Terms of Service for Claimeye Mobile Application
This Terms of Service Agreement (“Agreement”) is entered as of the date on which the User first applies for and/or uses the ClaimEye Mobile Application (as defined below “Effective Date”) by and between NETVITA, LLC and its affiliates (“ClaimEye”) and User (“User”). These Terms of Service may change. The most current version of the Terms of Service shall always be available via the ClaimEye Mobile Application and Website (https://www.claimeye.com/terms-of-use.html). You agree to review these Terms of Service each instance you use the application.
BY SIGNING YOUR NAME, YOU AGREE THAT WE WILL USE YOUR SIGNATURE TO FACILITATE THE PRODUCTS AND SERVICES WE PERFORM ON YOUR BEHALF INCLUDING, BUT NOT LIMITED TO, EXCHANGING YOUR PERSONAL INFORMATION, FINANCIAL INFORMATION, AND/OR PROTECTED HEALTH INFORMATION (DEFINED BELOW) WITH YOUR HEALTH PLANS, HEALTHCARE PROVIDERS, AND OTHERS INVOLVED IN YOUR MEDICAL TREATMENT, REIMBURSEMENT, AND HEALTH CARE OPERATIONS.
BY SIGNING YOUR NAME, YOU ALSO AGREE THAT WE WILL COMMUNICATE WITH YOU AND OTHERS ON YOUR BEHALF, INCLUDING EXCHANGING AND TRANSMITTING YOUR PERSONAL INFORMATION, FINANCIAL INFORMATION, AND/OR PROTECTED HEALTH INFORMATION (DEFINED BELOW) AND PROVIDING YOU WITH INFORMATION ABOUT CLAIMEYE’S PRODUCTS AND SERVICES, VIA EMAIL, ELECTRONIC FACSIMILE, AND OTHER MODES OF COMMUNICATION.
WHEREAS, ClaimEye, a registered trademark of NETVITA, LLC enables patients, providers and payers in exchanging information transactions in the realm of out of network medical expenses claims and tracks its processing and payment. ClaimEye believes that the collaboration of the three can accomplish the same assurance as in-network services. At the core of ClaimEye is the simplification of the claim documentation process which varies from health plan to health plan.
WHEREAS, User wants to access and use the ClaimEye application under the Terms of Service outlined in this Agreement to make reimbursement claim process to their health care plan easier and faster. NOW, THEREFORE, in consideration of the mutual covenants and agreements hereinafter set forth, and other good and valuable consideration, User and ClaimEye agree to the foregoing and as follows:
Terms and Conditions
- ClaimEye Obligations:
- ClaimEye License Grant. NETVITA, LLC hereby grants User a limited, revocable, non-exclusive, non-transferable right to use ClaimEye described in these Terms of Service obtained by User (Authorized User) in accordance with this Agreement for the period ending on the earlier of (i) the termination of this Agreement, or (ii) the expiration of any extended term applicable subject to the terms of this Agreement. User grants ClaimEye the non-exclusive, worldwide, right to use, copy, store, transmit and display the User Data to the maximum extent permitted by applicable law.
- Password. ClaimEye is password restricted to authorized users only and can only be accessed with the login account and password the User decided to use at the beginning of the registering process. The User is responsible for keeping the password confidential. The User hereby takes responsibility for all actions taken—and instructions provided to ClaimEye—under the User’s account or any third parties, whether or not authorized.
- Services. ClaimEye shall perform the submittal of the claim and tracks the processing and payment of User’s claim, but not limited to, sending electronic or telephonic notices to shorten adjudication from the health plan, programming or other services for Users within the configuration period. Additionally, ClaimEye may contact your health plan through other means to ensure a response or adjudication of the claim.
- HOWEVER, CLAIMEYE DOES NOT ASSURE, PROMISE OR SECURE PAYMENT OR CLAIM PROCESSING BY THE HEALTHCARE INSURANCE PROVIDER TO THE USER. CLAIMEYE IS NOT LIABLE FOR ANY ACTS OR LACK THEREOF FROM THE HEALTH PLAN’S FULFILMENT OF THE REIMBURSEMENT AND DOES NOT GUARANTEE REIMBURSEMENT IN OTHER OR ANY WAY.
