SunKnowledge Adds Orthopedic Client for O&P Insurance Verification

SunKnowledge, a New York City-based provider of business and knowledge process outsourcing for the US healthcare industry, has announced a new engagement with a large orthopedic solutions company serving communities across western Pennsylvania, eastern Ohio, and West Virginia. The client, which handles approximately 600 orders per month and specializes in orthotics and prosthetics (O&P), needed additional support for eligibility verification and insurance benefits checks. As order volume grew, these administrative tasks consumed significant staff time, often requiring direct insurer calls with long hold times and information not consistently available through online portals. The new workflow is designed to relieve that burden while allowing patient service staff to focus more on patient care.

Under the proposed support model, SunKnowledge will implement a dedicated eligibility and benefits verification workflow, using payer portals where sufficient information is available and contacting insurance representatives when additional details are required. The team will work within the client’s existing processes and use the Nimble platform, with which SunKnowledge has prior experience. The engagement goes beyond checking whether a patient has active coverage: it involves verifying that the prescribed product, relevant Healthcare Common Procedure Coding System (HCPCS) codes, and the payer’s applicable medical policies align. Reviews may also consider billing history, frequency limitations, and documentation requirements—particularly important for custom bracing and ankle-foot orthoses, where an active policy alone does not establish coverage. SunKnowledge will review available documentation against payer requirements and identify missing information or questions requiring follow-up, while treating professionals remain responsible for clinical decisions and insurers retain coverage determinations.

Ronnie Hastings, spokesperson for SunKnowledge, emphasized that orthopedic providers put great care into ensuring patients receive the right product, proper fit, and clear instructions, and that the administrative work behind that service deserves the same attention. The initial scope centers on eligibility verification and benefits checks, but SunKnowledge has offered a flexible service model that could later include prior authorization, billing, denial management, and document management under a separate agreement. For the orthopedic solutions company, the immediate goal is to add administrative capacity while maintaining attentive patient service. For SunKnowledge, the engagement expands its work with orthopedic providers and reinforces the importance of detailed verification support.