Terms of Service

1. Acceptance of Terms

By creating an account, clicking "I Agree," or otherwise accessing or using the AIDentalClaims platform and related services (collectively, the "Service"), you acknowledge that you have read, understood, and agree to be bound by these Terms of Service (the "Terms"). If you do not agree to these Terms, you must not access or use the Service.

Your affirmative act of clicking the "I Agree" button during account registration constitutes an electronic signature and creates a legally binding agreement between you and AIDentalClaims, Inc. (the "Company," "we," "us," or "our") with the same force and effect as a handwritten signature.

2. Eligibility

The Service is intended solely for use by authorized representatives of dental practices, dental service organizations, billing companies, and other entities that qualify as covered entities or business associates under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). By using the Service, you represent and warrant that:

• You are at least eighteen (18) years of age or the age of majority in your jurisdiction, whichever is greater.
• You are an authorized representative of a HIPAA-covered entity or business associate and have the authority to bind that entity to these Terms.
• Your use of the Service will comply with all applicable federal, state, and local laws and regulations, including but not limited to HIPAA, the False Claims Act, and applicable state insurance fraud statutes.

3. Account Registration and Security

To access the Service, you must register for an account by providing accurate, current, and complete information. You agree to maintain the accuracy of this information and to update it promptly if it changes.

3.1 Credentials

You are responsible for maintaining the confidentiality of your account credentials, including your username, password, and any API keys or tokens associated with your account. You must not share your credentials with any unauthorized individual.

3.2 Multi-Factor Authentication

Due to the sensitive nature of protected health information ("PHI") processed through the Service, multi-factor authentication ("MFA") is required for all accounts. You must enable and maintain MFA as a condition of continued access. Failure to enable MFA may result in account suspension.

3.3 Unauthorized Access Notification

You agree to notify the Company immediately—and in no event later than twenty-four (24) hours—upon becoming aware of any unauthorized access to or use of your account, any breach of security, or any suspected compromise of credentials. The Company shall not be liable for any loss or damage arising from your failure to comply with this obligation.

4. Description of Service

AIDentalClaims provides an AI-assisted claims intelligence platform designed to support dental practices in managing insurance claims workflows. The Service includes, but is not limited to:

• Narrative Drafting: AI-generated draft narratives for dental insurance claims, including clinical justifications, procedure descriptions, and supporting documentation language.
• Denial Risk Analysis: Predictive risk scoring that estimates the likelihood of claim denial based on historical patterns, payer-specific guidelines, and procedure-level data.
• Claims Intelligence: Insights, recommendations, and analytics to help dental practices understand claim trends, optimize submission workflows, and reduce denial rates.

The Service leverages artificial intelligence technologies, including third-party large language model APIs, to generate content and analysis. All AI-generated outputs are intended as drafts and decision-support tools only.

5. AI-Generated Content Disclaimer

All content generated by the Service, including claim narratives, risk scores, recommendations, and analytical outputs, constitutes draft material only. AI-generated content:

• Does not constitute dental advice, medical advice, legal advice, or insurance advice of any kind.
• Must be reviewed, verified, and approved by a qualified dental professional, licensed provider, or authorized billing specialist before submission to any insurance carrier or third-party payer.
• May contain inaccuracies, omissions, or errors. The Company makes no guarantee of the accuracy, completeness, correctness, or appropriateness of any AI-generated content.
• Does not guarantee approval, payment, or favorable adjudication of any insurance claim.

You acknowledge and agree that you bear sole responsibility for reviewing all AI-generated outputs and ensuring that any content submitted to an insurance carrier is accurate, truthful, clinically supported, and compliant with all applicable laws and payer requirements.

6. Medical and Clinical Disclaimer

The Service is not a substitute for professional clinical judgment, dental diagnosis, treatment planning, or any other aspect of patient care. Nothing provided by the Service should be construed as a clinical recommendation or as guidance on the appropriateness of any dental procedure.

All clinical determinations, including treatment necessity, procedure selection, and documentation of clinical findings, remain the sole responsibility of the treating dentist or licensed dental professional. The Company does not practice dentistry, medicine, or any other regulated healthcare profession.

7. No Guarantee of Claim Approval

Denial risk scores, approval likelihood estimates, and any other predictive outputs provided by the Service are statistical estimates based on historical data and algorithmic modeling. They are not guarantees, promises, or assurances of any particular outcome.

