TERMS OF SERVICE
1. Scope of Services
Clarity shall provide administrative, consulting, and support services related to healthcare revenue cycle management (collectively, the “Services”) to Client, subject to the terms and conditions set forth in a mutually executed written agreement, statement of work, or addendum (collectively, the “Agreement”).
The Services may include, without limitation, the following:
Provider Credentialing and Enrollment: Preparation, submission, monitoring, and follow-up of applications for initial credentialing and enrollment with governmental and commercial payors.
- Re-Credentialing and Maintenance: Ongoing maintenance of provider enrollment records, including re-credentialing, revalidation, and updates required by payors or regulatory agencies.
- Attestation Services: Preparation and submission of provider attestations, including review of supporting documentation and coordination with applicable entities as required for regulatory or payor compliance.
- Eligibility Verification: Verification of patient insurance coverage and benefits, including documentation of coverage details relevant to services rendered.
- Prior Authorization: Preparation, submission, and follow-up of prior authorization requests with applicable payors, based solely on information provided by Client.
- Medical Billing and Revenue Cycle Support: Claims preparation and submission, electronic and paper claim transmission, payment posting, denial management, accounts receivable follow-up, patient statement processing (if applicable), and related billing support services.
- Clarity shall perform only those Services expressly identified in the Agreement. Any services not specifically described in the Agreement shall be deemed outside the scope of the engagement unless agreed to in writing by both parties.
Client acknowledges that Clarity’s Services are administrative and consultative in nature. Clarity does not provide clinical services, medical judgment, or legal advice. Client retains sole responsibility for compliance with all applicable federal, state, and local laws, regulations, and payor requirements, as well as for the accuracy and completeness of all information provided to Clarity.
2. Credentialing, Re-Credentialing, and Attestation Services
2.1 Client Responsibilities
Client acknowledges that credentialing, enrollment, re-credentialing, revalidation, and attestation processes require the timely submission of accurate, complete, and current information. In connection with such Services, Client shall:
a. Provide all documentation, disclosures, authorizations, and supporting materials reasonably requested by Clarity or required by applicable governmental or commercial payors, including licensure documentation, certifications, malpractice insurance coverage, ownership disclosures, and practice information;
b. Ensure that all information submitted to Clarity is true, accurate, complete, and not misleading, and that such information remains current throughout the term of the engagement;
c. Respond to Clarity’s requests for information or documentation within forty-eight (48) hours of receipt of email or other written communication, unless otherwise agreed in writing;
d. Promptly notify Clarity in writing of any changes to licensure status, certifications, disciplinary actions, practice location(s), tax identification numbers, National Provider Identifier (NPI) information, ownership interests, malpractice coverage, or other material information affecting payor participation;
e. Execute all applications, attestations, authorizations, and related documents in a timely manner.
Failure to fulfill these responsibilities may adversely affect processing times, participation status, reimbursement eligibility, or effective dates.
2.2 Delays; No Guarantee of Approval
Client acknowledges that Clarity has no control over the review, approval, or processing timelines of any governmental agency, commercial payor, credentialing organization, or regulatory authority. Clarity shall not be liable for delays, denials, rejections, or adverse determinations arising from:
- Client’s failure to provide required documentation or timely responses;
- Incomplete, inaccurate, or expired information supplied by Client;
- Payor backlogs or internal review procedures;
- Regulatory or third-party verification delays; or
- Changes in applicable laws, regulations, or payor policies.
Clarity does not guarantee approval of any credentialing, re-credentialing, enrollment, or attestation application; participation in any payor network; assignment of reimbursement rates; processing timelines; retroactive participation; or effective dates. All determinations are made solely at the discretion of the applicable payor or regulatory authority.
2.3 Estimated Hours and Billing
Unless otherwise specified in the Agreement, credentialing-related services are provided based on estimated minimum hours. Such estimates are for planning purposes only and do not constitute a fixed or capped fee.
If Services require time in excess of the stated minimum due to complexity, corrective filings, follow-up activities, or circumstances beyond Clarity’s reasonable control, additional time shall be billed at the agreed-upon hourly rate and invoiced at the end of the applicable month.
3. Medical Billing and Revenue Cycle Management Services
Clarity shall provide medical billing and revenue cycle management services (“Billing Services”) as expressly set forth in the Agreement. Billing Services are administrative in nature and performed based solely upon information and documentation provided by Client.
