Terms of Service

1. SERVICES

ClaimGrade provides software tools that analyze clinical documentation for potential reimbursement risk, documentation completeness signals, and related analytics (the "Services").

The Services are provided solely as informational, analytical, and decision-support tools. The Services do not provide medical, legal, coding, billing, or reimbursement advice.

2. BETA STATUS AND AI LIMITATIONS

The Services are provided in beta / pre-release form.

You acknowledge and agree that:

• the Services may contain defects, errors, or inaccuracies;
• outputs may be incomplete, incorrect, misleading, or outdated;
• models and scoring logic are probabilistic and may evolve over time;
• results may vary across similar inputs; and
• historical outputs are not predictive of future outcomes.

You assume all risk arising from use of beta functionality.

3. NO ACCURACY GUARANTEE; NO RELIANCE

CLAIMGRADE MAKES NO REPRESENTATION, WARRANTY, OR GUARANTEE regarding the accuracy, completeness, correctness, reliability, or suitability of any output, score, flag, recommendation, or analysis generated by the Services.

You expressly acknowledge and agree that:

• ClaimGrade does not guarantee accuracy or completeness;
• ClaimGrade does not verify source documentation;
• ClaimGrade does not ensure compliance with payer, regulatory, or legal requirements; and
• any reliance on the Services is solely at your own risk.

4. NO MEDICAL, LEGAL, OR BILLING ADVICE

The Services do not constitute:

• medical advice;
• legal advice; or
• billing, coding, or reimbursement advice.

ClaimGrade does not practice medicine, law, or medical billing, and does not replace professional clinical, legal, compliance, or billing judgment.

5. AUDITS, DENIALS, AND ENFORCEMENT

You acknowledge and agree that:

• you remain solely responsible for the accuracy, completeness, and compliance of all clinical documentation, coding, and submissions;
• ClaimGrade has no control over payer audits, determinations, or enforcement actions; and
• ClaimGrade assumes no responsibility or liability for insurance audits, reimbursement denials, recoupments or clawbacks, fines, penalties, or sanctions, government or private enforcement actions, or any outcomes arising from documentation submitted to payers.

This applies regardless of whether ClaimGrade outputs were reviewed, followed, ignored, or partially used.

6. CUSTOMER RESPONSIBILITIES

You are solely responsible for:

• reviewing and validating all documentation and submissions;
• complying with applicable laws, regulations, and payer requirements;
• ensuring appropriate professional review prior to submission; and
• determining whether and how to use any output generated by the Services.

7. ACCEPTABLE USE

You shall not:

• use the Services for unlawful purposes;
• rely on the Services as a sole basis for clinical or billing decisions;
• reverse engineer or attempt to extract models or logic;
• use outputs to train third-party models; or
• misuse or misrepresent ClaimGrade outputs.

8. HIPAA AND DATA

To the extent ClaimGrade acts as a Business Associate, use of the Services is governed by the applicable Business Associate Agreement ("BAA"), which is incorporated by reference.

In the event of a conflict between these Terms and the BAA regarding PHI, the BAA controls.

9. SUSPENSION AND TERMINATION

ClaimGrade may immediately suspend or terminate access to the Services if we reasonably determine that:

• continued access poses a security or compliance risk;
• use violates these Terms or the BAA; or
• suspension is necessary to protect data or systems.

10. DISCLAIMER OF WARRANTIES

THE SERVICES ARE PROVIDED "AS IS" AND "AS AVAILABLE."

CLAIMGRADE DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, ACCURACY, AND NON-INFRINGEMENT.

11. LIMITATION OF LIABILITY

TO THE MAXIMUM EXTENT PERMITTED BY LAW:

• CLAIMGRADE SHALL NOT BE LIABLE FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR PUNITIVE DAMAGES, INCLUDING LOST REVENUE, LOST PROFITS, DENIALS, AUDITS, OR PENALTIES.
• CLAIMGRADE'S TOTAL AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THE SERVICES SHALL NOT EXCEED THE FEES PAID BY YOU TO CLAIMGRADE IN THE TWELVE (12) MONTHS PRECEDING THE EVENT GIVING RISE TO THE CLAIM.

12. INDEMNIFICATION

You agree to indemnify and hold harmless ClaimGrade from and against claims arising from:

• your use of the Services;
• your documentation or submissions; or
• your violation of law or payer requirements.

13. GOVERNING LAW AND VENUE

These Terms are governed by the laws of the State of Texas.

Venue lies exclusively in the state or federal courts located in Travis County, Texas.

14. MISCELLANEOUS

These Terms constitute the entire agreement regarding use of the Services.

If any provision is unenforceable, the remainder will remain in effect.

ClaimGrade may update these Terms with notice.