Insurance claim adjudication decisions are made solely by the applicable insurance carrier or third-party payer. The Company has no control over and accepts no responsibility for claim outcomes, including approvals, denials, downcodes, requests for additional information, or any other carrier action.

8. Insurance Fraud Prohibition

You must not use the Service to create, support, or submit any false, misleading, or fraudulent insurance claim. This prohibition includes, without limitation, using the Service to:

• Generate narratives for procedures that were not performed or were not clinically necessary.
• Misrepresent the nature, extent, or severity of a patient's condition.
• Support claims for services rendered by unlicensed or unauthorized individuals.
• Circumvent payer policies, coverage limitations, or benefit exclusions through misrepresentation.

Any use of the Service in connection with insurance fraud or suspected fraud will result in immediate account termination without refund. Additionally, the Company reserves the right to report suspected fraudulent activity to applicable law enforcement agencies, state dental boards, insurance fraud bureaus, the Office of Inspector General (OIG), and any other relevant authorities.

9. HIPAA Compliance Obligations

The Company operates as a business associate under HIPAA with respect to any PHI processed through the Service. Prior to transmitting any PHI to the Service, you must execute a Business Associate Agreement ("BAA") with the Company. Use of the Service to process PHI without an executed BAA in place constitutes a violation of these Terms.

9.1 Your Compliance Responsibilities

You are solely responsible for your own compliance with HIPAA, including but not limited to the Privacy Rule, the Security Rule, and the Breach Notification Rule. This includes:

• Ensuring that you have obtained all required patient authorizations or that a valid exception applies before transmitting PHI to the Service.
• Implementing appropriate administrative, physical, and technical safeguards within your own organization.
• Training your workforce on HIPAA requirements as they relate to the use of the Service.
• Promptly reporting to the Company any breaches or suspected breaches involving PHI processed through the Service.

10. Data Ownership and License

You retain all ownership rights in and to the PHI and other data you submit to the Service ("User Data"). The Company does not claim ownership of your User Data.

By using the Service, you grant the Company a limited, non-exclusive, non-transferable license to access, process, store, and transmit your User Data solely to the extent necessary to provide and maintain the Service, as further described in the BAA. This license terminates upon the termination or expiration of your account, subject to the data retention provisions in Section 18.

11. Anonymized and De-Identified Data

You acknowledge and agree that the Company may create de-identified and aggregated datasets derived from User Data, provided that such de-identification is performed in accordance with the standards set forth in HIPAA, 45 CFR § 164.514, including either the Expert Determination method or the Safe Harbor method.

De-identified data is not PHI and is not subject to the restrictions of the BAA. The Company may use de-identified and aggregated data for any lawful purpose, including but not limited to improving the Service, conducting research, generating benchmarking reports, developing new products, and publishing industry insights, provided that no individual patient or practice is identifiable from such data.

12. Subscription and Payment

12.1 Pricing and Plans

Access to the Service requires a paid subscription. Current standard pricing is $351 per month (monthly) or $281 per month (annual). Current pricing, feature availability, and plan details are published on the Company's website and may be updated from time to time. The Company will provide at least thirty (30) days' notice before any price increase takes effect for existing subscribers.

12.2 Billing Cycle and Auto-Renewal

Subscriptions are billed on a recurring basis (monthly or annually, as selected at the time of purchase). Your subscription will automatically renew at the end of each billing cycle unless you cancel before the renewal date. You authorize the Company to charge your designated payment method for all recurring fees.

12.3 Cancellation

You may cancel your subscription at any time through your account settings. Cancellation takes effect at the end of the current billing period. You will retain access to the Service until the end of the period for which you have already paid.

12.4 Refunds

Subscription fees are generally non-refundable. However, if you cancel within fourteen (14) days of your initial subscription purchase and have not submitted more than ten (10) claims through the Service, you may request a full refund. Refund requests must be submitted to the Company's support team. The Company reserves the right to grant or deny refund requests at its reasonable discretion.

13. Limitation of Liability

TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, THE COMPANY'S TOTAL AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THESE TERMS OR THE SERVICE SHALL NOT EXCEED THE TOTAL AMOUNT OF FEES PAID BY YOU TO THE COMPANY DURING THE TWELVE (12) MONTH PERIOD IMMEDIATELY PRECEDING THE EVENT GIVING RISE TO THE CLAIM.

