Terms & Conditions

1. Agreement to Terms

These Terms and Conditions (“Terms”) govern the provision of Revenue Cycle Management, medical billing, medical coding, credentialing, accounts receivable follow-up, and related services (the “Services”) by Competant Global Solution Pvt. Ltd. (“Company,” “we,” “us”) to the healthcare provider, practice, facility, or organization engaging us (“Client,” “you”). By signing a Service Order, Statement of Work, or Master Service Agreement (“Agreement”) referencing these Terms, or by accessing our billing portal or services, the Client agrees to be bound by these Terms.

These Terms, together with the applicable Service Order/Statement of Work, Business Associate Agreement (BAA), and Privacy Policy, constitute the entire agreement between the parties regarding the Services and supersede any prior understandings. In the event of a conflict, the specific Service Order shall control over these general Terms.

2. Description of Services

Subject to the terms of the applicable Service Order, the Company will provide one or more of the following Services:
• Medical coding (ICD-10-CM, CPT, HCPCS) and charge entry
• Insurance eligibility and benefits verification, and prior authorization support
• Electronic and paper claims submission to commercial payers, Medicare, Medicaid, and other third-party payers
• Payment posting, reconciliation, and remittance/EOB processing
• Denial management, claim corrections, and appeals
• Accounts receivable (A/R) follow-up and aging analysis
• Provider credentialing and payer enrollment support
• Patient billing support, statement generation, and (where separately agreed) patient inquiry handling
• Reporting, dashboards, and revenue cycle analytics
The Company is a billing and administrative services provider only. The Company is not a healthcare provider, does not practice medicine, does not provide medical advice, and holds no clinical licensure. The Client retains full and sole responsibility for the accuracy of clinical documentation, medical necessity determinations, and the clinical care provided to patients.

3. Client Responsibilities

• Provide complete, accurate, legible, and timely clinical documentation, charge information, and supporting records necessary for coding and claims submission;
• Designate authorized personnel to communicate with the Company and approve billing-related decisions;
• Maintain active enrollment and good standing with applicable payers, Medicare, and Medicaid, and promptly notify the Company of any change in payer contracts, fee schedules, or credentialing status;
• Provide timely access to its practice management system, EHR, clearinghouse portal, and any other systems reasonably required to perform the Services;
• Review and approve claims, statements, and reports within the timeframes specified in the Service Order;
• Maintain appropriate professional liability (malpractice) insurance; and
• Promptly notify the Company of any suspected billing error, compliance concern, payer audit, or potential PHI incident of which the Client becomes aware.
The Company's ability to meet turnaround times and performance metrics described in Section 5 is contingent on the Client's timely fulfillment of the above responsibilities.

4. Fees and Payment Terms

4.1 Fee Structure

Fees for the Services shall be as set out in the applicable Service Order and may be structured as: (a) a percentage of net collections; (b) a per-claim or per-encounter fee; (c) a flat monthly/retainer fee; or (d) a combination thereof, plus any agreed ancillary fees (e.g., credentialing, software/clearinghouse fees, denied-claim appeals, or out-of-scope project work).
Unless otherwise defined in the Service Order, “net collections” means total monies actually collected by or on behalf of the Client for services billed by the Company, less any refunds, voids, or credits issued to patients or payers.

4.2 Invoicing and Payment

• Invoices will be issued on a monthly basis (or as otherwise specified in the Service Order) and are due within fifteen (15) days of the invoice date, unless a different term is agreed in writing.
• Late payments may accrue a late fee of up to 1.5% per month (or the maximum permitted by applicable law) on the outstanding balance.
• Any disputed charge must be raised in writing within fifteen (15) days of the invoice date with reasonable supporting detail; undisputed amounts remain due and payable in the interim.
• The Company reserves the right to suspend Services for accounts more than thirty (30) days past due, upon prior written notice, until the account is brought current.

4.3 Taxes

Fees are exclusive of applicable taxes (including GST, where applicable), which shall be borne by the Client unless prohibited by law.

5. Service Levels and Performance

The Company will use commercially reasonable efforts to meet the turnaround times, clean-claim rates, and other performance benchmarks specified in the Service Order. The parties acknowledge that claim adjudication timelines, payer rules, and reimbursement outcomes are ultimately controlled by third-party payers and government programs and are not guaranteed by the Company. Performance metrics may be reviewed periodically (e.g., quarterly) and adjusted by mutual written agreement.

6. Confidentiality and Data Protection

Each party will maintain the confidentiality of the other party's non-public business, financial, and technical information disclosed in connection with this engagement, using at least the same degree of care it uses to protect its own confidential information, and will not disclose such information to third parties except as permitted under this Agreement or required by law.
Because the Services involve access to Protected Health Information, the Client and Company shall execute a Business Associate Agreement (BAA) prior to the commencement of Services. The BAA is incorporated into and forms part of this Agreement. In the event of any conflict between these Terms and the BAA regarding the treatment of PHI, the BAA shall control.

7. Compliance with Law

Both parties shall comply with applicable laws and regulations relevant to the Services, including HIPAA, the HITECH Act, applicable state and federal billing/coding regulations, payer-specific billing guidelines, and (for the Company's operations in India) the Digital Personal Data Protection Act, 2023 and the Information Technology Act, 2000. The Company does not engage in, and the Client agrees not to request, any billing practice that constitutes upcoding, unbundling, billing for services not rendered, or other fraudulent or abusive billing practices.

