Terms of Service

1.1 Acceptance of Terms

These Terms constitute a legally binding agreement between you (the "Client") and ClaimsCure. By:

• Signing a Service Agreement with ClaimsCure
• Using our Services through any interface
• Accessing our client portal or website

You acknowledge that you have read, understood, and agree to be bound by these Terms.

1.2 Modifications to Terms

We reserve the right to modify these Terms at any time. We will notify you of material changes:

• Via email to the address on file
• Through our client portal
• By posting updated Terms on our website

Continued use of Services after changes constitutes acceptance of modified Terms.

2.1 Services Provided

Our Services include but are not limited to:

• Claims Processing: Electronic submission of healthcare claims to insurance carriers
• Payment Posting: Reconciliation of payments and adjustments
• Denial Management: Tracking and appealing denied claims
• Patient Billing: Generation and management of patient statements
• Reporting: Detailed financial and performance reporting
• Coding Services: CPT, ICD-10, and HCPCS coding support

2.2 Service Limitations

Our Services are subject to the following limitations:

• We act as a HIPAA Business Associate, not as a healthcare provider
• We do not provide medical, legal, or financial advice
• Services are limited to billing and administrative functions
• We rely on accurate information provided by the Client

3.1 Business Associate Agreement

Prior to receiving any PHI, Clients must execute a Business Associate Agreement (BAA) with ClaimsCure. The BAA:

• Defines permitted uses and disclosures of PHI
• Establishes security and privacy obligations
• Outlines breach notification procedures
• Details data destruction requirements

3.2 Security Measures

We implement comprehensive security measures including:

• Encryption of data in transit and at rest
• Secure access controls and authentication
• Regular security audits and risk assessments
• Employee HIPAA training and confidentiality agreements
• Physical security of facilities and equipment

4.1 Information Accuracy

Clients are responsible for:

• Providing accurate and complete patient information
• Submitting timely documentation of services rendered
• Verifying insurance eligibility and benefits
• Maintaining proper licensure and credentialing

4.2 Timely Submission

Clients agree to:

• Submit encounter forms within agreed timeframes
• Provide supporting documentation promptly
• Respond to inquiries within 48 business hours
• Review and approve claims prior to submission

4.3 Compliance

Clients must:

• Comply with all applicable healthcare laws and regulations
• Maintain proper malpractice and liability insurance
• Ensure services billed are medically necessary and properly documented
• Cooperate with audits and investigations

5.1 Fee Structure

Fees are typically based on:

• Percentage Model: Percentage of collections
• Per-Claim Model: Fixed fee per claim processed
• Hourly Model: Hourly rate for specific services
• Monthly Retainer: Fixed monthly fee

Specific fees and structure are detailed in the Service Agreement.

5.2 Payment Terms

• Invoices are issued monthly
• Payment is due within 15 days of invoice date
• Late payments may incur interest at 1.5% per month
• Services may be suspended for non-payment after 30 days

6.1 Our Intellectual Property

ClaimsCure retains all rights to:

• Our software, systems, and technology
• Proprietary processes and methodologies
• Training materials and documentation
• Branding, logos, and trademarks

Clients are granted a limited, non-exclusive license to use our systems for Services only.

6.2 Client Data

Clients retain all rights to:

• Patient medical records and PHI
• Business information and data
• Financial records and reports

We only use Client data to provide Services as authorized.

7.1 Confidential Information

Includes but is not limited to:

• Protected Health Information (PHI)
• Business processes and strategies
• Financial information and pricing
• Technical information and trade secrets
• Employee and patient information

7.2 Confidentiality Obligations

Each party agrees to:

• Use confidential information only for Services
• Protect information with reasonable security measures
• Limit access to authorized personnel only
• Return or destroy information upon termination

8.1 Term

The initial term is specified in the Service Agreement, typically 12-36 months, automatically renewing for successive terms unless terminated.

8.2 Termination Rights

Either party may terminate for:

• Material breach not cured within 30 days
• Insolvency or bankruptcy
• Violation of laws or regulations
• Mutual agreement in writing

8.3 Post-Termination Obligations

Upon termination:

• We will return or destroy all Client data
• Final invoices will be issued
• Confidentiality obligations continue
• Transition assistance may be provided (fees may apply)

9.1 No Guarantees

We do not guarantee:

• Payment from insurance companies or patients
• Specific collection rates or timelines
• Elimination of all claim denials
• Compliance with all payer requirements

9.2 Liability Cap

Our total liability is limited to:

• The lesser of actual damages or fees paid in the 6 months preceding the claim
• No liability for consequential, incidental, or punitive damages
• No liability for third-party actions or decisions

9.3 Exclusions

Limitations do not apply to:

• Breaches of confidentiality or data security
• HIPAA violations
• Gross negligence or willful misconduct
• Indemnification obligations

10.1 Client Indemnification

Client agrees to indemnify ClaimsCure against claims arising from:

• Inaccurate or incomplete information provided by Client
• Client's failure to obtain proper patient consents
• Services rendered by Client that are not medically necessary
• Client's violation of laws or regulations

10.2 Our Indemnification

We agree to indemnify Client against claims arising from:

• Our gross negligence or willful misconduct
• HIPAA violations by ClaimsCure
• Infringement of intellectual property rights

11.1 Negotiation

Parties agree to attempt to resolve disputes through good faith negotiation for at least 30 days before initiating formal proceedings.

11.2 Mediation

If negotiation fails, parties agree to mediation with a mutually acceptable mediator before pursuing litigation.

11.3 Governing Law

These Terms are governed by Maryland law. Any legal action must be brought in Montgomery County, Maryland.

11.4 Arbitration

Disputes not resolved through negotiation or mediation shall be resolved through binding arbitration under AAA rules.

12.1 Entire Agreement

These Terms, along with the Service Agreement and BAA, constitute the entire agreement between parties.

12.2 Severability

If any provision is found invalid, the remaining provisions remain in full force.

12.3 Force Majeure

Neither party is liable for delays due to circumstances beyond reasonable control.

12.4 Assignment

Neither party may assign rights without prior written consent, except in merger or acquisition.

12.5 Notices

Notices must be in writing and sent to addresses in the Service Agreement.