Settlement Terms
Terms governing how recovered claim dollars are calculated, confirmed, and reconciled through the NorthStarClaim contingency recovery service.
Terms of Settlement
Terms & Conditions — Recovery Calculation, Fee Assessment & Reconciliation for the NorthStarClaim Contingency Recovery Service
These terms govern how recovered dollars are calculated, how the contingency fee is assessed, and how reconciliations are handled across the NorthStarClaim recovery service. NorthStarClaim is a claim-recovery software service; it is not a bank, clearinghouse, or payment network.
ARTICLE I: Recovery Scope & Claim Eligibility
NorthStarClaim analyzes submitted claim data and drafted appeals to identify denial-recovery opportunities for commercial insurance payers, managed care networks, and government healthcare programs. Recoveries are calculated only from dollars actually confirmed as recovered from a payer.
By submitting claim data, the participating healthcare provider ("Beneficiary Provider") represents that all clinical data, medical coding summaries, and supporting documentation submitted to the platform are accurate and correspond to true, non-fraudulent claim events.
ARTICLE II: Recovery Confirmation & Finality
A recovery is considered confirmed when the applicable payer remits payment or issues an adjustment that restores the previously denied amount, and that remittance is reconciled in the Beneficiary Provider's records.
NorthStarClaim does not operate a payment network and does not itself move funds. Funds are remitted by payers directly to the Beneficiary Provider using the payer's own payment rails. NorthStarClaim records recoveries for the purpose of calculating the contingency fee.
Recovery Confirmation
A recovery is confirmed when a payer remittance or adjustment restoring the denied amount is matched to the corresponding claim in the Beneficiary Provider's records. Confirmed recoveries are the basis on which the contingency fee is calculated.
Fee Basis
The contingency fee applies only to dollars that are confirmed as recovered. No fee is assessed on claims that remain denied, are written off, or otherwise do not result in a confirmed recovery.
Liability Boundary
The Beneficiary Provider bears full responsibility for the accuracy of all claim data submitted. Post-recovery disputes are handled through the reconciliation process described in Article III.
ARTICLE III: Payer Clawback & Fee Reconciliation
Commercial health insurance payers may issue retrospective audits, down-code adjustments, or post-payment clawbacks weeks or months after a claim clears. To keep fee calculations accurate, the following reconciliation process applies:
1. DEFICIT IDENTIFICATION: If a payer issues a retroactive cancellation, down-code, or clawback against a previously recovered claim, that claim is marked as a "Reconciliation Deficit."
2. FEE ADJUSTMENT: Rather than requiring separate invoicing, the contingency fee associated with the clawed-back dollars is credited against the Beneficiary Provider's subsequent fee assessment.
3. NET BALANCE RECONCILIATION: Adjustments are applied until the net reconciled balance returns to zero. This keeps fee assessments tied to dollars that remain genuinely recovered.
ARTICLE IV: Governing Law
This document is governed by the laws of the State of Wyoming, United States, without regard to conflict-of-laws principles. Any dispute arising from the recovery calculation, fee assessment, or reconciliation terms described here will be resolved through the dispute-resolution provisions set out in the Master Services Agreement between the parties.
ARTICLE V: Billing & Contingency Fee Capture
Payment Processing
Invoicing and payment processing are handled through Stripe, Inc. NorthStarClaim does not itself hold or transmit recovered funds; payer remittances flow directly to the Beneficiary Provider, and the contingency fee is billed separately through Stripe.
Contingency Fee Mechanics
The contingency fee is 42.5% of recovered dollars, with $0 upfront cost. The fee is calculated only against confirmed recoveries, not at the point of claim submission. No fee is assessed on claims that fail to recover or that are rejected by the payer.
Billing Basis
Fees are assessed on the net value of confirmed recoveries. Where an enterprise Private Offer provides for committed-spend drawdown, fees reconcile against that commitment; otherwise fees are invoiced directly. There is no charge for platform access, onboarding, or claims that do not recover.
ARTICLE VI: Data Handling & Audit Logging
Transient Processing
Clinical data is processed transiently to perform claim analysis and appeal drafting. NorthStarClaim designs its platform for HIPAA-aligned handling and does not retain clinical data after transmission, beyond what is required to complete the requested processing.
Audit Logging
Platform actions are recorded in an audit log with access restricted to authorized users. Audit entries are retained for compliance review and are protected by encryption and role-based access controls. This document does not claim the audit log is immutable; administrative retention rules apply.
Data Interchange
Standard healthcare billing formats (for example, ANSI-X12 837/835) are parsed to support claim analysis and appeal generation. NorthStarClaim does not operate payment rails or proprietary clearinghouse networks; interchange with payers is performed using standard healthcare transaction formats.
ARTICLE VII: Roles & Responsibilities
Role of NorthStarClaim
NorthStarClaim provides claim analysis and appeal-drafting software on a contingency basis. It is not a bank, clearinghouse, or payment network, and it does not provide legal or clinical advice. Fee calculations and reconciliation follow the terms described in these Articles.
Role of the Beneficiary Provider
The Beneficiary Provider is responsible for the accuracy of submitted claim data, for maintaining its own billing and remittance records, and for complying with applicable healthcare and privacy regulations. Recovery outcomes depend on payer decisions and are not guaranteed.
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