8. Intellectual Property

Each party retains all rights, title, and interest in its own pre-existing intellectual property, including the Company's proprietary billing methodologies, software tools, templates, and workflow processes (“Company IP”). The Client retains ownership of its clinical data, patient records, and Client-provided materials (“Client Data”). Nothing in this Agreement transfers ownership of Company IP to the Client, or ownership of Client Data to the Company. The Company may use de-identified, aggregated data (containing no PHI) for internal benchmarking, quality improvement, and service development purposes.

9. Disclaimers and Limitation of Liability

Except as expressly stated in the applicable Service Order, the Services are provided “as is” and the Company makes no warranties, express or implied, regarding the amount, timing, or certainty of reimbursement, claim approval by any payer, or outcomes of any appeal. The Company shall not be liable for: (a) denials, underpayments, or delays caused by inaccurate, incomplete, or untimely information or documentation provided by the Client; (b) changes in payer policy, reimbursement rates, or government regulation; or (c) the Client's own clinical, coding-approval, or compliance decisions.
To the maximum extent permitted by law, the Company's total aggregate liability arising out of or relating to this Agreement shall not exceed the total fees paid by the Client to the Company in the three (3) months immediately preceding the event giving rise to the claim. Neither party shall be liable for indirect, incidental, special, consequential, or punitive damages, including loss of revenue or loss of profits, even if advised of the possibility of such damages. Nothing in this section limits liability that cannot be limited by applicable law, including liability arising from a party's gross negligence, wilful misconduct, or breach of HIPAA/PHI obligations to the extent such limitation is not permitted by law.

10. Indemnification

Each party agrees to indemnify, defend, and hold harmless the other party from third-party claims, damages, and reasonable legal costs arising from: (a) its breach of this Agreement; (b) its negligence or wilful misconduct; or (c) its violation of applicable law, including HIPAA, in connection with the Services. The Client specifically agrees to indemnify the Company for claims arising from inaccurate clinical documentation, coding instructions, or charge information supplied by the Client or its clinical staff.

11. Term and Termination

11.1 Term

This Agreement commences on the Effective Date specified in the Service Order and continues for the initial term specified therein, automatically renewing for successive periods unless either party provides written notice of non-renewal as specified in the Service Order.

11.2 Termination for Convenience

Either party may terminate this Agreement without cause upon thirty (30) to ninety (90) days' prior written notice, as specified in the applicable Service Order.

11.3 Termination for Cause

Either party may terminate this Agreement immediately upon written notice if the other party: (a) materially breaches this Agreement and fails to cure such breach within thirty (30) days of written notice; (b) becomes insolvent or files for bankruptcy; or (c) loses any license, certification, or program participation (e.g., Medicare/Medicaid exclusion) necessary to perform or receive the Services.

11.4 Effect of Termination — Wind-Down

Upon termination, the Company shall continue to process claims and follow up on accounts receivable existing as of the termination date for a transitional “Wind-Down Period” of up to ninety (90) to one hundred twenty (120) days (as specified in the Service Order), at the Client's then-current rates, unless the parties agree otherwise. The Client shall pay all fees accrued through the effective date of termination and through the Wind-Down Period. Following full payment of undisputed fees, the Company will provide the Client with a complete accounts receivable report and, where feasible, transfer billing data in a standard electronic format. All PHI will be returned or securely destroyed in accordance with the BAA.

12. Force Majeure

Neither party shall be liable for delay or failure to perform obligations (other than payment obligations) due to causes beyond its reasonable control, including natural disasters, governmental action, internet or telecommunications failures, payer system outages, or other events of force majeure, provided the affected party promptly notifies the other party and uses reasonable efforts to resume performance.

13. Independent Contractor Relationship

The Company performs the Services as an independent contractor. Nothing in this Agreement shall be construed to create a partnership, joint venture, agency, or employment relationship between the parties, except to the limited extent the Company is authorized to submit claims and communicate with payers on the Client's behalf as the Client's billing agent.

14. Dispute Resolution and Governing Law

The parties shall first attempt to resolve any dispute arising out of this Agreement through good-faith negotiation between designated representatives. If unresolved within thirty (30) days, the dispute shall be referred to mediation, and if still unresolved, to final and binding arbitration in accordance with the rules specified in the Service Order, with the seat of arbitration and governing law (e.g., the laws of India, or a specified U.S. state) as set out in the Service Order. Each party shall bear its own costs unless the arbitrator determines otherwise.

15. General Provisions

• Entire Agreement: These Terms, the Service Order, the BAA, and the Privacy Policy constitute the entire agreement between the parties.
• Amendment: These Terms may be amended only by mutual written agreement, except for non-material updates to the Privacy Policy as described therein.
• Assignment: Neither party may assign this Agreement without the other's prior written consent, except in connection with a merger, acquisition, or sale of substantially all assets.
• Severability: If any provision is held unenforceable, the remaining provisions shall remain in full force and effect.
• No Waiver: Failure to enforce any provision shall not constitute a waiver of that or any other provision.
• Notices: All formal notices shall be in writing and delivered to the addresses specified in the Service Order.
• Survival: Sections relating to Confidentiality, Fees owed, Limitation of Liability, Indemnification, and Dispute Resolution shall survive termination of this Agreement.

8. Contact Us

For questions about these Terms & Conditions, please contact us at:
Email: info@competantgs.com
Phone: +1 732-929-7270