Acceptable Use Policy

1. Purpose

This Acceptable Use Policy ("AUP") defines the acceptable and prohibited uses of the AIDentalClaims platform (the "Service"). This policy is designed to protect the integrity of the Service, safeguard patient data, ensure compliance with healthcare regulations, and prevent misuse of AI-assisted tools in dental claims processing. By accessing or using the Service, you agree to comply with this policy.

2. Prohibited Uses

You may not use the Service for any unlawful, fraudulent, or harmful purpose. The following activities are strictly prohibited:

2.1 Insurance Fraud and Misrepresentation

• Insurance Fraud — Using the Service to submit fraudulent insurance claims, misrepresent services performed, or otherwise defraud insurance carriers, government payers, or patients.
• Upcoding — Intentionally selecting CDT procedure codes that represent more expensive services than those actually performed in order to increase reimbursement.
• Unbundling Fraud — Separately billing for procedures that should be billed as a single bundled code in order to inflate reimbursement amounts.
• False Documentation— Creating, altering, or submitting clinical documentation that does not accurately reflect the services rendered or the patient's clinical condition.
• Claims for Services Not Rendered — Submitting claims for dental procedures, examinations, or treatments that were not actually performed on the patient.

2.2 Data Misuse and Unauthorized Access

• Identity Theft — Using the Service to access, steal, or misuse patient identities or Protected Health Information for any unauthorized purpose.
• Sharing Account Credentials — Sharing, transferring, or disclosing your login credentials or multi-factor authentication tokens to any other person, including colleagues within the same practice.
• Accessing Other Practices' Data — Attempting to access, view, or obtain data belonging to other dental practices or their patients.

2.3 Technical Misuse

• Reverse Engineering — Reverse engineering, decompiling, disassembling, or otherwise attempting to derive the source code, algorithms, or underlying models of the Service.
• Interfering with the Service— Taking any action that imposes an unreasonable load on the Service's infrastructure, introduces malware, or disrupts the availability or performance of the platform for other users.
• Automated Scraping — Using bots, scrapers, crawlers, or any automated means to extract data from the Service without express written authorization.
• Reselling the Service — Reselling, sublicensing, or redistributing access to the Service or its outputs to third parties without prior written consent from AIDentalClaims.

3. AI-Specific Prohibitions

The Service incorporates artificial intelligence to assist with claims processing, narrative generation, and denial prediction. The following AI-specific prohibitions apply:

• Submitting AI-Generated Narratives Without Professional Review — All AI-generated clinical narratives, claim documentation, and supporting materials must be reviewed and approved by a licensed dental professional before submission to any insurance carrier, government payer, or other third party. Submitting unreviewed AI output as clinical documentation is prohibited.
• Using AI Output as Sole Basis for Clinical Decisions — AI-generated recommendations, risk assessments, and predictions are decision-support tools only. They must not be used as the sole basis for clinical treatment decisions, diagnoses, or patient care planning. Professional clinical judgment must always take precedence.
• Intentionally Manipulating AI to Produce Inaccurate Narratives — Deliberately providing false, misleading, or incomplete clinical data to the AI system in order to generate narratives that misrepresent the services rendered or the patient's condition is strictly prohibited.
• Using AI to Fabricate Clinical Findings— Using the Service's AI capabilities to generate fabricated clinical findings, diagnoses, or treatment records that do not correspond to actual patient examinations or procedures performed.

4. User Responsibilities

All users of the Service are responsible for the following:

• Verify All AI Output — Review and verify the accuracy of all AI-generated content, including clinical narratives, coding suggestions, and denial risk assessments, before relying upon or submitting such content.
• Maintain Accurate Clinical Records — Ensure that all clinical records entered into the Service are accurate, complete, and reflect actual patient encounters and procedures performed.
• Comply with HIPAA — Adhere to all applicable provisions of the Health Insurance Portability and Accountability Act, including the Privacy, Security, and Breach Notification Rules, in connection with your use of the Service.
• Comply with State Dental Board Regulations — Operate in compliance with all applicable state dental board regulations, licensing requirements, and standards of practice that govern your professional activities.
• Report Suspected Misuse — Promptly report any suspected violations of this policy, security incidents, or unauthorized access to the Service to [email protected].

5. Consequences of Violation

Violations of this Acceptable Use Policy may result in one or more of the following actions, at AIDentalClaims's sole discretion and depending on the severity and nature of the violation:

• Warning — Written notice describing the violation and requiring immediate corrective action.
• Suspension — Temporary suspension of access to the Service pending investigation and resolution of the violation.
• Termination — Permanent termination of your account and access to the Service, with or without prior warning depending on the severity of the violation.
• Referral to Authorities — Reporting of suspected illegal activity, including insurance fraud, identity theft, and HIPAA violations, to appropriate law enforcement agencies, the Office for Civil Rights (OCR), the Office of Inspector General (OIG), or other regulatory authorities.
• Reporting to Dental Boards — Notification to the relevant state dental board(s) of conduct that may constitute a violation of professional standards or licensing requirements.

AIDentalClaims reserves the right to take any of the above actions without prior notice when, in our sole judgment, immediate action is necessary to protect the Service, our users, patients, or third parties.

6. Reporting Violations

If you become aware of any violation of this Acceptable Use Policy, or if you suspect that the Service is being used for any prohibited purpose, please report it immediately to [email protected]. Reports may be submitted anonymously. We investigate all reports and take appropriate action to address confirmed violations. AIDentalClaims prohibits retaliation against any user who makes a good-faith report of a suspected violation.

For questions about this Acceptable Use Policy, contact [email protected].