ClinAssist Referral Criteria

ClinAssist is appropriate 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 admissions)
  • complex pediatric conditions
  • ICU/CCU
  • orthopedic surgery
  • transplants
  • burn cases
  • oncology
  • implants
  • cardiac
  • multiple co-morbidities
  • traumas
  • diabetes complications
  • other catastrophic claims greater than $50,000 payable.

ClinAssist's services can also be used even if the claim has been paid where an established "Right of Recovery" is in place.

Did you know?

A November 2006, Journal of the American Academy of Pediatrics Randomized controlled study showed that there were 7.9 fewer days for total Length of Stay for infants weighing less than 1,500 grams whose parents participated in an educational behavioral intervention program called “Creating Opportunities for Parent Empowerment” or COPE

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