- Delivery. ClaimEye is delivered solely by online means, over the digital or the World Wide Web which is a system of Internet servers that supports specially formatted documents. User of the application uses it at their own risk. When accessing ClaimEye, User is responsible for the proper functioning of their connection to the web and telephone service or signal.
- Configuration. The basic configuration of the application shall be the sole responsibility of ClaimEye. User is solely responsible for providing an environment corresponding to the application specifications, and that is otherwise suitable for the configuration and operation. Without limiting the generality of the foregoing, the application or software selected by User shall be ideal as to the availability of electrical power, cables, connectivity devices, Internet services and hardware. Software and supplies not included with the services but requires for its configuration, operation or use.
- User Obligations:
- User Requirements. The User registering to use ClaimEye must be of Minimum Age (as defined below) or older. User will only have one account for him and their eligible dependents. The account must be in the User’s real name; and User is not already restricted from using ClaimEye.
“Minimum Age” means eighteen (18) years old for the United States and its Territories. However, if law requires that User must be older for ClaimEye to lawfully provide the Services to the User (including collection, storage and use of User information) the Minimum Age is such older age. ClaimEye is not intended for- and we do not direct it to- anyone less than thirteen (13) years.
“Dependents” means someone who is sustained by another person, for health care plans generally includes all of those people whom the insured person is under a legal duty to support or care, such as a spouse and minor children.
- Account. To access and use the ClaimEye application, a ClaimEye account must be created first. The User can apply for a ClaimEye account by creating or submitting User’s necessary information and health insurance provider details on ClaimEye’s “Sign Up”, “Register”, “Create an Account”. User will create a password only known to them or authorized third party. It is the Users responsibility to keep this information secret. If for any reason the password is lost, forgotten or if any unauthorized use of any password or account or any security violations occur, the User must contact ClaimEye immediately at firstname.lastname@example.org; to either (i) reset the password, (ii) deactivate the account and prevent fraud and other illegal activity, or (iii) proceed with any reasonable efforts to detain any reproduction or distribution of the content.
- Acceptance. By installing, copying, accessing or otherwise using ClaimEye, User agrees to be bound by the terms and conditions of this Agreement. If User does not agree to these terms of service, do not install, copy, access or use the ClaimEye Application. The User agrees to give ClaimEye an express, specific and limited power to act on behalf of the User and or in the rights of the User to make a claim to the Health Plan and collect the reimbursement, as the case may be based on the services requested by User. ClaimEye is not authorized to edit, modify, or remove information or data given by the User to effectively submit the claim unless express written consent of the User. ClaimEye is only responsible for the processing of the claim, but not for the timely submission due to force majeure situations such as, but not limited to, electrical and Internet outages, software downtime or failure from the health plan on processing the claim and provide timely reimbursement. ClaimEye works based on information entered by the User and, as represented by User, presumes it to be accurate, current and legal. However, ClaimEye is not liable for any misinformation or lack thereof, nor is ClaimEye responsible for the acts the User performed when submitting the information and or any illegal activities or intentions the User may have or had, or have committed when filing the claim to get fraudulent compensation.
- Information. The User promises to provide information and data that is true, accurate, complete, correct, current and legal and will not encourage or use ClaimEye for illegal, fraudulent and/or unauthorized actions, such as but not limited to unauthorized claims or infringements of intellectual property and privacy in violation of applicable law, rule, regulation, judicial or government order or give rise to civil liability or violate or infringe intellectual property, proprietary, privacy, patent, trade secret, copyright, moral, publicity or other rights of any person or entity. User assumes all responsibility deriving from any errors or inaccuracies and is solely responsible for any consequences deriving from those errors, mistakes, and any acts while using the ClaimEye application. The User also gives ClaimEye express consent through the acceptance of this Terms of Service to sell analysis base or intelligence base information according to the User’s usage of the services to eventually sell to affiliates and contracting companies such as Health Plans. This information will not identify the Users by name or any other identifiable way.
- User Requirements. The User registering to use ClaimEye must be of Minimum Age (as defined below) or older. User will only have one account for him and their eligible dependents. The account must be in the User’s real name; and User is not already restricted from using ClaimEye.
- User Rights.
- User shall only access ClaimEye through a mobile device where the ClaimEye application is legally installed.
