Terms of Service

1. Description of Services

BillingClaw provides an AI-assisted medical billing audit and EDI claim recovery platform. The Services systematically ingest electronic insurance claim files (EDI 837) and remittance details (EDI 835), identify procedural modifier errors or pre-authorization issues, suggest compliant corrections, and resubmit corrected claims directly to connected healthcare clearinghouses.

2. Performance-Based Pricing Model

BillingClaw charges strictly on a contingency fee basis relative to successfully recovered cash. Fees are calculated directly from adjudicated payments received by the Provider on claims audited and corrected by our Services:

• Fresh Claims (Under 12 Months): A platform commission fee of 20.00% of the recovered cash amount.
• Aged Claims (12+ Months): A platform commission fee of 25.00% of the recovered cash amount.

Recovered amounts are validated daily against electronic remittance advices (835 ERA) and EHR cash postings. Statements are issued monthly, with payment automatically settled via Provider's connected Stripe Account.

Late Payment Clause: If automatic Stripe payment processing fails, the Provider shall have ten (10) calendar days to resolve the billing failure and clear all outstanding amounts. Failure to resolve payment within this ten-day grace period will result in immediate suspension of all claim audits, EDI resubmissions, and platform services. Overdue balances shall accrue interest at a rate of 1.5% per month (18% per annum), calculated daily from the original due date until fully paid.

3. Provider Responsibilities

The Provider agrees to and warrants the following operational obligations:

• Providing valid credentials and api permissions to Provider's active Electronic Health Record (EHR) and clearinghouse portals.
• Maintaining absolute accuracy of primary diagnostic, medical, and patient encounter record entries.
• Promptly reviewing flagged claims in the audit queue requiring manual document uploads or retroactive authorizations.
• Ensuring the correct NPI details and provider credentials are kept active with payer directories.

4. BillingClaw Responsibilities

BillingClaw agrees to provide the Services in a professional, work-like manner, utilizing advanced algorithmic checks to maximize claims recovery rates. We maintain absolute commitment to:

• Providing highly secure, schema-isolated database tenant accounts.
• Upholding strict HIPAA BAA guidelines and PHI firewalls.
• Exerting daily nightly claim audit cycles with high-uptime EDI transmission gateways.

5. Limitation of Liability

To the maximum extent permitted by applicable law, in no event shall BillingClaw, LLC be liable for any indirect, incidental, special, exemplary, or consequential damages arising out of or in connection with the Services, including without limitation, any claims that are written off or denied due to untimely filings, modifier mismatch disputes, or EHR integration failures.

BillingClaw's aggregate liability under this Agreement shall not exceed the total platform fees paid by the Provider in the three (3) months preceding the incident.

6. Term & Termination

This Agreement commences upon account activation and continues on a month-to-month basis. Either party may terminate this Agreement at any time with thirty (30) days written notice. Upon termination, the Provider remains liable for any platform fees due on claims corrected prior to the termination date. All customer records and schema files will be purged in compliance with our standard HIPAA data retention policies.

7. Governing Law

This Agreement and all claims or disputes arising out of it shall be governed by, and construed in accordance with, the laws of the State of Texas, without regard to conflict of law principles. Any legal actions or proceedings must be filed in state or federal courts located in Austin, Texas.

8. Contact Information

For contract inquiries, formal dispute notices, or terms feedback, please reach out to us at:

BillingClaw Legal & Contract Relations
Email: hello@billingclaw.io