Superior Outcomes, Bottom Line Results

The Assist Group is the leader in integrated claims review and resolution.

Million dollar claims used to be a rarity; now payers are frequently seeing claims in excess of a million dollars. In fact, many claims can reach as high as $10 million dollars or more. While reinsurance may cover excess charges, there is a price to pay in future premium costs. Our experience shows that these large claims contain more potential for errors and improper billing. In addition, as health care reform influences our health care system, improper billed charges are a focus for Medicare, Medicaid, and government payments. But what is an improper billed charge and how does a plan detect them?

Detecting errors on high dollar facility claims is complex and requires a hands-on approach to the clinical and financial detail. There may be hundreds or even thousands of lines of billed charges in a single catastrophic claim. It is a difficult to keep up with complex hospital charge masters and varying billing methods. Benefit and contract language add another dimension to an already convoluted bill review process. Ultimately, even when billed charges are questioned, the negotiation, appeals and resolution of the claim are arduous tasks.

What is the solution to this challenging dilemma? The Assist Group's claims review and resolution program -- ClinAssist is the answer.