- User may use ClaimEye licensed hereunder only for User and its eligible dependents.
- User can opt-out of some notification notices such as push notifications. However, User cannot opt out of email communications since it is the method which ClaimEye and User or User and health plan use to communicate.
- User Limitations.
- User shall not use ClaimEye to perform any data or information processing services for any third party in return for a fee or other pecuniary benefit of any kind.
- User shall not copy ClaimEye for any reason or commercially exploit ClaimEye or create Internet “links” to or “frame” any content contained in, or accessible from, the services on any other server, wireless or Internet-based device.
- User shall not re-license, sublicense, sell, resell, assign, give access, make available or otherwise transfer or distribute to any other person all or any part of ClaimEye, or any right, title or interest therein of any kind.
- User agrees not to modify, reverse engineer, disassemble, decompile, make derivative works or access ClaimEye to build a competitive service or build a product using or copying similar ideas, features, functions or graphics based on ClaimEye, or any portion thereof.
- User is solely responsible for the precision, quality, integrity, legality, reliability, and adequacy of the content supplied. User is responsible for any and all activities that occur under User’s account and shall abide by all applicable local, state, national and foreign laws, treaties and regulations in connection with the use of the ClaimEye. User shall assure that use of the application shall at all times comply with all applicable local, state, federal, and international laws, regulations, and conventions, including without limitation to those related to data privacy, global communications, and Protected Health Information.
- User acknowledges and agrees that it obtains no right, title or interest in or any ClaimEye copyright, trademark, patent, or other proprietary right relating to ClaimEye, and agrees not to assign, loan, sublicense, alter, modify, adapt, reproduce, duplicate, copy, sell, trade, resell or exploit for commercial purposes, all or any portion of ClaimEye. User shall not remove, alter, cover or obscure any copyright, patent, trademark or other proprietary rights notice on ClaimEye or any portion thereof.
- THE USER IS IN THE OBLIGATION NOT PRETEND TO BE OR TAKE THE IDENTITY OF ANOTHER USER OR CUSTOMER OF CLAIMEYE OR PROVIDE INFORMATION OF THE FALSE IDENTITY TO GAIN ACCESS TO THE SERVICES.
- Fees & Payment Fees. User shall pay ClaimEye for the use of the service in the following specified rates depending on the service requested. ClaimEye will charge:
- Claim Based: A fee of nine dollars and ninety-nine cents ($9.99) per claim submitted on claims where total amount is below one thousand dollars ($1,000.00); or
- Session Based: A fee of forty-nine dollars with ninety-nine cents ($49.99) on a monthly basis (30 days) for unlimited claim submittals. A year basis (365 days) option is also available for a fee of ninety-nine dollars with ninety-nine cents ($99.99) for unlimited claim submittals.These payments are to be charged automatically through the User’s preferred credit card, using third-party payment processors or gateways. The User can choose to save this credit card information for recurring billing, or the User can re-enter the data in the future by not keeping it.
Payment Authorization. User gives ClaimEye, and its representatives express authorization to charge their credit card for the purpose detailed above. User understands that this form constitutes a legally binding contract and that by affixing its signature to the Agreement, User will be held responsible for all agreed upon (as stated above) charges as well as any and all collection and legal fees. The authorization given hereby is for the sole purpose of this Agreement.
Tax. The User is responsible for the tax payments to be done for processing, submittal, collection, payment and final reimbursement.
