Frequently Asked Questions

What is ClinAssist?
ClinAssist is a complete claims review and resolution service that uses sophisticated technology and a team of clinical and industry experts to significantly reduce claim costs.
How are you different from other bill review or claims auditing companies?
A conventional medical record audit focuses on matching services billed to physician orders. The savings outcomes generally range from two to five percent. However, a ClinAssist Forensic ReviewSM goes beyond the typical claim audit and often results in significantly higher savings.
How is this possible? Beyond a typical claim audit, ClinAssist uses a sophisticated Forensic Review system that combines advanced technology with hands-on, clinical and financial experts to reconstruct the course of care and thoroughly document categories of exceptions.
Unlike other companies, ClinAssist doesn't simply turn over the claim review results to clients. After identifying all savings opportunities, many typically missed by automated review services, we will recommend a negotiation strategy and our experts will work with the hospital on our client's behalf to achieve a fair and equitable settlement. This is all part of our standard process.
What is a Pre-Screen?
A Pre-Screen is a complimentary preliminary review of a claim to determine whether a Forensic Review is warranted.
What is a Forensic Review?
A Forensic Review includes a complete course-of-care reconstruction, from both a clinical and financial perspective, and a thorough analysis using ClinAssist's proprietary algorithms. The results are documented in a detailed report that includes recommended payment amounts.
What is your Negotiation and Settlement service?
ClinAssist offers negotiation and settlement services for claims that are not suitable for a Forensic Review, including: bills that are "clean," but may not reflect an adequate contractual discounts or when your relationship with the hospital does not allow a detailed Forensic Review.
What types of claims do you review?
ClinAssist is suitable for unpaid claims where: billed charges are greater than $50,000 or outlier charges exceed DRG or per diem threshold.
Conditions that typically meet these criteria include: complex newborns (NICU), complex pediatric conditions, ICU/CCU, orthopedic surgery, transplants, burn cases, oncology, implants, cardiac, multiple co-morbidities, traumas, diabetes complications and other catastrophic claims greater than $50,000 payable.
We conduct a complimentary Pre-Screen on every claim to determine if the client would benefit from a Forensic Review.
Can ClinAssist review an interim bill?
Absolutely. Interim bills are reviewed as they are available and can be utilized to address contractual payment timeframes.
Will ClinAssist review a paid claim?
Yes, ClinAssist has been successful reviewing claims that have been paid. However, this is only possible when our client has an established "Right of Recovery" in place.
Can you help us develop referral criteria that meet our needs?
Yes. We can tailor our services to meet your needs.
How do I refer a claim for review?
You can refer a claim to us via Internet, phone, or fax. You can submit a claim through our secure website – www.AssistGroup.com, by calling 877-631-9080, or faxing us at 800-435-2049.
What documentation do you need to review a claim?
We require the UB-04 and the line item detail for all claims submitted. Additionally, we may require Plan benefit documents, case management and/or utilization notes and the medical records, depending on the pre-screen findings.

Did you know?

Two recent studies of twins suggest a genetic predisposition for preterm birth with heritability of approximately 20 to almost 40 percent.

The increased risk of preterm birth associated with ethnicity or race can persist, even if corrected for socio-economic status.

Mothers who were preterm themselves have an increased risk of delivering preterm.

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