Optum Property and Casualty Clearinghouse
OptumInsightTM will provide you, the user, with access to electronic data interchange (EDI) services (the "Services") through the Optum Property and Casualty Clearinghouse. You agree that you are a health care provider or clinic, hospital or other health care facility, billing company or payer or administrator of health care claims legally authorized to enter into a binding contract with OptumInsight for the provision of the Services. If you or the organization has an existing agreement with OptumInsight, the Services are also subject to the terms of that Agreement.
1. Services. The Optum Property and Casualty Clearinghouse enables health care professionals to submit workers' compensation and automobile liability/medical insurance electronic bills and related information electronically and receive timely information about those bills. The Services will capture and forward eBill transactions (X12 837 files) and image file attachments (the "Transactions") electronically to insurance payers by use of the Internet. OptumInsight will also return X12 TA1/999, 277, and 835 responses from insurance payers to bill submitters. OptumInsight will provide you with access to the Services, which may change from time to time. OptumInsight will submit the Transactions in a timely manner to the recipient you indicate. OptumInsight is not responsible for payment or processing of any Transaction after OptumInsight delivers it to the addressed recipient. You acknowledge that the Optum Property and Casualty Clearinghouse may be unavailable from time to time to permit OptumInsight to perform maintenance or for other business reasons. You agree to use the Services for your internal business only.
2. Your Responsibilities. You agree to send only workers' compensation, auto injury liability bills, and related Property and Casualty transactions via the Optum Property and Casualty Clearinghouse. The Optum Property and Casualty Clearinghouse does NOT ACCEPT "commercial" insurance bills. You are responsible for delivering the data content in the Transactions as specified either by the appropriate jurisdictional requirement or by the receiver of the Transaction. You (and not OptumInsight) are responsible for the accuracy of data OptumInsight receives from you and any data forwarded to the insurance payer. It is not the responsibility of OptumInsight to check the accuracy of any bills submitted or to settle any disputes concerning bills submitted. If OptumInsight cannot match an attachment to a bill, OptumInsight is not responsible for forwarding that attachment to a payer. If OptumInsight identifies a problem with a Transaction that may prevent it from being delivered, OptumInsight will notify you, and it is your responsibility to correct and resend the Transaction or otherwise communicate with the applicable recipient. You are responsible for the consequences of the submission of any Transactions to any recipient, and for retaining all bill submission reporting generated by OptumInsight or insurance payers.
3. Data Accuracy.
You are responsible for:
• Proper data entry, coding and submission of only valid data in compliance with all applicable laws and any user guides made available by the Optum Property and Casualty Clearinghouse.
• Testing the Transactions as required by the user guides available on the Optum Property and Casualty Clearinghouse customer web portal before submitting transactions in a production mode.
• Maintenance and security of detailed records is required of all information submitted and received.
4. Fees. OptumInsight is not charging you, in your role as a submitter, a fee for your use of the Optum Property and Casualty Clearinghouse and/or Services. You agree to bear your own costs in any hardware, software, connectivity or other expenses you incur in order to use the Optum Property and Casualty Clearinghouse and/or Services.
5. Use of Materials. This clearinghouse is the property of OptumInsight. You are granted a nonexclusive, nontransferable, limited license to view and use information retrieved from the Optum Property and Casualty Clearinghouse solely in connection with conducting your lawful business. You agree that OptumInsight owns materials OptumInsight has made available through the Optum Property and Casualty Clearinghouse. Using any automatic program with the Optum Property and Casualty Clearinghouse to gather information in an automated manner, or using the Optum Property and Casualty Clearinghouse in any manner which disrupts the normal operation of the Optum Property and Casualty Clearinghouse or its network connection is prohibited and may result in the termination of your access to this website.
6. Your Confidentiality Obligations. From time to time, OptumInsight may disclose or make available to you confidential or proprietary information concerning its business, products or services (together, "Confidential Information"). Confidential Information of OptumInsight includes, without limitation, business plans, systems architecture, information systems, technology, data, computer programs and codes, processes, methods, operational procedures, policies and procedures, customer and employee information, claims information, the existence of any business dealings or agreements between OptumInsight and other third parties, and any other information which is normally and reasonably considered confidential. You agree that during the term of this Agreement and thereafter, you will (i) use Confidential Information belonging to OptumInsight solely for the purposes of this Agreement; and (ii) take all reasonable precautions to ensure that you do not disclose Confidential Information belonging to OptumInsight to any third party (other than your employees, contractors and/or professional advisors on a need-to-know basis who are bound by obligations of nondisclosure and limited use at least as stringent as those contained herein) without first obtaining OptumInsight's written consent. Upon request by OptumInsight, you will return all copies of any Confidential Information to OptumInsight. Confidential Information does not include information that is available to the public or that you obtain from a source other than OptumInsight.