- Additional Provisions
Intellectual Property. NETVITA, LLC is the authorized licensee of products and services, including but not limited to: (i) service codes and documentation, (ii) manuals or user information, (iii) the design and format of the input and output screens, (iv) graphical user interface, and printable form, reports and other hard copy output incorporated in or generated by ClaimEye, (v) and all additions, enhancements, revisions, updates, customizations or other modifications to the Services or any part thereof are owned and control by NETVITA, LLC., its licensor or other providers of such material and are protected by the United States and international copyright, trademark, patent, trade secret and other intellectual property or proprietary rights laws. User shall not cause or permit removal or alteration in any way of any notice, legend or symbol denoting any copyright, trademark, patent or other proprietary right or interest of the Intellectual Property owner appearing on any input or output screen or hard copy output incorporated in or generated by ClaimEye, or any documentation, manuals, brochures, or other written or printed material of any kind related to the ClaimEye.Without limiting the foregoing, copying or reproduction of ClaimEye to any other server or location for any purpose including but not limited to further reproduction, is expressly prohibited. ClaimEye is warranted, if at all, only by the terms of the License Agreement. EXCEPT AS WARRANTED IN THE APPLICABLE LICENSE AGREEMENT FOR THAT SOFTWARE, NETVITA, LLC HEREBY DISCLAIMS ALL WARRANTIES AND CONDITIONS, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION, IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE AND NON-INFRINGEMENT. User acknowledges that ClaimEye application available or provided to you may contain technology that is subject to strict controls by various agencies of the United States Government according to the United States export control laws and regulations and this Agreement. User hereby agrees that they will not transfer or export such software from the United States or re-export such services outside the United States in violation of United States export laws and regulations. NETVITA, LLC does not authorize the downloading or exportation of any software or technical data from ClaimEye to any jurisdiction prohibited by the United States export control laws and regulations.
Licensing. ClaimEye is a registered trademark product of NETVITA, LLC, and is a license not sold to the User. The User may utilize ClaimEye only as permitted by these Terms. The User may not, and will not allow any other party to (i)modify, adapt, alter, translate or create derivative works of the Applications; (ii) use or merge the Application, or any component or element thereof, with other software, databases or services not provided by ClaimEye; (iii) sublicense, distribute, sell or otherwise transfer the Application to any third party; (iv) use the Application as a service bureau, or lease, rent or loan the Application to any third party; (v) reverse engineer, decompile, disassemble or otherwise attempt to derive the source code or structure of the Application; (vi) interfere in any manner with the operation of the Application; (vii) circumvent, or attempt to circumvent, any electronic protection measures in place to regulate or control access to the Application; (viii) create a database by systematically downloading and storing the Application; (ix) use any robot, spider, site search/retrieval application or other manual or automatic device to retrieve, index, “scrape,” “data mine” or in any way gather the Application or reproduce or circumvent the navigational structure or presentation of the Applications without our express prior written consent; or (x) use the Application for any commercial purposes. The User agrees not to develop, distribute or sell any software or other functionality capable of launching, being launched from or otherwise integrated with the Application. User may not remove, alter or obscure any copyright notice or any other proprietary notice that appears on or in the Application.
Internet Sites. Regarding ClaimEye, the mobile application and site may contain links to other Internet Sites. Links to and from Site to other third-party sites do not constitute an endorsement by ClaimEye or any of its Affiliates of such third-party sites, an acceptance of responsibility for the content on such sites or any data transfer to such sites. In the event that User requests that ClaimEye provides any User Data to any third party or any non-U.S. user location, User represents that it has acquired consent or provided notices required to transfer such content or information and that such transfer does not violate any applicable international, federal, state or local laws and/or regulations.
Third Party Providers. We work with third-party providers to help us operate, provide, improve, understand, customize, support and market our services. When we share information with third party providers, we require them to use your information in accordance with our instructions and terms or with express permission from you.
Term and Termination. This Agreement shall commence upon the Effective Date and continue until terminated as provided below. This Agreement shall terminate upon the first to occur of the following: (1) in the case of a breach of this Agreement, ClaimEye reserves the right to suspend or terminate User’s use of or access to the Application if User fails to comply with these Terms of Service. Such suspension or termination may result in the permanent deletion of User’s information or other previously available content upon written Notice to the User in breach; (2) the User may terminate at their sole discretion (for any or no reason whatsoever) the use of the ClaimEye upon written Notice and following the account deletion process. Termination of the service will not alter obligation to pay all charges pending in the User billing account.
Refunds and Cancellations. User has until forty-eight hours (48) after purchase ClaimEye to request a full refund for its purchase (“Refund Period”). After the Refund Period, ClaimEye has no obligation to refund or return monies to User and there is no refund or cancellation option.
Dispute Resolutions. The Parties agree that in case of any differences, disputes or alleged breach relating to these Terms of Service they will not resort to automatic legal court procedures and will, within a reasonable time, use an agreed alternative dispute resolution technique before resorting to litigation. This is not applicable in case of a breach due to fraud, in which case a Party will be free to seek available remedies.
