ClinAssist Referral Criteria
ClinAssist is appropriate for unpaid claims where:
- Billed charges are greater than $100,000
- Outlier charges exceed DRG or per diem threshold
- The average daily charge exceeds $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
- 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.