IN NO EVENT SHALL THE COMPANY, ITS AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, OR LICENSORS BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES, INCLUDING BUT NOT LIMITED TO:

• Loss of revenue, profits, or business opportunities.
• Claim denials, downcodes, or adverse adjudication decisions by any insurance carrier or third-party payer.
• Actions taken by insurance carriers, including audits, recoupments, or termination of provider participation.
• Regulatory actions, investigations, penalties, or fines imposed by any governmental authority.
• Loss or corruption of data.
• Costs of procurement of substitute goods or services.

These limitations apply regardless of the theory of liability (contract, tort, strict liability, or otherwise) and even if the Company has been advised of the possibility of such damages.

14. Indemnification

You agree to indemnify, defend, and hold harmless the Company and its affiliates, officers, directors, employees, agents, and licensors from and against any and all claims, damages, losses, liabilities, costs, and expenses (including reasonable attorneys' fees) arising out of or related to:

• Your use of the Service, including any content you submit, generate, or transmit through the Service.
• Any insurance claims you submit based in whole or in part on content generated by the Service.
• Your violation of HIPAA or any other applicable law, regulation, or industry standard.
• Any fraudulent, misleading, or unlawful activity conducted through or in connection with your use of the Service.
• Your breach of these Terms or any representation or warranty made herein.

15. Disclaimer of Warranties

THE SERVICE IS PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS WITHOUT WARRANTIES OF ANY KIND, WHETHER EXPRESS, IMPLIED, OR STATUTORY. TO THE FULLEST EXTENT PERMITTED BY LAW, THE COMPANY DISCLAIMS ALL WARRANTIES, INCLUDING BUT NOT LIMITED TO:

• IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT.
• WARRANTIES THAT THE SERVICE WILL BE UNINTERRUPTED, ERROR-FREE, SECURE, OR FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS.
• WARRANTIES REGARDING THE ACCURACY, RELIABILITY, OR COMPLETENESS OF ANY CONTENT GENERATED BY THE SERVICE, INCLUDING AI-GENERATED NARRATIVES AND RISK SCORES.
• WARRANTIES THAT THE SERVICE WILL MEET YOUR SPECIFIC REQUIREMENTS OR EXPECTATIONS.

16. Acceptable Use Policy

You agree that you will not, and will not permit any person using your account to:

• Upcoding: Use the Service to generate narratives or documentation intended to justify a higher-level procedure code than was actually performed or clinically supported.
• Unbundling fraud: Use the Service to separate procedures that should be billed under a single code into multiple codes for the purpose of increasing reimbursement.
• Reverse engineering: Reverse engineer, decompile, disassemble, or otherwise attempt to discover the source code, algorithms, models, or underlying technology of the Service.
• Account sharing: Share your account credentials or allow multiple individuals to access the Service under a single account, except as expressly permitted by your subscription plan.
• Use the Service to transmit any malware, viruses, or other harmful code.
• Interfere with or disrupt the integrity or performance of the Service or its underlying infrastructure.
• Attempt to gain unauthorized access to the Service, other user accounts, or any related systems or networks.
• Use the Service in any manner that violates applicable law or infringes the rights of any third party.

17. Intellectual Property

All intellectual property rights in and to the Service, including but not limited to the software, algorithms, machine learning models, user interface designs, trademarks, trade names, logos, documentation, and all improvements, modifications, and derivative works thereof, are and shall remain the exclusive property of the Company or its licensors.

Subject to your compliance with these Terms and payment of all applicable fees, the Company grants you a limited, non-exclusive, non-transferable, non-sublicensable, revocable license to access and use the Service during the term of your subscription solely for your internal business purposes. This license does not convey any ownership interest in the Service or any right to use the Company's intellectual property outside the scope of the Service.

18. Data Retention and Deletion

The following retention periods apply to different categories of data:

• PHI / User Data: 30 days after account termination, then securely deleted.
• Audit Logs: 6 years per HIPAA requirements (45 CFR 164.530(j)).
• De-identified Data: Retained indefinitely for service improvement (see Section 11).
• Payment Records: 7 years per IRS requirements.
• Account Metadata: Deleted with account unless required by law.

