Terms of Service

1. Acceptance of Terms

These Terms of Service ("Terms") constitute a legally binding agreement between you (whether individually or on behalf of an entity, practice, or billing organization, "Client", "Practice", or "you") and Payer Delta Arizona, operated by Jentlemens LLC, an Arizona limited liability company ("Payer Delta", "Company", "we", "us", or "our").

By accessing payerdelta.summithillholdings.com, requesting a Free Denial Snapshot, or entering into an operational engagement with Payer Delta, you agree to be bound by these Terms. If you do not agree to all terms and conditions, you must discontinue use of the website and services immediately.

2. Administrative & Analytical Scope

Our services encompass: (a) parsing electronic remittance advice (ANSI X12 835) and CARC/RARC denial reason codes; (b) researching commercial payer clinical policy bulletins, Local Coverage Determinations (LCDs), and billing manuals; (c) drafting structured appeal evidence packets and redetermination letters; and (d) providing predictive cash forecasting and revenue integrity surveillance.

3. Provider Retained Review & Submission Safeguards

Payer Delta does not directly sign provider appeal declarations or submit claims under its own entity name. The client practice represents and warrants that all documentation submitted to payers has been reviewed, approved, and authorized by qualified clinical or billing personnel.

4. Commercial Denial Recovery Fees (22% Contingency)

Commercial denial recovery services are provided strictly under the following performance terms:

• 22% Contingency Fee: Client agrees to pay Payer Delta twenty-two percent (22%) of the gross collected cash recovered from commercial insurance payers on accounts, claims, or line items worked, prepared, or appealed by Payer Delta.
• Direct Payer Disbursements: Payer Delta never takes possession of client collections. All insurance disbursements are paid by the payer directly to the provider's practice account.
• Performance Firewall: If no commercial reimbursement is recovered and received by the practice on a worked claim, zero commercial recovery fee is owed.
• Invoicing & Payment: Invoices are issued following verified provider receipt of funds (demonstrated via 835 remittance or payment voucher) and are payable within fifteen (15) calendar days of invoice date.

5. Medicare Administrative Packet Preparation

Pursuant to federal healthcare statutory guidelines—including the federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b) and Civil Monetary Penalties Law—commercial contingency fee arrangements do not apply to claims submitted to federal healthcare programs (such as Original Medicare Fee-for-Service).

Medicare redetermination and administrative packet drafting is provided strictly on a pre-agreed flat-fee basis ($95 per administrative packet) or under a flat hourly consulting scope, confirmed in writing prior to commencing work.

6. Third-Party Payer Discretion & No Guarantee

Client expressly understands and agrees that:

• Commercial insurance payers, Medicare Administrative Contractors (MACs), and Medicaid administrators exercise independent, discretionary adjudicative authority over all claims.
• Payer Delta prepares robust, evidence-backed appeal packets referencing applicable payer policies and medical records; however, Payer Delta does not and cannot guarantee that any individual claim or appeal will be overturned, approved, or paid by the payer.
• Filing deadlines, timely filing limits, and appeal stages vary significantly by payer contract, benefit plan, and jurisdiction. Payer Delta is not liable for claims submitted outside filing deadlines if the delay arose from missing practice records or client review delays.

7. Practice Responsibilities

To enable accurate denial analysis and packet preparation, the Client agrees to:

1. Provide timely access to necessary non-clinical remittance files, denial notices, and relevant supporting clinical notes through secure, encrypted transfer channels.
2. Designate a primary billing liaison authorized to review, sign, and submit completed appeal packets within payer deadlines.
3. Promptly notify Payer Delta upon receipt of payer determinations or payments corresponding to worked accounts.

8. Confidentiality, BAA & Data Security

Client operational data, reimbursement fee schedules, and practice records are treated with strict commercial confidentiality. Active engagements involving electronic Protected Health Information (ePHI) mandate execution of our standard HIPAA Business Associate Agreement (BAA) pursuant to 45 C.F.R. § 164.504(e) prior to data transfer.

Both parties agree to implement industry-standard administrative, physical, and technical safeguards pursuant to HIPAA Security Rules (45 C.F.R. Part 164, Subpart C).

9. Limitation of Liability & Indemnification

To the fullest extent permitted by Arizona law, in no event shall Payer Delta, Jentlemens LLC, or its officers, managers, or employees be liable for any indirect, punitive, special, incidental, or consequential damages (including loss of anticipated revenue, business interruption, or payer offset actions) arising out of or related to our services.

Payer Delta’s aggregate liability for any direct claim arising out of an active engagement shall not exceed the total fees actually received by Payer Delta from Client in the preceding three (3) months for the specific claim giving rise to liability.

10. Governing Law & Jurisdiction

These Terms, and any dispute arising out of or related to Payer Delta Arizona, shall be governed by, construed, and enforced in accordance with the laws of the State of Arizona, without giving effect to conflict of law principles. Any legal action or proceeding arising under these Terms shall be instituted exclusively in the state or federal courts located in Maricopa County, Arizona, and each party irrevocably submits to the personal jurisdiction of such courts.