1. Agreement to Terms

Welcome to ClaimRight. These Terms of Service ("Terms") constitute a legally binding agreement between you and ClaimRight, Inc. ("ClaimRight," "we," "us," or "our") regarding your use of our AI-powered healthcare claims appeal platform.

By accessing or using ClaimRight, you agree to be bound by these Terms and our Privacy Policy. If you do not agree to these Terms, you may not access or use our services.

2. Description of Services

ClaimRight provides an AI-powered platform that assists healthcare providers in generating appeal letters for denied insurance claims. Our services include:

• Automated extraction of claim information from uploaded documents
• AI-generated draft appeal letters based on medical guidelines and payer policies
• Analytics and reporting on appeal success rates
• Workflow management tools for appeal processing
• HIPAA-compliant data storage and processing

3. Eligibility and Account Registration

3.1 Eligibility

ClaimRight is intended for use by licensed healthcare providers, healthcare organizations, and their authorized representatives. You must be at least 18 years old and have the legal authority to enter into this agreement.

3.2 Account Accuracy

You agree to provide accurate, complete, and current information during registration and to maintain the accuracy of your account information.

3.3 Account Security

You are responsible for maintaining the confidentiality of your account credentials and for all activities that occur under your account.

4. Acceptable Use Policy

4.1 Permitted Uses

You may use ClaimRight only for legitimate healthcare appeal purposes and in compliance with applicable laws.

4.2 Prohibited Uses

You agree not to:

• Submit false, fraudulent, or misleading information
• Violate any applicable laws, regulations, or third-party rights
• Attempt to gain unauthorized access to our systems
• Interfere with or disrupt our services
• Use our services for any unlawful or unethical purpose
• Share your account credentials with unauthorized parties
• Reverse engineer or attempt to extract our proprietary algorithms

5. Professional Responsibility

Important: ClaimRight provides AI-generated draft appeal letters as tools to assist healthcare professionals. You acknowledge and agree that:

• All AI-generated content must be reviewed and approved by licensed healthcare professionals
• You remain solely responsible for the accuracy and completeness of all appeals submitted
• ClaimRight does not provide medical advice or legal counsel
• You must ensure all appeals comply with applicable regulations and payer requirements
• Final approval and submission of appeals is your professional responsibility

6. Subscription and Billing

6.1 Subscription Plans

ClaimRight offers both subscription-based plans and pay-per-use options. Current pricing is available on our website and may be updated periodically.

6.2 Billing

• Subscription fees are billed monthly or annually in advance
• Usage-based fees are billed monthly in arrears
• All fees are non-refundable unless otherwise specified
• We may suspend services for non-payment after appropriate notice

6.3 Price Changes

We may modify our pricing with 30 days' written notice. Price changes will apply to subsequent billing periods.

7. Intellectual Property

7.1 ClaimRight Property

ClaimRight retains all rights to our platform, software, algorithms, and related intellectual property. You receive only a limited license to use our services as described in these Terms.

7.2 Your Content

You retain ownership of any data or content you upload to ClaimRight. However, you grant us a limited license to process this information to provide our services, including AI training and improvement (using only de-identified data).

7.3 Generated Content

You own the appeal letters generated through our platform, subject to your compliance with these Terms and our Privacy Policy.

8. Data Protection and HIPAA

ClaimRight serves as a Business Associate under HIPAA. Our data protection practices are detailed in our Privacy Policy. Key commitments include:

• Maintaining appropriate safeguards for Protected Health Information (PHI)
• Using PHI only as permitted by our Business Associate Agreement
• Implementing security measures consistent with HIPAA requirements
• Providing breach notification as required by law

9. Disclaimers and Limitations

9.1 Service Disclaimers

ClaimRight is provided "as is" without warranties of any kind. We do not guarantee:

• Appeal success rates or claim approval outcomes
• Uninterrupted or error-free service
• Compatibility with all systems or workflows
• Accuracy of AI-generated content (professional review required)

9.2 Limitation of Liability

To the maximum extent permitted by law, ClaimRight's liability for any damages arising from these Terms or your use of our services shall not exceed the amount you paid to ClaimRight in the 12 months preceding the claim.

10. Indemnification

You agree to indemnify and hold ClaimRight harmless from any claims, damages, or expenses arising from your use of our services, violation of these Terms, or infringement of third-party rights.

11. Termination

11.1 Termination by You

You may terminate your account at any time through your account settings or by contacting support.

11.2 Termination by ClaimRight

We may suspend or terminate your access for violation of these Terms, non-payment, or other reasons with appropriate notice.

11.3 Effect of Termination

Upon termination, your access to ClaimRight will cease, and we will handle your data according to our Privacy Policy and applicable law.

12. Compliance and Regulatory

You acknowledge that healthcare appeals are subject to various federal and state regulations. You agree to:

• Comply with all applicable healthcare laws and regulations
• Ensure appeals meet payer-specific requirements
• Maintain appropriate professional licenses and credentials
• Follow your organization's compliance policies

13. Governing Law and Disputes

These Terms are governed by [Your State] law. Any disputes will be resolved through binding arbitration, except for claims that may be brought in small claims court.

14. Changes to Terms

We may modify these Terms periodically. Material changes will be communicated through the platform or via email. Continued use of ClaimRight after such modifications constitutes acceptance of the updated Terms.

15. Contact Information

For questions about these Terms, please contact:

16. Entire Agreement

These Terms, together with our Privacy Policy and any additional agreements, constitute the entire agreement between you and ClaimRight regarding your use of our services.