Last updated: March 6, 2026
These Terms of Service (“Terms,” “Agreement”) constitute a legally binding agreement between you, the entity you represent, or the individual accessing or using the DenialFixer platform (“Customer,” “you,” “your”) and DenialFixer (“Company,” “we,” “us,” “our”). By accessing, registering for, or using the DenialFixer platform, including all associated software, services, applications, and websites (collectively, the “Service” or “Platform”), you acknowledge that you have read, understood, and agree to be bound by these Terms. If you are entering into this Agreement on behalf of a company, organization, or other legal entity, you represent and warrant that you have the authority to bind such entity to these Terms.
If you do not agree to these terms, do not access or use the service.
“Authorized User” means any individual authorized by Customer to access and use the Service under Customer's account, including employees, contractors, and agents.
“Business Associate Agreement” or “BAA” means the separate agreement governing the use, disclosure, and protection of Protected Health Information in accordance with HIPAA, incorporated herein by reference.
“Customer Data” means all electronic data, information, or material submitted, uploaded, or transmitted by Customer or its Authorized Users to the Service, including ERA files, claim information, patient records, appeal letters, and any Protected Health Information.
“ERA File” means an Electronic Remittance Advice file (ANSI X12 835 transaction) containing payment and claim adjudication information from health insurance payers.
“HIPAA” means the Health Insurance Portability and Accountability Act of 1996, as amended, including the Privacy Rule, Security Rule, Breach Notification Rule, and the HITECH Act.
“PHI” or “Protected Health Information” has the meaning set forth in 45 C.F.R. Section 160.103, and includes any individually identifiable health information transmitted or maintained through the use of the Service.
“Subscription Term” means the period during which Customer has agreed to subscribe to the Service, including any renewal periods.
DenialFixer is a cloud-based software-as-a-service platform designed to assist behavioral health practices with medical billing denial management. The Service provides tools for uploading and parsing ERA files, identifying denied claims, generating AI-assisted appeal letters, editing and submitting appeal correspondence, tracking denial patterns, and accessing analytics.
The Service utilizes artificial intelligence technology, including large language models provided by third-party AI providers, to assist in the generation of appeal letter drafts. The AI-generated content is intended as a starting point and drafting aid only. All AI-generated output requires review, editing, and approval by qualified personnel at the Customer's practice before submission to any payer or third party.
The Service is a software tool designed to increase operational efficiency. DenialFixer does not provide legal advice, medical advice, medical coding advice, billing consultation, or any form of professional advisory services. The Service does not guarantee that any appeal will be successful, that any denied claim will be overturned, or that any particular outcome will result from use of the Platform.
The Service is available only to entities and individuals engaged in the lawful provision of behavioral health services or that provide billing and administrative services on behalf of such entities. By registering, you represent that you are at least eighteen (18) years of age and have the legal authority to enter into this Agreement.
Customer must provide accurate, current, and complete information during registration and promptly update it. Customer is responsible for maintaining the confidentiality of account credentials and for all activity under its account. Customer shall immediately notify DenialFixer of any unauthorized use.
Customer shall use the Service solely for its intended purpose of managing medical billing denials in compliance with all applicable laws and regulations. Customer shall not:
AI-Generated Content may contain errors, inaccuracies, omissions, or statements that are incomplete or not applicable to a specific claim. It is not a substitute for the professional judgment of qualified billing specialists, healthcare providers, or legal professionals. The AI models are developed by third-party providers and DenialFixer does not control their underlying logic or output.
Customer assumes full and sole responsibility for reviewing, editing, verifying, and approving all AI-Generated Content before submitting it to any payer, clearinghouse, government agency, or third party. DenialFixer makes no guarantee that AI-Generated Content will result in the reversal of any denial or the recovery of any payment.
In the course of providing the Service, DenialFixer will create, receive, maintain, and transmit Protected Health Information on behalf of Customer. The parties shall execute a Business Associate Agreement (BAA) governing DenialFixer's obligations with respect to PHI. The BAA is incorporated into these Terms. In the event of any conflict between these Terms and the BAA regarding PHI, the BAA shall control.
Customer represents and warrants that it has obtained all necessary consents and authorizations required under HIPAA and applicable state law to upload and process PHI through the Service, and shall comply with all applicable provisions of HIPAA.
Customer acknowledges that PHI may be processed by AI systems, including third-party AI providers, for the purpose of generating appeal letters. DenialFixer shall not use PHI for training AI models without Customer's prior written consent.