Choice of Venue. The Parties agree that any action or proceeding arising out of or related to this Agreement shall be instituted only in the first instance court in the city of San Juan of the Commonwealth of Puerto Rico. Each Party consents and submits to the jurisdiction of such court and agrees that venue therein shall be proper and convenient. In any such action or proceeding in such court, each Party waives any right to raise any objection based upon improper venue, lack of jurisdiction or inconvenient forum.
Choice of Law. In connection with any such action or proceeding, each Party consent to personal jurisdiction of such court and agrees service of process may be affected by United States mail. This Agreement shall govern by and construed in accordance with the laws of the Commonwealth of Puerto Rico.
Rights Reserved. ClaimEye reserves the right to modify this Agreement at any time, without the need of User’s consent or formal manifestation of consent and will notify the User of said modification prominently. User’s continued use of the ClaimEye will mean acceptance to the new Terms of Service. Changes to this Agreement will become effective immediately upon posting and shall supersede all prior versions of the Terms of Service unless otherwise noted.
Limitation of Actions. Except as set forth in this Agreement, neither Party shall bring any action or institute any proceeding related, directly or indirectly, to this Agreement more than one year after the Party initiating the action or proceeding knew (or reasonably should have known) of the essential facts giving rise to underlying cause of action.
RELEASE. BECAUSE CLAIMEYE IS NOT INVOLVED IN THE RENDERING OF MEDICAL ADVICE, IN THE EVENT THAT YOU HAVE A DISPUTE WITH ANY INDIVIDUAL AND/OR ENTITY THAT ARISES OUT USER’S USE OF CLAIMEYE, USER RELEASES CLAIMEYE (AND CLAIMEYE’S AFFILIATES, OFFICERS, DIRECTORS, AGENTS, SUBSIDIARIES AND EMPLOYEES) FROM CLAIMS, DEMANDS AND DAMAGES (ACTUAL AND CONSEQUENTIAL) OF EVERY KIND AND NATURE, KNOWN AND UNKNOWN, SUSPECTED AND UNSUSPECTED, DISCLOSED AND UNDISCLOSED, ARISING OUT OF OR IN ANY WAY CONNECTED WITH SUCH DISPUTES. IF USER IS A CALIFORNIA RESIDENT, YOU WAIVE CALIFORNIA CIVIL CODE §1542, WHICH SAYS: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.”
NO LIABILITY. IN NO EVENT WILL CLAIMEYE OR ITS AFFILIATES BE LIABLE TO ANY PARTY FOR ANY DIRECT, INDIRECT, SPECIAL OR OTHER CONSEQUENTIAL DAMAGES ARISING OUT OF ANY USE OF THE APPLICATION, OR ANY OTHER HYPER-LINKED WEBSITE OR SOFTWARE APPLICATION (INCLUDING MOBILE APPLICATIONS), INCLUDING, WITHOUT LIMITATION, ANY LOST PROFITS, BUSINESS INTERRUPTION, LOSS OF PROGRAMS OR DATA ON THE USER’S EQUIPMENT, OR OTHERWISE, EVEN IF CLAIMEYE IS EXPRESSLY ADVISED OF THE POSSIBILITY OR LIKELIHOOD OF SUCH DAMAGES.
