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.