7. Security. You are responsible for identifying the members of your staff who are permitted to access the Services (the "Authorized Users"). You agree to ensure that all Authorized User information provided to OptumInsight is accurate, current and complete, and to notify OptumInsight promptly if any information regarding Authorized Users changes (e.g. role change or termination). Each Authorized User requires an individual user ID and password. Sharing of user IDs and passwords is prohibited. You may not attempt to log in with a User ID and password other than your own, and you may only access portions of the Optum Property and Casualty Clearinghouse you are authorized to access. You agree to treat your password and User ID as confidential, and to share them only with your personnel who have a need to use them for your legitimate business purposes with OptumInsight. You are responsible for maintaining the confidentiality of the IDs and passwords assigned to Authorized Users, and training your Authorized Users regarding proper protection of the IDs and passwords. If you believe your password(s) or User ID(s) have been accessed by an unauthorized person, it is your responsibility to contact OptumInsight immediately, in writing, so that OptumInsight may deactivate them. You are responsible for any damages or losses incurred as a result of your failure or your Authorized Users' failure to maintain the IDs' and passwords' confidentiality, and that OptumInsight shall have no responsibility for damages or losses in such circumstances.
8. Duration. This Agreement continues for one (1) year from the date you accept these terms and shall automatically renew for additional one (1) year terms unless earlier terminated. Either party may terminate this Agreement upon thirty (30) days prior written notice for any reason. If you materially breach your obligations under this Agreement, OptumInsight may terminate this Agreement immediately. OptumInsight may also immediately terminate an individual user's access, if it believes it must do so in good faith in order to comply with law, or to protect its systems or data.
9. Changes to Agreements Terms. OptumInsight may revise any of the terms of this Agreement. If you do not agree with the Agreement revisions, you should no longer use the the Optum Property and Casualty Clearinghouse.
10. Disclaimer of Warranties. Except as expressly provided in this Agreement, OPTUMINSIGHT MAKES NO WARRANTIES OR REPRESENTATIONS RELATING TO THE OPTUM PROPERTY AND CASUALTY CLEARINGHOUSE OR THE SERVICES, EXPRESS OR IMPLIED, AND SPECIFICALLY DISCLAIMS THE WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. THIS WEBSITE AND THE SERVICES ARE PROVIDED "AS IS," SOME JURISDICTIONS MAY NOT ALLOW THE EXCLUSION OF IMPLIED WARRANTIES, OF SOME OF THE ABOVE EXCLUSIONS MAY NOT APPLY TO YOU. IN USING THE SERVICES OR THE OPTUM PROPERTY AND CASUALTY CLEARINGHOUSE, YOU RECOGNIZE AND ASSUME THE RISK OR MISTRANSMISSION, INTERRUPTION AND CORRUPTION OF DATA. Your sole remedy for any damage resulting from your use of the Services or the Optum Property and Casualty Clearinghouse shall be that OptumInsight shall use reasonable commercial efforts to correct any nonconformity in the Optum Property and Casualty Clearinghouse of the Services.
11. Limitation of Damages. OptumInsight is not liable for any direct, indirect, incidental, special or consequential damages resulting in any way from your use of or inability to use the Optum Property and Casualty Clearinghouse or the Services, even if OptumInsight has been advised of the possibility of such damages. You agree that the foregoing allocation of liability and risk is made, in part, in consideration of the fact that you are not charged fees to use the Services or the Optum Property and Casualty Clearinghouse. Absent this allocation, OptumInsight would not provide you with Services or access to the Optum Property and Casualty Clearinghouse. In the event that a court with jurisdiction determines that OptumInsight is liable for damages under this Agreement, such damages shall not exceed $1000.
12. Indemnification. To the maximum extent allowed by law, you will defend, indemnify and hold harmless OptumInsight from and against any and all claims, losses, damages, suits, fees, judgments, costs and expenses (collectively, "Claims"), including attorneys' fees incurred in responding to such Claims, that OptumInsight may suffer or incur arising out of or in connection with: (a) your breach of warranty or damages due to your negligence or willful misconduct; (b) any breach by you of this Agreement; or (c) your introduction of any unauthorized material, "computer virus" or other contaminant into OptumInsight's environment.
13. Applicable Law. This Agreement is
governed by the laws of the State of
14. Force Majeure. OptumInsight is not responsible for delays or failures to perform under this Agreement due to acts or events beyond its control, such as acts of nature, acts of God, natural disasters, governmental actions, civil disturbances, transportation problems, power interruption, communication disruptions, supply disruptions, fire, labor disputes or shortages or acts of any other third parties.
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