LIMITATION OF DAMAGES. IF, NOTWITHSTANDING THE PROVISIONS OF THIS AGREEMENT TO THE CONTRARY, A COURT OF COMPETENT JURISDICTION OR ARBITRATOR PANEL DETERMINES THAT USER IS ENTITLED TO DAMAGES IN RESPECT OF ANY CLAIM BY USER ARISING UNDER THIS AGREEMENT, LIMIT TO TWELVE (12) MONTHS PRIOR TO THE FACT, THE TOTAL AMOUNT OF SUCH DAMAGES SHALL BE LIMITED TO AS FOLLOWS: (1) IF SUCH DAMAGES ARE IN RESPECT TO THE PERFORMANCE OR NONPERFORMANCE OF ANY SERVICES, THE AMOUNT OF SUCH DAMAGES SHALL NOT EXCEED THE AGGREGATE AMOUNT OF ALL CHARGES IN RESPECT OF SUCH SERVICES THAT (PRIOR TO THE DATE AS OF WHICH THE DAMAGES ARE DETERMINED) WERE PAID BY THE USER TO CLAIMEYE AFFILIATES; OR (2) IF SUCH DAMAGES ARE IN RESPECT TO ANY OTHER BREACH TO THIS AGREEMENT BY CLAIMEYE OR ITS AFFILIATES (OTHER THAN BREACH OF WARRANTY OF NON-INFRINGEMENT), THE AMOUNT OF SUCH DAMAGES SHALL NOT EXCEED THE AGGREGATE AMOUNT OF ALL CHARGES WHICH, PRIOR TO THE DATE AS OF WHICH SUCH DAMAGES ARE DETERMINED, WERE PAID BY USER TO CLAIMEYE OR ITS AFFILIATES IN RESPECT OF THIS AGREEMENT. UNDER NO CIRCUMSTANCES SHALL CLAIMEYE, OR ITS AFFILIATES HAVE ANY LIABILITY FOR CONSEQUENTIAL DAMAGES, INCLUDING, BUT WITHOUT LIMITATION TO PUNITIVE DAMAGES, EXEMPLARY DAMAGES, OR OTHER SPECIAL DAMAGES OF ANY KIND.
Indemnification. Except as expressly provided in this Terms of Service, User agrees to indemnify, defend and hold harmless ClaimEye and its Affiliates, and their respective shareholders, directors, officers, employees, agents and other representatives from and against any damages, loss expense or other liability arising, directly or indirectly, from: (1) any claim by any Person other than the User involving or related to any development or use of any Service by User (regardless of any flaw or defect of any kind in the Service, and regardless of any wrongful act or omission or other fault attributable to any of the above named indemnities), or (2) any breach of any User obligations under the Agreement.
Warranties & Disclaimer.
- The NETVITA, LLC, Its Affiliates do not represent or warrant that the services will be error-free or uninterrupted; that defect will be corrected; or that the service or the server that makes the service available is free from any harmful component, including, without limitation, viruses. Claimeye or its affiliates do not make any representations or warranties that the information (including any instructions) on the services is accurate, complete or useful. User acknowledges that the use of the service is lawful in any particular jurisdiction, and the NETVITA, LLC, or its affiliates specifically disclaim such warranties, some jurisdictions limit or do not allow the disclaimer of implied or other warranties so the above disclaimer may not apply to the User to the extent such jurisdiction’s law is applicable to the User and these Terms of Service. By accessing or using the service, the User represents and warrants that the activities the User does are lawful in every jurisdiction where the User access or use the service.
- The service, including, without limitation, Claimeye content, is provided on an “As Is”, “As Available” and “With All Faults” basis. To the fullest extent permissible by law. Neither NETVITA, LLC. nor any of their employees, managers, officers, agents or affiliates make any representations or warranties or endorsements of any kind whatsoever, express or implied. In addition, NETVITA, LLC, their employees, managers, officers, agents or affiliates hereby disclaim all warranties, express or implied, including, but not limited to, the warranties of merchantability, fitness for a particular purpose, non-infringement, data Integrity, title, custom, trade, uninterrupted service and freedom from computer virus.
- CPT ® only © 2016 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and or related component are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT® is a registered trademark of the American Medical Association. The responsibility for the content of any “National Correct Coding Policy” included in this product is with the Centers for Medicare and Medicaid Services, and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product.
Network Adequacy Disclosure. The Centers for Medicare and Medicaid Services (CMS) finalized several changes to the network adequacy standards according to 45 CFR 156.230 and review process that an issuer must meet to be certified as a qualified health plan (QHP). CMS will rely on state reviews for network adequacy in states in which a federally facilitated exchange is operating, so long as the state has the authority and its standard is at least equal to the current federal “reasonable access standard.” In states that do not have the authority or means to conduct sufficient network adequacy reviews, CMS will rely on an issuer’s accreditation from one of the three CMS-recognized accreditation entities to validate network adequacy: the National Committee for Quality Assurance, URAC, and Accreditation Association for Ambulatory Health Care. Unaccredited issuers must submit a plan consistent with the National Association of Insurance Commissioners’ Health Benefit Plan Network Access and Adequacy Model Act. ClaimEye is not responsible for compliance with these standards or laws.
