SunKnowledge has added an established orthopedic solutions company to its client roster, taking on orthotics and prosthetics (O&P) eligibility verification and insurance benefits checks for a provider that handles approximately 600 orders a month. The engagement is intended to reduce the administrative load on the client's patient service staff, allowing those employees to spend more time assisting patients.
The client serves communities across western Pennsylvania, eastern Ohio and West Virginia, combining orthopedic products with specialist fitting, patient education and continued support. Its credentialed and licensed staff provide fitting services and product training, supported by delivery options that extend care from the clinic to the home. That model requires close coordination among patient service personnel, clinical professionals and administrative teams, and maintaining that coordination has become an operational priority as demand grows.
Insurance verification has been a particular pressure point. Much of the workload involves contacting insurers and checking benefits, including obtaining information that is not consistently available through online portals. Long payer hold times make it difficult for staff to predict how much of a day a single verification will consume, competing with patient questions, follow-up activities and other service responsibilities.
SunKnowledge's support will use a dedicated eligibility and benefits verification workflow. The team will use payer portals where sufficient information is available and contact insurance representatives when additional details are required. The goal is to give the client's internal staff clearer verification information while reducing the number of insurance inquiries they must handle directly.
The engagement goes beyond confirming that a patient has an active insurance plan. Verification must account for 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 available billing history, frequency limitations and documentation requirements. That 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 a plan's coverage conditions. Staff may need to clarify product-specific benefits, identify prior utilization or determine which supporting records the payer requires before an order can proceed.
SunKnowledge's responsibilities include reviewing available documentation against payer requirements and identifying missing information or questions requiring further 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 and support more informed communication with patients.
The client currently uses Nimble, and SunKnowledge confirmed prior experience with the platform during discussions. The proposed workflow will use secure, authorized access and follow the organization's existing processes, allowing verification support to be added 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 a separate agreement.
"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, a 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 announcement matters because orthopedic providers face growing administrative demands tied to payer-specific coverage rules, and verification errors or delays can hold up orders for custom-fitted devices. By outsourcing detailed benefits checks, the client aims to add capacity while preserving the attentive service its patients receive. For SunKnowledge, the engagement expands its work with orthopedic providers and reinforces the role of detailed verification support in revenue cycle operations.
