TABLE OF CONTENTS
- Experian Health Products
- Health Language Content
- Navicure® Clearinghouse Services
- Surescripts
- ProviderFlow
- Acumen Physician Solutions SMS Terms and Conditions
1. Experian Health Products
The following products and services (the “EHI Products”) provided by Experian Health, Inc. (“Experian Health”) are available for use with the Software if and to the extent that Practice enters into a written Community Connect User Agreement with Experian Health:
| Product Description |
| Address & Identity Verification uses expansive, regulated data sources to provide standardized and verified current contact information for patients. This tool validates and corrects a patient’s name, address, Social Security Number (SSN), date of birth (DOB), phone number, and county. |
| Local Coverage Determination (LCD) / National Coverage Determination (NCD) Part B rule set built in Epic format. |
| PaymentSafe for EDI is the engine behind HIS payment collection UI, connecting it to the processor of choice, and creating remit files as necessary. Reports are included. |
Use of the EHI Products are subject to the terms of the Community Connect User Agreement.
2. Health Language Content
a) HL CONTENT. Acumen has the right to make available certain healthcare terminology data distributed by Health Language, Inc. (“HL”) for use with the Software (“HL Content”). Such HL Content includes concepts, terms, hierarchies, properties, relationships, mappings, and metadata associated with individual terminological sources. HL Content will include updates, revisions, corrections, and new releases.
b) SUBLICENSE. HL hereby grants a limited nonexclusive and nontransferable sublicense for the HL Content through Acumen to the Practice. Practice acknowledges that HL or its licensors own the HL Content subject to this sublicense.
c) PROTECTIONS AND NONDISCLOSURE. Practice agrees that it shall protect all intellectual properties in the HL Content, including without limitation, patents, copyrights, and trade secrets. Further, Practice shall not disclose any HL Content to any third parties, nor reverse engineer any HL Content.
d) WARRANTY DISCLAIMER. ANY USE BY PRACTICE OF THE HL CONTENT IS AT PRACTICE’S OWN RISK. THE HL CONTENT IS PROVIDED FOR USE “AS IS” WITHOUT WARRANTY OF ANY KIND. TO THE MAXIMUM EXTENT PERMITTED BY LAW, HL AND ITS LICENSORS AND SUPPLIERS DISCLAIM ALL WARRANTIES OF ANY KIND, EXPRESS, STATUTORY OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. HL IS NOT OBLIGATED TO PROVIDE ANY UPDATES TO THE HL CONTENT.
e) LIMITATION OF LIABILITY. NO LIABILITY FOR DAMAGES. IN NO EVENT SHALL HL OR ITS LICENSORS AND SUPPLIERS HAVE ANY LIABILITY FOR ANY INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES IN ANY WAY ARISING OUT OF THE USE OR INABILITY TO USE THE HL CONTENT AND HOWEVER CAUSED AND UNDER ANY THEORY OF LIABILITY, INCLUDING BUT NOT LIMITED TO LOSS OF PROFITS OR LOSS OF DATA, EVEN IF SUCH PARTY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. IN NO EVENT SHALL HL’S CUMULATIVE LIABILITY ARISING OUT OF THIS SUBLICENSE EXCEED THE AMOUNTS ACTUALLY PAID BY PRACTICE TO ACUMEN OR HL FOR THE HL CONTENT PURSUANT TO THIS SUBLICENSE
3. Navicure® Clearinghouse Services
a) Navicure, Inc. (“Navicure”) provides certain clearinghouse services that are available for use with the Software if and to the extent that Practice enters into a written agreement with Navicure.
b) If Practice receives access to Navicure’s clearing house services for use with the Software, Practice acknowledges that certain Practice and patient-related information may be transferred between the Software and Navicure’s propriety on-line software application as necessary to use Navicure’s clearinghouse services. Navicure may use anonymized and aggregated Practice data to prepare statistical comparative analyses and benchmarking statistics for Navicure’s own use, provided such uses are in accordance with applicable federal and state law. Payer rejection or denial messages which occur as a byproduct of Practice’s use of Navicure’s services are not Practice’s data and may be utilized by Navicure on a de-identified (as defined by HIPAA) and aggregated basis to augment Navicure’s claim editor, which is available to all Navicure customers. Navicure may disclose Practice’s data to any government body, or duly authorized representatives thereof, upon an audit or other inspection by any of the same of the records or facilities of Navicure, but shall first seek confidential treatment thereof.
c) Navicure is a registered trademark of Navicure, Inc.
