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RCM Services

BACK CLAIMS SERVICES TERMS AND CONDITIONS

These Back Claims Services Terms and Conditions govern Customer’s access to, and use of, the Back Claims Services and are incorporated into and made a part of the Agreement. All terms and conditions of the Agreement apply except to the extent expressly modified herein.

  1. 1. Services. To the extent the parties have entered into an Order Form, or another written agreement, pursuant to which Prompt has agreed to provide Back Claims Services to Customer, Prompt will provide the Back Claims Services subject to these Back Claims Services Terms and Conditions and Customer’s payment of all relevant fees.

  2. 2. Scope.

    1. 2.1. Prompt will make reasonable efforts to process and submit Back Claims using information provided by Customer.

    2. 2.2. For each Back Claim, Prompt will perform a maximum of two (2) attempts to resolve or collect payment.

    3. 2.3. If, after two (2) documented attempts, the Back Claim remains unpaid, Prompt will return the Back Claim to Customer such that Customer may:

      1. 2.3.1. Pursue further resolution internally, or

      2. 2.3.2. Write off the Back Claim.

  3. 3. Limitations. 

    1. 3.1. Prompt will not be responsible for any obligation related to any Back Claim beyond the two-attempt process described above.

    2. 3.2. Prompt will not responsible or liable for the denial or non-payment of any Back Claim due to timely filing limits or other circumstances outside of Prompt’s control.

    3. 3.3. A Back Claim may involve a date of service that predates the Back Claims Services Go-Live Date by a significant amount of time. Customer acknowledges that the likelihood of reimbursement decreases as such Back Claim approaches applicable timely filing deadlines.

  4. 4. Customer Obligations. 

    1. 4.1. Customer will provide Prompt with all necessary information, supporting documentation, and system access required to process Back Claims.

    2. 4.2. Customer acknowledges and agrees that any Back Claim may not be recoverable.

  5. 5. Definitions.

    1. 5.1. “Accounts Receivable Start Date” means the date set forth in the Order Form or as otherwise agreed to in writing by the parties.

    2. 5.2. “Back Claim” means a claim generated within the PTS EMR System associated with dates of service occurring on or after the Accounts Receivable Start Date but thirty or more days before the RCM Base Services Go-Live Date. For clarity, Back Claims are distinct and different from the Standard Claims.

    3. 5.3. “Back Claims Services Go-Live Date” means the date upon which Prompt has agreed to begin to provide Back Claims Services to Customer. 

  6. 6. Fees. 

    1. 6.1. Additional Monthly Service Fees applicable to the Back Claims Services only apply to Back Claims and shall not affect the fees applicable to any Standard Claims processed pursuant to the Agreement arising on or after the Back Claims Services Go-Live Date.