SunKnowledge has secured a new client among established orthopedic solutions companies, taking on eligibility and benefits verification for orthotics and prosthetics (O&P) orders. The engagement is designed to help the provider manage increasing administrative demands while freeing its patient service staff to spend more time assisting patients.
The client, which serves communities across western Pennsylvania, eastern Ohio, and West Virginia, combines orthopedic products with specialist fitting, patient education, and continued support. With approximately 600 orders per month, the provider needed additional support to keep up with insurance verification. Even as its team grew, these tasks consumed much of the staff's time, and the company wanted SunKnowledge to handle the workload within its existing processes.
Much of the workload involves contacting insurers and checking benefits, as well as obtaining information not consistently available through online portals. Long payer hold times made it difficult for staff to predict how much of the day would be spent on a single verification. SunKnowledge's proposed support addresses these demands through a dedicated eligibility and benefits verification workflow, with a team that will use payer portals where sufficient information is available and contact insurance representatives when additional details are required.
"Orthopedic providers put a great deal of care into making sure patients receive the right product, a proper fit, and clear instructions," said Ronnie Hastings, spokesperson for SunKnowledge. "The administrative work behind that service deserves the same attention. Our role is to handle detailed insurance verification so their patient service team has more time to help patients."
The engagement goes beyond checking whether a patient has an active insurance plan. It requires verification that considers the prescribed product, relevant Healthcare Common Procedure Coding System (HCPCS) codes, and the payer's applicable medical policies. Depending on the order, the review may also involve billing history, frequency limitations, and documentation requirements. This level of detail is especially relevant to custom bracing and ankle-foot orthoses, where an active policy does not by itself establish that a particular orthosis meets coverage conditions.
SunKnowledge's responsibilities include reviewing available documentation against payer requirements and identifying missing information or questions requiring follow-up. Treating professionals remain responsible for clinical decisions, and insurers retain responsibility for coverage determinations. Eligibility and benefits verification does not guarantee payment, but documenting what has been verified and what remains unresolved can help the provider recognize coverage concerns earlier.
The client currently uses Nimble, and SunKnowledge confirmed prior experience with the platform during discussions. The workflow will use secure, authorized access and follow the organization's existing processes, allowing the client to add verification support without a major change to daily work. The initial scope centers on eligibility verification and benefits checks, with a flexible service model that could later include prior authorization, billing, denial management, and document management under separate agreements.
For the orthopedic solutions company, the immediate objective is to add administrative capacity while maintaining attentive service. For SunKnowledge, the engagement expands its work with orthopedic providers and reinforces the importance of detailed verification support.
