ClinAssist Referral Criteria

ClinAssist is appropriate for unpaid claims where:

  • Billed charges are greater than $100,000 or
  • Outlier charges exceed DRG or per diem threshold

Conditions that typically meet these criteria include:

  • complex newborns (NICU admissions)
  • complex pediatric conditions
  • organ transplants
  • implants
  • cardiac
  • cancer
  • diabetes
  • dialysis
  • orthopedic surgeries
  • complex injuries such as spinal cord, brain, and multiple trauma

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?

There is a hormone, 17 alpha hydroxy progesterone caproate (17P), that can be given to prevent recurrent preterm birth for women with a history of a previous spontaneous singleton premature delivery. 17 P was able to reduce recurrent preterm births by 34% in a randomized trial published in the New England Journal of Medicine 2003.

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