Terms of Service

1. Agreement

These Terms of Service (“Terms”) govern access to and use of the websites and services of Appelo, Inc. (“Appelo,” “we,” “us”). By using the service, you agree to these Terms on behalf of yourself and, if you use the service for an organization, on behalf of that organization (“Customer”). If you have a signed agreement with Appelo (such as an order form or master services agreement), that agreement controls where it conflicts with these Terms.

2. The service — and the human-approval model

Appelo provides software agents that prepare and draft revenue-cycle work: appeal letters, documentation-gap findings, and prior-authorization packets and tracking. The service is designed so that a member of Customer's staff reviews and approves every output before it is used or submitted. Appelo does not make, and is not a substitute for, any clinical, coding, coverage, or billing decision. Appelo does not provide medical, legal, or billing advice.

3. Accounts and access

• Customer is responsible for the accuracy of account information and for safeguarding credentials and sign-in methods.
• Customer will ensure that only authorized personnel access the service, and will notify us promptly of any suspected unauthorized access.

4. Customer responsibilities

• Review and approval. Customer is responsible for reviewing, editing where needed, and approving every draft before submission to a payer or any third party. Approved outputs are Customer's submissions.
• Accuracy of inputs. Customer is responsible for the accuracy and lawfulness of the data it provides to the service.
• Lawful use. Customer will use the service in compliance with applicable law, including HIPAA and payer-program requirements, and will not use it to prepare claims or appeals it knows to be false or unsupported.
• No misuse. No reverse engineering, no circumventing security, no reselling access, and no use of the service to build a competing product.

5. PHI and the Business Associate Agreement

Before any protected health information (PHI) is processed, Appelo and Customer execute a Business Associate Agreement (BAA). The BAA — not these Terms — governs the use, disclosure, and safeguarding of PHI, and controls over these Terms with respect to PHI. See our BAA overview.

6. Data and intellectual property

• Customer data is Customer's. Customer retains all rights to the data it submits and to the approved letters, packets, and other outputs generated for it through the service.
• The service is ours. Appelo retains all rights to the service, software, and underlying technology. We never use Customer PHI to train machine-learning models.
• Feedback you choose to give us may be used to improve the service without obligation.

7. Fees

Fees, billing terms, and any usage-based components are set out in the applicable order form. Unless stated otherwise there, fees are non-refundable. Our pricing approach is described on the Pricing page.

8. Confidentiality

Each party will protect the other's confidential information with at least the care it uses for its own, and use it only as needed to perform under these Terms. This obligation does not cover information that is public, independently developed, or rightfully received from a third party.

9. Disclaimers

THE SERVICE IS PROVIDED “AS IS.” APPELO DOES NOT WARRANT THAT ANY APPEAL WILL BE OVERTURNED, THAT ANY PRIOR AUTHORIZATION WILL BE APPROVED, OR THAT ANY CLAIM WILL BE PAID. DRAFTS MAY CONTAIN ERRORS, WHICH IS WHY EVERY OUTPUT REQUIRES CUSTOMER REVIEW AND APPROVAL. TO THE MAXIMUM EXTENT PERMITTED BY LAW, APPELO DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT.

10. Limitation of liability

TO THE MAXIMUM EXTENT PERMITTED BY LAW, NEITHER PARTY WILL BE LIABLE FOR INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES, OR FOR LOST PROFITS OR REVENUE; AND EACH PARTY'S AGGREGATE LIABILITY ARISING OUT OF THE SERVICE WILL NOT EXCEED THE FEES PAID OR PAYABLE BY CUSTOMER IN THE TWELVE MONTHS BEFORE THE EVENT GIVING RISE TO THE CLAIM. THESE LIMITS DO NOT APPLY WHERE PROHIBITED, AND DO NOT LIMIT OBLIGATIONS UNDER THE BAA TO THE EXTENT THE BAA SAYS OTHERWISE.

11. Term, suspension, and termination

• Either party may terminate as set out in the applicable order form, or for material breach that goes uncured after written notice.
• We may suspend access to protect the security or integrity of the service, with notice where practicable.
• On termination, Customer may export its data, and PHI will be returned or destroyed as the BAA directs.

12. General

These Terms are governed by the laws of the State of Delaware, excluding its conflicts rules. We may update these Terms from time to time; material changes will be posted here with an updated date, and continued use after the effective date constitutes acceptance. If any provision is unenforceable, the rest remain in effect.

13. Contact

Questions about these Terms: [email protected].