4. Surescripts
Acumen Epic Connect connects to and works with Surescripts Network and Surescripts Services (defined below) and, subject to the provisions contained in this Section 4, Practice may access and use the Surescripts Network and Surescripts Services.
a) Definitions. The following defined terms apply to this Section 4.
i) “Applicable Law” means any and all applicable federal, state, local, common law, rules, regulations, directives, and guidelines, including but not limited to the Health Insurance Portability and Accountability Act of 1996, as amended and related regulations (“HIPAA”); the Health Information Technology for Economic and Clinical Health Act (“HITECH”) and related regulations; the Anti-Kickback provisions of the Social Security Act and related regulations; the federal Physician Self-Referral Prohibition provisions of the Social Security Act and related regulations; state and federal pharmacy laws and regulations; and state and federal laws and regulations regarding breach notifications.
ii) “Certified Aggregator” means an entity that has contracted with Surescripts to become either a pharmacy aggregator or prescriber aggregator on the Surescripts network and is designated as such by Surescripts.
iii) “Certified VAR” means an entity that has been designated by Surescripts as a value-added reseller of the Surescripts Services and connectivity to other entities that aggregate prescribers and/or pharmacies.
iv) “Data Source” means all PBM Data Sources and Pharmacy Data Sources.
v) “End User” means an individual, located in the United States or a United States territory, that: (1) is employed by, an active member of the medical staff of, or otherwise performing healthcare services as a legally authorized representative of Practice; and (2) if required by Applicable Law to be licensed, registered, or otherwise authorized by a Governmental authority, is properly and duly licensed, registered, or otherwise authorized with the appropriate Governmental authority to perform the applicable healthcare services. Practice shall ensure that End Users obtain (and certify that they have obtained) any and all necessary patient consents and authorizations required by Applicable Law to provide or access any of the Surescripts Services hereunder.
vi) “Government” or “Governmental” means any United States local, state or federal government or governmental authority.
vii) “Participants” means all Certified Aggregators, Certified VARs, Data Sources, prescribers, health care providers and facilities, technology vendors, and other entities and individuals that have entered into written agreements with Surescripts, either directly or indirectly, in order to access, provide, or communicate through the Surescripts network.
viii) “Pharmacy Data Source” means a pharmacy, pharmacy chain, or Certified Aggregator that aggregates information on behalf of pharmacies, or other similar entity which has entered into a written agreement with Surescripts to allow access through the Surescripts network to information in its possession.
ix) “PBM Data Source” means a pharmacy benefit manager (“PBM”), health benefit payor or administrator, or other similar entity which has entered into a written agreement with Surescripts to allow access through the Surescripts network to information in its possession.
x) “Point of Care” means the place and time that a prescriber or his/her agent is in the act of prescribing a pharmaceutical for a patient.
xi) “Prescribing Decision” means a prescriber’s decision to prescribe a certain pharmaceutical or direct a patient to a certain pharmacy.
xii) “Private Information” means: (i) Nonpublic Personal Financial Information and, as applicable, Nonpublic Personal Health Information, as defined by the Gramm-Leach-Bliley Act; or (ii) any data or information that: (1) relates to an individual, and (2) identifies or can reasonably be believed to form the basis for identifying an individual (such as, but not limited to, an individual’s name, postal address, e-mail address, telephone number, date of birth, Social Security number, driver’s license number, financial account number, or any other unique identifier), in each case, that is provided to APS by Surescripts or to Surescripts by APS, Practice or an End User. Private Information does not include Protected Health Information (“PHI”) as defined under HIPAA and related regulations, created or received on behalf of, or received from Surescripts.
