Terms of Service

Agreement and authority

These Terms of Service form an agreement between SimpliClaim and the organization that creates or uses a SimpliClaim account (the "Customer"). The person accepting these Terms confirms that they are authorized to bind the Customer and to establish the first administrator account.

An applicable checkout, order form, Business Associate Agreement (BAA), or other signed agreement may add to these Terms. If documents conflict, a signed BAA controls for protected health information, an order form controls for pricing and plan details, and these Terms control for general use of the service.

The SimpliClaim service

SimpliClaim provides healthcare scheduling, patient and provider directories, eligibility workflows, claim preparation, clearinghouse transport, claim-status tools, remittance processing, reporting, automation, and support features. Features vary by subscription plan, configuration, payer, and connected service.

SimpliClaim is an administrative and claims-operations platform. It does not provide medical care, medical advice, legal advice, or a guarantee that a payer will accept or pay a claim.

Accounts and authorized users

Customers must provide accurate organization, billing, and administrator information. Each user must have an individual account and must protect their credentials, devices, and active sessions. Shared logins are not allowed.

Customer administrators are responsible for assigning appropriate roles, reviewing access, promptly removing users who no longer need access, and notifying SimpliClaim of suspected unauthorized access or compromised credentials.

Customer data and permissions

The Customer retains its rights in the information it submits or directs SimpliClaim to process. The Customer gives SimpliClaim permission to host, process, transmit, reproduce, and display that information only as needed to provide, secure, support, and maintain the service, comply with law, and follow the Customer's authorized instructions.

The Customer is responsible for the accuracy, legality, and completeness of organization, patient, provider, payer, appointment, claim, payment, and document data, and for providing required notices and obtaining required authorizations or consents before entering or transmitting that data.

Claims, eligibility, and AI assistance

The Customer must review payer routing, coverage information, provider identifiers, coding, charges, dates of service, attachments, and generated transactions before relying on or submitting them. Payer directories, validation messages, confidence scores, suggestions, and automation can be incomplete or become outdated.

AI-assisted and automated features provide decision support. They must not be used as the sole basis for clinical, coverage, legal, or financial decisions. The Customer remains responsible for final review and submission.

HIPAA and protected health information

When SimpliClaim creates, receives, maintains, or transmits protected health information on behalf of a covered entity or business associate, the parties must have an applicable written BAA in effect before production PHI is used. The BAA, not this public page alone, defines permitted uses and disclosures, safeguards, incident cooperation, subcontractor obligations, and return or destruction requirements.

Customers remain responsible for their own HIPAA obligations, including workforce training, minimum-necessary use, access controls, patient notices, authorizations, and lawful disclosures.

Subscription, usage, renewal, and cancellation

The plan, base monthly price, billing interval, included features or claim allowance, usage rates, and payment method shown at checkout, on the pricing page, or in an order form are part of the agreement. Usage is measured within the Customer's Stripe subscription billing cycle. Graduated rates apply only to usage within each listed band and are not retroactively applied to all usage in the cycle.

For Starter, a transmitted claim is one production outbound 837 claim successfully transmitted through the configured SFTP workflow. For Pro and Premium, an accepted claim is one production claim accepted by an authoritative, exactly matched 277CA response. Drafts, saves, previews, validation attempts, local spooling, failed SFTP uploads, technical retries, duplicate clicks, 999 acknowledgments, 835 files, ordinary 277 status responses, ambiguous or unmatched responses, and accepted-with-errors responses are not billable usage. An intentional corrected, replacement, or void claim counts when it independently meets the applicable billable-event definition.

Portal usage amounts may be estimates until an invoice is finalized. The Customer authorizes SimpliClaim and its payment processor to charge recurring fees, applicable usage, taxes, and approved add-ons. High-volume activity does not stop claim transmission; SimpliClaim may contact the Customer about Enterprise pricing while the highest published band continues unless a written agreement states otherwise. Billing questions or disputes should be sent promptly to support@simpliclaim.com. Valid corrections are recorded as credits, adjustments, or reversals.

The Customer may stop the next renewal through available billing controls or by contacting support before the next billing date. Cancellation normally takes effect at the end of the current paid billing cycle, and applicable usage through that effective date may be included in the final invoice. Amounts already paid are nonrefundable except where required by law or agreed in writing. SimpliClaim will provide advance notice before a material price change applies to a future renewal.

Acceptable use

Customers and users may not:

• access data or organizations they are not authorized to access;
• submit false, fraudulent, unlawful, or unauthorized healthcare transactions;
• upload malware, probe security controls, disrupt the service, or evade access limits;
• sell, sublicense, reverse engineer, or misuse the platform except where applicable law permits; or
• use the service in a way that violates privacy, healthcare, communications, export, or other applicable law.

Connected services and communications

SimpliClaim may connect to payment processors, cloud providers, email and messaging services, clearinghouses, payer systems, SFTP mailboxes, and other services selected or authorized by the Customer. Those services may have their own terms, availability, and technical requirements. SimpliClaim is not responsible for a third party's independent acts, outages, or data outside SimpliClaim's control.

When a patient or authorized contact separately opts in, SimpliClaim may send non-marketing appointment reminders and scheduling messages. Message frequency varies. Message and data rates may apply. Consent is not a condition of treatment or purchase. Reply STOP to opt out or HELP for help.

Availability, support, and service changes

SimpliClaim works to keep the service available and secure, but maintenance, internet failures, connected-service outages, emergencies, and events outside reasonable control can interrupt access. Support level and response targets depend on the Customer's plan or written agreement.

SimpliClaim may improve, replace, or retire features. Material changes that significantly reduce paid functionality will be communicated through the portal, email, or another configured contact channel when reasonably practicable.

Suspension, termination, and data

SimpliClaim may restrict or suspend access when needed to protect customers or the service, respond to a security or legal issue, address nonpayment, or stop a material violation. When circumstances allow, SimpliClaim will provide notice and a reasonable opportunity to cure.

After cancellation or termination, Customer access may end. Data export, retention, deletion, and PHI handling are governed by the applicable plan, written agreement, BAA, legal obligations, backup cycles, and the Privacy Policy. Customers should export records they are required to retain before access ends.

Ownership and important limits

SimpliClaim and its licensors retain rights in the platform, software, designs, documentation, and service content. Subject to these Terms and payment of applicable fees, the Customer receives a limited, nonexclusive, nontransferable right to use the service during the subscription term.

The service and its guidance are provided without a guarantee of uninterrupted operation, error-free output, payer acceptance, reimbursement, or a particular business result. Any negotiated warranties, liability limits, indemnification duties, governing law, or dispute terms in a signed order form or master agreement control over this paragraph.

Changes to these Terms

SimpliClaim may update these Terms as the service or applicable requirements change. The version and effective date identify the applicable text. Material changes will be communicated through reasonable account, portal, or email notice before they take effect when required.

Continued use after an updated version takes effect constitutes acceptance only to the extent permitted by law and the Customer's other signed agreements. When affirmative acceptance is required, SimpliClaim will request it in the portal and preserve an audit record.