Upon termination or expiration of your account, the Company will retain your User Data, including PHI, for a period of thirty (30) days ("Retention Period"). During the Retention Period, you may request an export of your User Data in a standard, machine-readable format.

After the Retention Period, the Company will securely delete or de-identify all User Data in accordance with the BAA and applicable HIPAA requirements. Notwithstanding the foregoing, the Company may retain de-identified and aggregated data as described in Section 11, and may retain limited records as required by applicable law or for legitimate legal or compliance purposes.

19. Termination

19.1 Termination by You

You may terminate your account at any time by canceling your subscription through your account settings and ceasing all use of the Service.

19.2 Termination by the Company

The Company may suspend or terminate your access to the Service at any time, with or without cause, upon written notice to you. The Company may terminate your account immediately and without prior notice in the event of:

• A material breach of these Terms.
• Suspected insurance fraud or other unlawful activity.
• A violation of the Acceptable Use Policy (Section 16).
• Non-payment of fees beyond any applicable grace period.
• A HIPAA breach or violation attributable to your use of the Service.

19.3 Effect of Termination

Upon termination, your right to access and use the Service will cease immediately. The Company will handle your PHI in accordance with the data retention provisions in Section 18 and the terms of the BAA. Sections of these Terms that by their nature should survive termination (including, without limitation, Sections 5, 6, 7, 8, 13, 14, 15, 17, and 20) shall survive and remain in full force and effect.

20. Governing Law and Dispute Resolution

20.1 Governing Law

These Terms shall be governed by and construed in accordance with the laws of the State of Delaware, without regard to its conflict of law principles.

20.2 Mandatory Arbitration

Any dispute, controversy, or claim arising out of or relating to these Terms or the Service, including the determination of the scope or applicability of this agreement to arbitrate, shall be resolved exclusively by binding arbitration administered by the American Arbitration Association ("AAA") in accordance with its Commercial Arbitration Rules. The arbitration shall take place in Wilmington, Delaware, and shall be conducted by a single arbitrator with experience in technology and healthcare law. The arbitrator's decision shall be final and binding and may be entered as a judgment in any court of competent jurisdiction.

20.3 Class Action Waiver

YOU AGREE THAT ANY DISPUTE RESOLUTION PROCEEDINGS WILL BE CONDUCTED ONLY ON AN INDIVIDUAL BASIS AND NOT IN A CLASS, CONSOLIDATED, OR REPRESENTATIVE ACTION. YOU WAIVE ANY RIGHT TO PARTICIPATE IN A CLASS ACTION LAWSUIT OR CLASS-WIDE ARBITRATION AGAINST THE COMPANY. If any court or arbitrator determines that this class action waiver is void or unenforceable for any reason, or that an arbitration can proceed on a class basis, then the arbitration provision in Section 20.2 shall be deemed null and void in its entirety, and the parties shall be deemed to have not agreed to arbitrate disputes.

21. Modifications to These Terms

The Company reserves the right to modify these Terms at any time. We will provide at least thirty (30) days' advance notice of any material changes by sending an email to the address associated with your account and by posting the updated Terms on our website with a revised "Last Updated" date.

Your continued use of the Service after the effective date of any modification constitutes your acceptance of the updated Terms. If you do not agree to the modified Terms, you must discontinue use of the Service and cancel your account before the changes take effect.

22. General Provisions

22.1 Severability

If any provision of these Terms is held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, such provision shall be modified to the minimum extent necessary to make it enforceable, or if modification is not possible, shall be severed from these Terms. The remaining provisions shall continue in full force and effect.

22.2 Entire Agreement

These Terms, together with the BAA, Privacy Policy, and any order forms or subscription agreements executed between you and the Company, constitute the entire agreement between you and the Company with respect to the Service and supersede all prior or contemporaneous communications, proposals, and agreements, whether oral or written.

22.3 Waiver

The failure of the Company to enforce any right or provision of these Terms shall not constitute a waiver of such right or provision. Any waiver must be in writing and signed by an authorized representative of the Company.

22.4 Assignment

You may not assign or transfer these Terms or any rights or obligations hereunder without the prior written consent of the Company. The Company may assign these Terms without restriction, including in connection with a merger, acquisition, or sale of all or substantially all of its assets.

22.5 Contact Information

If you have any questions about these Terms of Service, please contact us at: