Frequently Asked Questions

What is ClinAssist?
ClinAssist is a complete, claims resolution service that uses sophisticated technology and a team of 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 ClinAssist Forensic Review combines advanced technology with hands-on clinical and financial expertise to analyze every aspect of a claim, identifying any and all savings opportunities… opportunities that are often missed in a standard automated review or a medical chart audit.
A Forensic Review includes a complete course-of-care reconstruction, from both a clinical and legal 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 $100,000, outlier charges exceed DRG or per diem threshold, the average daily charge is in excess of $3,000, or a single Revenue Code is more than 40% of the bill.
Conditions that typically meet these criteria include: complex newborns (NICU admissions), complex pediatric conditions, organ transplants, implants, cardiac, cancer, dialysis, diabetes, orthopedic surgeries, and complex injuries such as spinal cord, brain, and multiple trauma.
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?
Unlike many other companies, we typically do not need the medical records because of our ability to reconstruct the course of care using the billing records. We generally only need the UB-92 and the line item detail.
We will contact the hospital if additional documentation is needed.

Did you know?

There are many risks for have a preterm delivery including uterine fibroids, cervical surgery for removal of cancer or precancerous lesions and multiple gestations. However 50% of women who deliver preterm infants had no identifiable risks.

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