Scope of the Solution Addendum

BY ENTERING INTO AN ORDER UNDER WHICH CUSTOMER WILL BE GIVEN ACCESS TO AND/OR USE OF ANY SAAS SERVICES IDENTIFIED AS “PATIENT ACCESS” AND/OR “REVENUE CYCLE AUTOMATION”, CUSTOMER HEREBY ENTERS INTO THIS SCOPE OF THE SOLUTION ADDENDUM (THIS “ADDENDUM”) AND IS LEGALLY BOUND THEREBY. THIS ADDENDUM IS HEREBY ATTACHED TO AND MADE A PART OF THE GENERAL TERMS AND CONDITIONS (“GENERAL TERMS”) SET FORTH AT HTTPS://WWW.INFINX.COM/TERMS-AND-CONDITIONS-FOR-CUSTOMER-AGREEMENTS BY AND BETWEEN THE CONTRACTING INFINX ENTITY PROVIDER DESIGNATED IN THE ORDER(S) ON BEHALF OF ITSELF AND ITS AFFILIATES (INCLUDING WITHOUT LIMITATION, ITS OFF-SHORE AFFILIATES WHICH INCLUDE INFINX SERVICES PVT. LTD., LOCATED IN INDIA AND INFINX HEALTHCARE PHILIPPINES, INC., LOCATED IN THE PHILIPPINES) (COLLECTIVELY, “INFINX”), AND THE PURCHASING BUSINESS OR OTHER ENTITY WHO IS ENTERING INTO THE ORDER(S) (“CUSTOMER”), REGARDING THE PROVISION AND USE OF THE INFINX OFFERINGS SET FORTH IN SUCH ORDER(S). THE PERSON EXECUTING THE ORDER(S) ON BEHALF OF CUSTOMER REPRESENTS AND WARRANTS TO INFINX THAT THEY HAVE FULL LEGAL AUTHORITY TO ACCEPT THE TERMS OF THIS ADDENDUM AND THAT THEY AND CUSTOMER ARE NOT BANNED FROM USING THE INFINX OFFERINGS UNDER THE LAWS OF THE UNITED STATES OR ANY OTHER COUNTRY. ALL CAPITALIZED TERMS USED IN THIS ADDENDUM BUT NOT DEFINED WILL HAVE THE SAME MEANINGS GIVEN IN THE GENERAL TERMS OR APPLICABLE ORDER. IN THE EVENT OF A CONFLICT BETWEEN THE TERMS OF THIS ADDENDUM, THE GENERAL TERMS AND THE ORDER, THE FOLLOWING DESCENDING ORDER OF PRECEDENCE WILL CONTROL: THE ORDER, THIS ADDENDUM AND THE GENERAL TERMS.

  1. SCOPE OF THE SOLUTION – REVENUE CYCLE AUTOMATION SAAS SERVICES.
    The scope of the claim status check consists of the following: (a) validate the request for completeness of information; (b) initiate claim status check for payers supported by the automation; and (c) communication or notification will be sent to requestors, informing them of the status of their request.
  2. SCOPE OF THE SOLUTION – PATIENT ACCESS SAAS SERVICES.
    Patient Access SaaS Services include setup and implementation as further described below:
    1. Infinx Responsibilities.
      1. Setup customer contract and tenant for the Patient Access SaaS Services.
      2. Configure product including payer, provider and facility master information.
      3. Configure payer portal credentials for automation.
      4. To the extent specifically provided in the applicable Order, integrate with the EMR via HL7 or API based integration based on existing APIs or EMR marketplace integrations.
      5. Setup reporting and analytics dashboards.
      6. Test and validate the setup for completeness and accuracy including integration and user acceptance testing with Customer.
      7. Remote user training and providing self-service training materials.
      8. Assist with system launch and transition to live operational use.
      9. 30 days of warranty support post go-live to assist with resolving issues.
      10. Process mapping and standardization of client patient access process.
      11. Create a Standard Operating Procedures (SOP) document following a process discovery call with Customer (such document to be amended to include Patient Access Production Services if not originally included but later added at the request of Customer).
      12. The following are out of scope for setup and implementation: (A) customization of software or any custom development; (B) custom integration development or customizations to the standard integration specifications; or (C) any custom payer mapping.
    2. Customer Responsibilities.
      1. Provide requested information regarding Customer as necessary for setup and implementation.
      2. Approve the SOP document prior to go-live (as well as any amendments if applicable).
  3. SCOPE OF THE SOLUTION – PATIENT ACCESS SAAS SERVICES AND PRODUCTION SERVICES: PRIOR AUTHORIZATION.
    1. Determination of requirement for authorization: The solution will determine if a given procedure requires a prior authorization from the payer.
    2. Initiation of Authorization: The initiation of authorization is a critical step in the prior authorization process and will focus on the following aspects: (i) validation and verification of the request to ensure completeness of information to submit for authorization; (ii) submission of authorization requests to the payer through the appropriate channel for the payer; (iii) communication or notification will be sent to requestors, informing them of the status of their authorization request; and (iv) requestors will be kept informed throughout the authorization process, including any additional information required or approvals granted.
    3. The following items are considered out of scope for this solution: (i) appeal initiation; (ii) reconsideration initiation; (iii) CPT/ICD interpretation; (iv) peer to peer consultations; (v) referral initiation; (vi) pre-determination checks and initiation; (vii) any changes to authorization post final status of authorization; or (viii) physician calling for clinical documents.
  4. SCOPE OF THE SOLUTION – PATIENT ACCESS SAAS SERVICES AND PRODUCTION SERVICES: ELIGIBILITY AND BENEFITS VERIFICATION.
    1. Verification of the insurance and plan eligibility based on the member information.
    2. Evaluation of coverage status, plan details, deductible and out of pocket information.
    3. The following are considered out of scope for this solution: (i) checking for authorization requirements; (ii) verifying referral requirements; (iii) re-verification of benefits at the time of appointment; or (iv) payer specification re-verification for Medicare and Medicaid.

Scope of the Solution Addendum to General Terms and Conditions, Version 1.0, Promulgated February 5, 2025.