Dental Provider Supplemental Terms
If you are a Dental Provider, the following Supplemental Terms apply to you:
1. Fee Schedule. Dental Provider acknowledges that the schedule of fees (“Fee Schedule”) listed for Dental Provider at a particular Sub-Merchant or for a particular Plan as set forth in Dental Provider’s Account is the basis for the costs for certain specified dental procedures (each, a “Procedure”) as generated for each Treatment Summary (defined below). Dental Provider is solely responsible for setting, maintaining, and updating the Fee Schedule as appropriate and in accordance with any applicable Plan rules.
2. Procedure Costs. The Services enable Dental Providers or their Practice User to present Members a financial presentation of costs, Employer contributions and Member discounts, if any, associated with each diagnosed Procedure (each, a “Treatment Summary”). The Employer contributions, Member discounts, and financial presentations displayed on the web portal are based on the Fee Schedule and other information provided by Dental Provider, the Plan and/or the applicable Member, the Company makes no representation or warranty with regard to the accuracy or completeness thereof. Dental Provider agrees to accept payment for the Services from the Member and Employer in accordance with the Member’s Plan.
3. Payment. With respect to any Treatment Summary that a Member has approved and Dental Provider or Practice User has confirmed as complete via the Services, the Company will (or will cause its vendors to) use commercially reasonable efforts to collect as payment facilitator those amounts from the Employer and Member as set forth in the Treatment Summary, and will remit such collected funds to the applicable Sub-Merchant account, less any deductions, offsets or payment processing fee (as set forth in the Sub-Merchant Payment Services Agreement), as payment for the Dental Provider’s services. You will not invoice the Member, directly or indirectly, except for a Member’s unpaid share as determined under the Member’s Plan, if applicable (provided that such invoices may, in a clear manner, identify those costs and expenses paid or payable by insurance or other third parties, as appropriate under applicable law). You acknowledge that no payment or portion thereof will be delivered to you until the Procedures in the Treatment Summary have been fully performed and such amount has been collected from the Employer, Member, or other third party. Such payments will be settled through the Services to the account of the Sub-Merchant at which the Procedures were performed, subject to the Sub-Merchant Supplemental Terms and all other applicable Terms. In the event you incorrectly or fraudulently notify the Company that any Procedure has been performed, you shall indemnify and hold the Company harmless from any and all claims, damages, liabilities, losses, penalties and settlements incurred by the Company with respect to such incorrect or fraudulent notification.
4. Payment Disputes. You acknowledge that all payments are conditional and subject to reversals and adjustments. The Company will notify you if any Member, Employer, or other third party disputes your performance of any Procedure or payments owed by a Member. The Company has the right to hold all amounts paid by a Member and the Employer, if any, with respect to such dispute, until: (i) the Member provides the Company with instructions to release the held amounts; or (ii) receipt of an order from a court of competent jurisdiction or binding arbitration.
HIPAA. For the avoidance of doubt, your behavior and interactions with your patients and our Members must conform to best practices as well as all applicable laws, including HIPAA.