Services & Scope Policy

Purpose

Claim Clarity Consulting provides medical billing and revenue-cycle support, consulting, assessments, workflow improvement, and training. This policy explains general service boundaries. A listed service is not automatically included in an engagement.

Services Available by Written Agreement

Depending on the accepted scope and required review, services may include:

• Billing and claims workflow reviews, operational assessments, and denial-trend analysis.
• Authorized claims follow-up, aging accounts-receivable support, reimbursement research, and denial-resolution support.
• Process mapping, workflow improvement, standard operating procedures, job aids, and implementation planning.
• Staff education, organizational training, and workflow coaching.
• Credentialing or enrollment support and short-term revenue-cycle projects.

Each engagement must identify the specific services, deliverables, responsibilities, schedule, fees, and any authorized access in the applicable Statement of Work or other written engagement document accepted by both parties. An inquiry, discovery call, website description, booking, or payment does not by itself authorize services beyond the accepted written scope.

Eligibility and Conflict Review

Services remain subject to applicable client-eligibility, confidentiality, compliance, outside-employment, and conflict-of-interest review. Claim Clarity Consulting may decline, restrict, pause, modify, or terminate work when necessary to meet those obligations, subject to applicable agreements and law.

Payment will not be accepted for an engagement while its applicable eligibility screen is designated Hold for Review or Decline. A booking or payment does not override required review or authorize restricted work.

Restricted and Excluded Activities

Unless specifically accepted in writing after applicable review, services exclude:

• Payer representation or acting as a client’s agent in appeals, grievances, provider disputes, hearings, or other adverse proceedings.
• Payer-side medical or reimbursement policy development.
• Claims-edit or FACETS configuration.

Operational research, documentation support, or education does not itself authorize payer representation.

Services always exclude legal, clinical, tax, accounting, cybersecurity, or other licensed professional advice, and work based on confidential, proprietary, or nonpublic information obtained through the owner’s employment or another restricted relationship. Client authorization or a scope change cannot authorize those always-excluded activities.

Information Sources and Client Responsibilities

Work may use general professional knowledge, public information, appropriately licensed authorities, independently developed methods, and information lawfully provided and authorized for the engagement.

Clients must provide accurate, complete, timely information and only documents or access they have authority to provide, using approved methods. Clients remain responsible for approvals, implementation, and final business, billing, coding, clinical, compliance, privacy, security, legal, financial, staffing, and payer decisions. Recommendations do not replace required client-specific validation or qualified professional advice.

Patient Information and System Access

Do not submit patient records, protected health information (PHI), passwords, access credentials, or other sensitive information through general email, public forms, booking questionnaires, general AI tools, or preliminary discussions.

PHI or client-system access must not be provided until the permitted scope, approved secure exchange or access method, and applicable safeguards have been agreed in writing. A Business Associate Agreement and other required agreements must be completed before access or disclosure when applicable. Availability of a business tool or a connected account does not establish its suitability or authorization for PHI.

Scope Changes

Material changes to services, deliverables, assumptions, access, schedule, responsibilities, or fees require written acceptance before the changed work begins and may require an amended Statement of Work or Change Order. Changes remain subject to required eligibility, conflict, confidentiality, security, and compliance review.

Fees, Results, and Training

Fees, payment timing, approved expenses, cancellation terms, and refund treatment are governed by the applicable accepted engagement, booking, invoice, and policy terms. This policy establishes no new pricing model, automatic late fee, or refund restriction.

Claim Clarity Consulting does not guarantee collections, reimbursement, denial reduction, payer decisions, compliance determinations, financial results, or other particular outcomes. Training does not award professional certification or approved continuing-education credit unless expressly stated for the specific offering.

Written Agreements Control

This policy provides general guidance and does not replace or modify signed engagement documents. The Consulting Services Agreement establishes general engagement terms; the applicable Statement of Work or Change Order defines the specific work and any express permitted modifications. A Business Associate Agreement, secure-access addendum, or other specialized agreement governs its stated subject matter. Nothing in this policy authorizes a violation of applicable law or changes binding contractual obligations.

Contact

Questions about services or an appropriate way to share information may be sent to hello@claimclarityconsulting.health. Please describe your needs without including sensitive information.