This document is a working draft prepared for internal review only. It is not legal advice, it is not final, and it must be reviewed and approved by Carepatron legal before any use, publication, or send. Numbers and positions marked [FOR REVIEW] are recommendations, not confirmed terms. See the open items list at the end.
If we do not get an eligible provider credentialed with their first commercial payer within 60 days, we pay you $200. These terms set out exactly what that means, who qualifies, when the clock runs, and how to claim.
1. Definitions 2. The promise 3. When the clock starts 4. Eligibility 5. Eligible payers 6. Your responsibilities 7. Amount, scope and cap 8. Exclusions 9. How to claim 10. General Open items for legal
In these terms, the following words have the meanings set out below.
Credentialed
A provider is "credentialed" when their first commercial payer approves enrollment, meaning the point at which that payer has accepted the provider into its network or panel so the provider can begin billing that payer for covered services. Credentialing is measured by the first commercial payer approval, not by completion of paperwork, submission of an application, or approval by any later payer.
Commercial payer
A private, non-government health insurer or health plan. Government payers, including Medicare, Medicaid and Tricare, are not commercial payers and are excluded from this guarantee (see section 5).
Complete information packet
All information, documents, signatures and authorizations we request from the practice to begin and submit a credentialing application, provided accurately and in full. This typically includes provider identifiers (such as NPI), licensure and certification details, practice and location details, CAQH access or completion, and any payer-specific forms or authorizations we request. The packet is "complete" only when we have everything we have asked for and the information is accurate.
Business day
A day other than a Saturday, Sunday or United States federal public holiday. [FOR REVIEW: confirm business-day definition and applicable holiday calendar.]
We, us, Carepatron
Carepatron and its managed billing service. For credentialing, Carepatron acts as the practice's agent only. Applications are made under the practice's own NPI, and Carepatron is never a signatory to the practice's payer agreements or bank accounts.
You, the practice, the provider
The Carepatron customer enrolled in managed billing, and each individual provider within that practice for whom we are performing new credentialing.
If an eligible provider's first commercial payer is not approved within 60 days of the clock start (defined in section 3), we will pay you $200 for that provider, subject to the eligibility rules, responsiveness condition, scope, cap and exclusions in these terms.
Payout form. The $200 will be applied as an account credit to your Carepatron managed billing account. [FOR REVIEW: confirm payout form. Drafted position is a $200 account credit (instant, no cheque). Alternative is a cash payment or cheque, which matches "we pay you" more literally but requires more operational handling.]
The 60-day period runs from the date we receive a complete information packet from the practice for the relevant provider. It does not run from your signup date, your subscription start date, or the date you first asked us to begin credentialing.
We will confirm in writing when we treat a packet as complete and the clock has started. If we later identify that information was missing or inaccurate, the clock start may be reset to the date the packet is actually complete and accurate. [FOR REVIEW: confirm clock-start trigger is receipt of a complete information packet, and confirm how clock-start is communicated to the practice.]
This guarantee applies to new credentialing only, meaning providers who are starting commercial payer credentialing with Carepatron.
It does not apply to, and the clock does not run for:
[FOR REVIEW: confirm eligibility is limited to new credentialing and the listed exclusions (re-credentialing, revalidations, in-progress enrollments).]
The guarantee and the 60-day clock apply to commercial payers only.
Government payers are excluded from the clock and from any payout, including Medicare, Medicaid and Tricare, because their processing timelines are set by the payer and are outside anyone's control. We will still perform government payer enrollment where it is part of your managed billing service, but it is not covered by this guarantee. [FOR REVIEW: confirm commercial-only scope and the list of excluded government payers with Glen.]
For us to deliver inside 60 days, we need timely, accurate input from the practice. The 60-day clock therefore counts days in our control:
We will tell you what we need and when we are waiting on you, so the status of the clock is clear.
The payout under this guarantee is your sole and exclusive remedy for a missed 60-day credentialing timeline. [FOR REVIEW: confirm "sole and exclusive remedy" framing.]
The guarantee does not apply, and no payout is due, where the delay is outside our control or otherwise falls into the cases below. This includes:
For clarity, the following are out of scope of managed billing and are never covered by this guarantee:
Nothing in these terms is a promise of any approval timeline beyond the conditioned scope set out here. We do not guarantee that any payer will approve a provider.
If an eligible provider's first commercial payer is not approved within the 60-day period (excluding any paused days under section 6), you can claim the $200 for that provider.
We may ask for reasonable information to verify a claim.
Every item below is marked [FOR REVIEW] in the terms above. These are recommended drafting positions, not confirmed terms, and need sign-off before any use.
Not represented in these terms, but required before launch (per spec): the current sub-60-day first-commercial-payer completion rate (spec item D7, Glen to provide) and the named legal sign-off owner (spec item D10). These are operational gates, not terms language.