3.1 Client Responsibilities
Client agrees to:
- Provide accurate, complete, and timely clinical documentation sufficient to support billed services and establish medical necessity where required;
- Ensure the accuracy of diagnosis codes, procedure codes, modifiers, units, and charge entries unless coding services are separately contracted in writing;
- Maintain compliant EHR and billing systems;
- Provide secure and timely access to systems and payer portals;
- Promptly forward all payer correspondence, audit notices, refund demands, or recoupment requests;
- Review reports provided by Clarity and notify Clarity of discrepancies.
Client retains sole responsibility for clinical documentation, medical necessity, coding accuracy (unless separately contracted), charge appropriateness, and regulatory compliance.
3.2 No Guarantee of Payment; Limitation of Responsibility
Submission of claims does not guarantee payment. Reimbursement is subject to factors beyond Clarity’s control, including:
- Payor policies and contractual terms;
- Medical necessity determinations;
- Member eligibility and benefit limitations;
- Coordination of benefits;
- Timely filing rules;
- Audits and post-payment reviews.
Clarity shall not be liable for denied claims, delayed payments, reduced reimbursements, recoupments, overpayment determinations, audits, civil monetary penalties, or other adverse actions, except to the extent directly caused by Clarity’s gross negligence or willful misconduct.
3.3 Regulatory Compliance
Client is solely responsible for compliance with all applicable healthcare laws and regulations, including but not limited to:
- Medicare and Medicaid laws and regulations;
- Commercial payor participation agreements;
- The Anti-Kickback Statute and Stark Law;
- The False Claims Act;
- HIPAA privacy and security regulations.
Nothing herein transfers legal or regulatory compliance obligations to Clarity.
4. Eligibility Verification and Prior Authorization Services
Clarity shall provide eligibility verification and prior authorization services (“Administrative Authorization Services”) as described in the Agreement. Eligibility information reflects payor disclosures at the time of inquiry and is subject to change. Prior authorization approvals are contingent upon payor review and may be modified or revoked. Eligibility verification and prior authorization do not guarantee reimbursement. Final payment determinations remain solely within the discretion of the payor. Clarity shall not be liable for denials, reductions, delays, recoupments, or adverse determinations resulting from coverage limitations, medical necessity decisions, or other payor-controlled factors.
5. Fees and Payment Terms
5.1 Payment
Invoices are due within thirty (30) calendar days of the invoice date.
5.2 Late Fees
A late fee equal to ten percent (10%) of the outstanding balance shall be assessed on invoices not paid within thirty (30) days. Client shall also be responsible for reasonable collection costs and attorneys’ fees.
5.3 Suspension
Clarity may suspend services for accounts more than thirty (30) days past due, upon written notice. Clarity shall not be liable for consequences arising from such suspension. Client’s obligation to pay survives termination of the Agreement.
6. No Guarantee of Outcome
Clarity provides administrative services only and does not control determinations made by payors or regulatory bodies. Clarity makes no representation or warranty regarding:
- Credentialing or enrollment approval;
- Participation status;
- Processing timelines;
- Reimbursement rates;
- Claim outcomes;
- Payment amounts or timeliness;
- Prevention of audits, recoupments, or sanctions.
All determinations are made exclusively by the applicable payor or regulatory authority. Client assumes all business risks associated with payor participation and reimbursement.
7. Limitation of Liability
To the fullest extent permitted by law, Clarity’s aggregate liability for any claim arising from the Services shall not exceed the total amount paid by Client for the specific service giving rise to the claim.
Clarity shall not be liable for indirect, incidental, consequential, special, exemplary, or punitive damages, including lost revenue, lost profits, business interruption, data loss, recoupments, or audit outcomes.
These limitations are an essential basis of the parties’ agreement and shall apply except where prohibited by law or in cases of gross negligence or willful misconduct.
8. Changes to Terms
Clarity reserves the right to modify these Terms upon sixty (60) days’ written notice. Continued use of Services after the effective date constitutes acceptance of the revised Terms.
Legal Disclaimer and No Attorney-Client Relationship
Clarity provides credentialing, payer enrollment, and revenue cycle management services in an administrative and consulting capacity only. Clarity is not a law firm and does not provide legal advice or representation. Nothing in this Agreement or in any communication from Clarity shall be construed as legal advice. No attorney-client relationship is formed. Client is solely responsible for obtaining independent legal counsel; reviewing payor contracts; and ensuring compliance with applicable laws and regulations. Clarity disclaims liability arising from Client’s reliance on information as legal advice, interpretation of laws, or legal consequences of business decisions. Clarity does not represent Client before any governmental agency, regulatory authority, payer, tribunal, or court. By engaging Clarity’s services, Client acknowledges and agrees to this Legal Disclaimer.