SunKnowledge has expanded its client base with the addition of an established orthopedic solutions company that provides orthotics and prosthetics (O&P) products and services across western Pennsylvania, eastern Ohio, and West Virginia. The engagement, announced on October 21, 2026, focuses on eligibility verification and insurance benefits checks, a critical administrative function that the client needed help managing as order volume grew to approximately 600 per month.
The client’s operations combine orthopedic products with specialist fitting, patient education, and continued support, requiring close coordination among patient service personnel, clinical professionals, and administrative teams. As demand increased, insurance verification tasks—contacting insurers, checking benefits, and obtaining information not consistently available through online portals—consumed significant staff time. Long payer hold times made it difficult to predict how much of the day would be spent on a single verification, competing with patient questions and follow-up activities.
SunKnowledge’s proposed support includes a dedicated eligibility and benefits verification workflow and a team that will work within the client’s existing processes. The team will use payer portals where sufficient information is available and contact insurance representatives when additional details are required. This is intended to provide clearer verification information to the client’s internal staff and reduce the number of insurance inquiries they must handle directly.
“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. We will work within their established processes and focus on the coverage questions that need to be answered for each order.”
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—details especially relevant to custom bracing and ankle-foot orthoses. An active policy alone does not establish that a particular orthosis meets coverage conditions, so staff may need to clarify product-specific benefits, identify prior utilization, or determine which supporting records the payer requires.
SunKnowledge’s responsibilities include reviewing available documentation against payer requirements and identifying missing information or questions requiring follow-up. The purpose is to give the client a more complete administrative picture of an order, while 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 and support more informed communication with patients.
The client currently uses Nimble, and SunKnowledge confirmed prior experience with the platform. The proposed 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 patient service. For SunKnowledge, the engagement expands its work with orthopedic providers and reinforces the importance of detailed verification support in reducing administrative burdens and improving patient interactions.
