.41 0:37:20 0:04:01
14 14 Total time 9.93 0:08:23
Total Touched 444 460 Average time 91.30 5.04
Average Touched 44 46 9.13
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SAMPLE OF A/R AGING REPORT
Sunknowledge WEEKLY AR AGEING REPORT FOR Client X Inc. - 07/06/2015 through 07/12/2015
>120 Days 91 – 120 Days 61 – 90 Days 31 – 60 Days
PAYER Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining Claims Completed Remaining
AARP HEALTH CARE 26 23 3 17 16 1 44 41 3 37 32 5
OPTIONS
AMERICAN TRANSIT 12 11 16 5 1 15 15 0 10 10 0
INSURANCE COMPANY
28 24 4 16 13 3 41 37 4 32 30 2
BCBS 13 12 1
6 6 19 9 0 23 22 1 11 10 0
MAGNACARE 12 10 2
HIP_PALLADIAN 7 7 0 12 9 3 12 10 2 15 15 5
HEALTH 12 9 6
MANAGED PHYSICAL 7 6 28 7 1 10 10 0 10 8 0
NETWORK 5 5 4
MAGNACARE 31 28 0 11 9 25 5 08 3 2
OXFORD 3 17 12 5 23 22 1 22 16
STATE FARM
INSURANCE 14 4 05 5 04 4
TOUCHSTONE HEALTH
08 6 26 4 2 16 12
UNITED HEALTHCARE
3 23 20 3 49 43 6 41 39
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SAMPLE SOW OF A/R FOLLOW-UP
Sunknowledge will make outbound calls to reach out to the Payers to gather
information about the status of claims as per the list provided by Customer. Key
tasks involved in carrying out this work are detailed below.
Planning to start calling Payers as per the list of claims based on the
downloaded AR Reports
Research details of the claims in the AR list in the Clients system
Making outbound calls to the respective Payers for claims aged
31 days and more
Document finding of the calls
Preparation of claims reports with status information gathered
during the call
Modifications, removal or adding tasks to this are agreed upon between client
and Sunknowledge.
…
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
SUMMARY OF BENEFITS
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
• Billing & Coding Accuracy > 99.9%; 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
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
TESTIMONIALS
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
CLIENTSPEAK
“We have had the pleasure of working with the Sunknowledge 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 Sunknowledge.”
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
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
CLIENTSPEAK
“My firm has evaluated an outsourcing transaction with Sunknowledge. 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 Sunknowledge 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
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA
CLIENTSPEAK
“I was always against the idea of outsourcing our back end claims processing
work but I was wrong. Sunknowledge provided extraordinary deliverables on
a timely basis which led to cost cutting considerably for us.”
CEO of a leading MA-PD Plan
READ ALL TESTIMONIALS
For Additional Information, Please Contact…
Ronnie Hastings
Phone: (646) 661 7853
Email: [email protected]
Sunknowledge Services Inc.
41 Madison Ave., Suite 2503, 25th Floor
New York, NY 11001, USA
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41 Madison Avenue, 25th Floor, New York, NY 10010, USA