As a valued partner, Summit Reinsurance Services continually assesses health care programs and services that provide quality outcomes and effectively manage health plan costs for our clients and their members. We would like to introduce you to The Assist Group and ClinAssist^TM, a value added leader in hospital claims review, resolution and proven savings.

According to the U.S. Government Accountability Office, 99% of hospital claims contain overcharges including unbundling, upcoding, level of care/room and board acuity and billing errors. The Assist Group has developed ClinAssist^TM and the Forensic Claim Review, combining hands on clinical, financial and coding expertise to review all aspects of facility claims, identifying savings opportunities often missed in a standard automated review or a medical chart audit. Each claim receives the most appropriate level of clinical, financial and coding expertise to ensure that savings are maximized. The Forensic Review assures that payers make appropriate payments, in accordance with defensible and transparent industry claims payment guidelines, for actual care rendered.

The Assist Group has helped payers identify and save millions of claims dollars by reviewing high dollar, greater than $50,000 in payable charges, and outlier claims and actively managing the settlement and resolution process. ClinAssist^TM offers a complimentary pre-screening for each claim, providing an estimate of potential savings. ClinAssist^TM fees are contingency based, a % of net savings realized at the close of the claim. In calendar year 2008, the Assist Group reviewed claims totaling approximately half a billion dollars in billed charges and delivered realized savings of 17% - 20% off adjusted payable charges (after billed charges are reduced for contractual discounts) . Automated or conventional medical record reviews typically yield a savings ranging from 3% - 5%.

We encourage you to consider a Forensic Review for any high dollar, greater than $50,000, or outlier claim. The ClinAssist^TM team will coordinate the referral process with your claims team. ClinAssist^TM fees are eligible claims expenses and will be considered with other charges in excess of the specific retention according to the terms of your reinsurance agreement.

To learn more about The Assist Group, please visit their Web site, www.assistgroup.com, or contact Debbie Stubbs, RN, MS, CCM, managed care specialist, at (260) 407-3939.