Severability. Information collected before changes are made will be secured according to the previous policies. If any of these conditions shall be deemed invalid, void, or for any reason unenforceable, that condition shall be deemed severable and shall not affect the validity and enforceability of the Agreement.
Geographic Limitations. We provide the application for use only by persons located within the United States. We make no claims that the application or any content available therein is accessible, appropriate, or lawful outside of the United States. Access to the application may not be legal by certain persons or in certain countries. If you access the application from outside the United States, you do so on your initiative and are responsible for compliance with local laws. Use of our application is void where prohibited.
- “Agreement” means these Terms of Service.
- “Affiliates” means a corporation that is related to another corporation by one owning shares of the other, by common ownership, or by other means of control.
- “Ancillary Document” means any document involving a transaction between ClaimEye and the User that becomes effective hereof. Such documents may include invoices and confirmations.
- “Application” means any software services installed in a mobile cellular device, being direct or derived and provided by ClaimEye.
- “Cardholder Data” means the full Primary Account Number along with cardholder name, expiration date and service/security code.
- “Claim” means demand or request for something, in this case, reimbursement of money paid for covered health care services by the User’s health insurance policy.
- “ClaimEye” means the solution provided by NETVITA, LLC, through ClaimEye on the downloadable mobile application to construct and submit online claims to receive reimbursement from the User’s healthcare insurance provider.
- “Document or Documents” means a piece of written, printed, or electronic matter that provides information or evidence or that serves as an official record.
- “Dependents” means someone who is sustained by another person, the term legal dependent generally includes all of those people whom the insured person is under a legal duty to support, such as a spouse and minor children.
- “Force Majeure” means any cause or circumstance beyond the parties control, such as, but not limited to, acts of God, changes in government regulations, acts of governmental bodies or their employees or agents, weather, strikes, lockouts, boycotts, and inability to secure labor or any material specified or reasonably necessary in connection with property through ordinary business channels, fire, unusual delays, etc.)
- “Hardware” means computer-related tangible personal property such as computers, monitors, terminals, storage devices, connectivity devices, printers, mobile, phones, tablets, etc.
- “Health Care Provider” means a physician, hospital, critical access hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, hospice program, inpatient hospital service, or a fund.
- “Health Plan” means any plan or organized format for delivery of healthcare services – e.g. HMO, indemnity, Medigap, self-insured plans, PPO or POS.
- “In-Network Copayment” means a fixed amount the User pay for covered health care services to providers who contract with your health insurance or plan.
- “Information” means any and all physical and digital material, including, but not limited to documents, photography, digital photocopy, User Data, Software etc.
- “Insurance” means coverage providing compensation for medical expenses.
- “License” means the right to access and use the ClaimEye granted under the Terms of Service in this Agreement to Authorized Users.
- “Out of Network Service Receipt” means an invoice from a health care provider to the User that the User sends to their Health Plan.
- “Out of Network Health Care Service Provider” means a health care service provider that does not contract with User’s health insurance or plan.
- “Party” in plural “Parties” mean either ClaimEye employees, managers, officers, agents or affiliates or User and Users.
- “Period” means the calendar period (monthly, quarterly or annually) corresponding to the frequency of payments in respect of a recurring charge.
- “Person” means a natural person or a private or government entity of any kind.
- “PHI” means Protected Health Information such as, but not limited to, any patient information, including very basic information such as their name or address, that (1) relates to the past, present, or future physical or mental health or condition of an individual, the provisions of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and (2) either identifies the individual or could reasonably be used to identify the individual; the definition according to CFR 160.103.
- “Service” means the software services, including any application programming interface that accesses functionality, that is provided through ClaimEye by NETVITA, LLC.
- “Software” means the object code versions of any downloadable software provided by ClaimEye solely for the purpose of accessing the Services, together with the updates, new releases or versions, modifications or enhancements, owned and provided by ClaimEye to the User pursuant to this Agreement
- “User” means an individual with authorized access to Services, Software, and Documentation, for whom the User has purchased a subscription or to whom the User has supplied a user identification and password.
- “User Data” means data, files, or information accessed, used, communicated, stored, or submitted by the User related to User’s use of the Services or Software.
Last revised: November 15, 2018
2019 © Claimeye by Netvita, LLC.