Customer retains all right, title, and interest in Customer Data, including all PHI. Nothing in these Terms transfers ownership of Customer Data to DenialFixer. Customer grants DenialFixer a non-exclusive, limited, royalty-free license to access and use Customer Data solely to provide the Service.
DenialFixer may create aggregated, anonymized, and de-identified data derived from Customer Data (“Aggregated Data”) and may use it for product improvement, benchmarking, and analytics. All de-identification shall comply with 45 C.F.R. Section 164.514.
DenialFixer and its licensors retain all right, title, and interest in the Service, including all software, algorithms, AI models and prompts, interfaces, and related intellectual property.
DenialFixer operates on a performance-based pricing model. There are no setup fees, subscription fees, per-claim charges, or monthly minimums. Customer's sole financial obligation is a percentage-based fee applied to revenue that DenialFixer successfully recovers on Customer's behalf (the “Performance Fee”).
The base Performance Fee is fifteen percent (15%) of the gross amount actually recovered by DenialFixer for each denied claim (“Recovered Revenue”). “Recovered Revenue” means the dollar amount paid by a payer on a previously denied claim after DenialFixer generates and/or submits an appeal or corrected claim on Customer's behalf. Recovered Revenue is determined by matching payments received in Customer's subsequent Electronic Remittance Advice (ERA/835) files to claims for which DenialFixer submitted an appeal.
Customer acknowledges and agrees that upon successful recovery of a denied claim, Customer is unconditionally obligated to pay DenialFixer the applicable Performance Fee. This obligation arises at the moment the payer remits payment on a previously denied claim for which DenialFixer provided appeal services, regardless of:
The Performance Fee is earned when the payer issues payment. Customer may not withhold, offset, or delay payment of the Performance Fee for any reason.
DenialFixer identifies Recovered Revenue by analyzing Customer's subsequent ERA files. Customer agrees to continue uploading ERA files (or maintain automated ERA retrieval) for a minimum of one hundred and eighty (180) days following termination to allow identification of recoveries on appeals submitted during the Subscription Term. DenialFixer will issue monthly invoices detailing each recovered claim, the payer, the recovered amount, and the Performance Fee owed. Invoices are due within thirty (30) days of issuance.
If a payer pays less than the originally denied amount, the Performance Fee applies only to the amount actually recovered. Example: if a $500 denied claim is recovered at $400, the Performance Fee at 15% is $60.
DenialFixer offers a referral program that allows Customer to reduce its Performance Fee rate. For each practice that registers for DenialFixer using Customer's unique referral code and maintains an active account, Customer's Performance Fee rate is reduced by one percentage point (1%), to a minimum of ten percent (10%). The discount applies for as long as the referred practice remains an active DenialFixer customer. If a referred practice cancels or becomes inactive, Customer's rate will be recalculated upward accordingly. DenialFixer reserves the right to modify, suspend, or terminate the referral program at any time upon thirty (30) days' notice. Any discounts earned prior to modification remain in effect for existing active referrals.
Overdue amounts accrue interest at 1.5% per month or the maximum rate permitted by law, whichever is lower. DenialFixer may suspend access to the Service until all outstanding amounts are paid. If an account remains delinquent for more than thirty (30) days, DenialFixer may terminate the account upon fifteen (15) days' written notice. Customer shall reimburse all reasonable collection costs, including attorneys' fees and costs incurred in enforcing payment.
Customer's obligation to pay the Performance Fee for all appeals submitted during the Subscription Term survives termination or expiration of this Agreement. If a payer issues payment on a previously denied claim after Customer terminates the Service, Customer remains obligated to pay the applicable Performance Fee. This obligation continues for twenty-four (24) months following the date of termination.
DenialFixer reserves the right, upon reasonable notice, to request ERA files or payment records from Customer to verify that all Recovered Revenue has been properly reported and that all Performance Fees owed have been paid. Failure to cooperate with a reasonable audit request constitutes a material breach of this Agreement.
DenialFixer offers a free denial audit tool that analyzes ERA files locally in Customer's browser to estimate recoverable revenue. The free audit does not require an account, does not transmit PHI, and creates no payment obligation. Results are estimates only and do not guarantee any level of actual recovery.
DenialFixer shall use commercially reasonable efforts to maintain 99.5% uptime monthly, excluding scheduled maintenance. Scheduled maintenance will be announced with at least 24 hours' notice when possible.
If DenialFixer fails to meet the uptime commitment, Customer may request service credits: 5% for 99.0%-99.4% uptime, 10% for 95.0%-98.9%, and 25% for below 95.0%. Credits are the sole remedy and may not exceed the monthly fee. Technical support is available via email during standard business hours (Mon-Fri, 9 AM - 6 PM ET).
DenialFixer implements administrative, physical, and technical safeguards including: encryption in transit (TLS 1.2+), encryption at rest (AES-256), role-based access controls, regular security assessments, audit logging, incident response procedures, and employee security training. The Service is hosted on enterprise-grade cloud infrastructure with SOC 2 Type II compliance.
In the event of a confirmed security incident involving Customer Data, DenialFixer shall notify Customer without unreasonable delay as specified in the BAA.
Each party agrees to hold the other's Confidential Information in strict confidence and to use it solely for fulfilling obligations under this Agreement. Confidential Information excludes information that is publicly available, previously known, independently developed, or rightfully obtained from a third party.
The Service, including all AI-generated content, analytics, reports, and all features, is provided on an “AS IS” and “AS AVAILABLE” basis without warranties of any kind. DenialFixer disclaims all warranties, including implied warranties of merchantability, fitness for a particular purpose, and non-infringement. DenialFixer does not warrant that the Service will be uninterrupted, error-free, or that use of the Service will result in the reversal of any claim denial or the recovery of any payment.
In no event shall DenialFixer be liable for any indirect, incidental, special, consequential, punitive, or exemplary damages, including loss of profits, revenue, goodwill, or data. DenialFixer's total aggregate liability shall not exceed the total amounts paid by Customer during the twelve (12) months preceding the claim. DenialFixer shall not be liable for any loss arising from Customer's submission of AI-generated content without adequate review, denial of any claim or appeal, or penalties imposed by any regulatory body.
Customer shall defend, indemnify, and hold harmless DenialFixer and its affiliates, officers, directors, employees, and agents from all claims, losses, damages, liabilities, costs, and expenses (including attorneys' fees) arising from: Customer's use of the Service; breach of these Terms; violation of any applicable law including HIPAA; submission of AI-generated content without adequate review; and the acts or omissions of Customer's Authorized Users.
Customer may terminate at any time by providing thirty (30) days' written notice through account settings or by emailing legal@denialfixer.com. There is no minimum contract term. DenialFixer may terminate for convenience upon thirty (30) days' notice, immediately for material breach not cured within fifteen (15) days, or immediately for non-payment exceeding thirty (30) days.
Upon termination: (a) DenialFixer will complete processing of any appeals that have already been submitted to payers; (b) Customer has thirty (30) days to export data; (c) DenialFixer will securely delete all Customer Data within thirty (30) additional days except as required by law. Customer remains unconditionally obligated to pay the Performance Fee for all claims recovered as a result of appeals submitted during the Subscription Term, even if recovery occurs after termination (see Section 8.8). Customer agrees to continue uploading ERA files for 180 days following termination to enable recovery tracking, or to provide equivalent payment records upon request.
The parties shall first attempt to resolve disputes through informal negotiation for thirty (30) days. If unresolved, disputes shall be submitted to binding arbitration under the Commercial Arbitration Rules of the American Arbitration Association. Each party bears its own costs; arbitration fees are shared equally.
Customer agrees that any dispute resolution will be conducted on an individual basis and not as a class, consolidated, or representative action. Customer waives any right to participate in a class action lawsuit or class-wide arbitration.
This Agreement is governed by the laws of the State of Delaware without regard to conflict of laws principles.
DenialFixer may modify these Terms at any time. For material changes, DenialFixer will provide at least thirty (30) days' prior notice via email or in-app notification. Continued use after the effective date of modifications constitutes acceptance. If Customer does not agree, the sole remedy is to discontinue use.
These Terms, the BAA, and any order forms constitute the entire agreement between the parties. If any provision is found unenforceable, it shall be modified to the minimum extent necessary or severed; the remaining provisions continue in full force. Failure to exercise any right does not constitute a waiver. Customer may not assign this Agreement without prior written consent. DenialFixer may assign freely in connection with a merger, acquisition, or sale of assets. The parties are independent contractors. Neither party is liable for delays caused by force majeure events.
Questions about these Terms? Contact us at legal@denialfixer.com
By accessing or using the DenialFixer Platform, you acknowledge that you have read, understood, and agree to be bound by these Terms of Service.