xiii) “Service Levels” means the qualitative and quantitative performance standards applicable to the Surescripts Services as set forth in the Surescripts Network Operations Guide.
xiv) “Surescripts Data” means any data or information relating to Surescripts, or its services or operations, provided to APS, Practice and/or End Users by or on behalf of Surescripts, including statistics collected by Surescripts regarding transactions processed by the Surescripts network, test data, test cases, configuration information, and problem description and resolution information.
xv) “Surescripts Materials” means the Surescripts Network Operations Guide, the Surescripts Style and Usage Guide, Implementation Guides and other materials that set forth the technical and other requirements for participation in the Surescripts network for the Surescripts Services, as such materials may be further developed or modified by Surescripts.
xvi) “Surescripts network” means the Surescripts proprietary technology for a secure, nationwide, interoperable health information infrastructure, including Surescripts Materials, interfaces, functionality, and transaction maps made available by Surescripts to APS, Practice and/or End Users, as they may be further modified or developed by Surescripts from time to time.
xvii) “Surescripts Network Operations Guide” means the operations guide provided by Surescripts setting forth the responsibilities, expectations, and operating principles for participation in the Surescripts network, as such guide may be further developed or modified by Surescripts from time to time.
xviii) “Surescripts Services” means those services provided by Surescripts, as more fully described in Section 4.j. below.
b) Access to and Participation in the Surescripts Network
i) Service Levels. Surescripts shall provide the Surescripts Services in accordance with the Service Levels set forth in the Surescripts Network Operations Guide.
ii) Permitted Uses. Surescripts shall provide Practice and the End Users with access to the Surescripts Network for the provision of the Surescripts Services for the sole purpose of using the Surescripts Services described in Section 4.j. to transmit and receive information relating to such Surescripts Services to and from Participants in the Surescripts network on behalf of Practice and End Users. Practice and the End Users shall access and request information through the Surescripts Network only in accordance with the terms and conditions of this Section 4 and only with respect to: (i) PBM Data Sources that have direct contracts with Surescripts; and (ii) Pharmacy Data Sources that have direct or indirect contracts with Surescripts or through a Participant to access the Surescripts network.
iii) Message Transmission and Content.
(1) Message Transmission in General. Practice shall conduct identity proofing and authentication sufficient to meet regulatory requirements and industry standards to Surescripts’ reasonable satisfaction to confirm that all messages transmitted via the Surescripts network originate from End Users who are licensed to use the application for the service(s) for which Surescripts has certified the application, and who are registered with Practice in accordance with the terms and conditions of this Section 4.
(2) Commercial Messaging Rules. Practice shall comply with the following, referred to as the Commercial Messaging Rules.
a) General Limitations.
(i) Prescribing Decisions. Practice and End Users shall not, (i) encourage a prescriber to prescribe or a patient to use a specific pharmaceutical or specific pharmacy, as compared to other pharmaceuticals or pharmacies; or (ii) use any means, program, or device, or permit any other person to use any means, program, or device, including, but not limited to, advertising, instant messaging, and pop-up ads, to influence or attempt to influence, through economic incentives or otherwise, the Prescribing Decision of a prescriber at the Point of Care if: (a) such means, program, or device (as described above) is triggered by, initiated by, or is in specific response to, the input, selection, and/or act of a prescriber or his/her agent prescribing a pharmaceutical or selecting a pharmacy for a patient; and (b) that prescription shall be delivered via the Surescripts network.
(ii) Diagnostic Decisions. Practice shall not, and shall ensure that End Users do not, in conjunction with the Surescripts network, use any means, program, or device, or permit any other person to use any means, program, or device, including, but not limited to, advertising, instant messaging, and pop-up ads, to solicit business or to influence or attempt to influence for commercial purposes (through economic incentives or otherwise) any diagnostic or treatment-related decision of a health care provider. The bona fide professional recommendation of an End User offered to another End User regarding the treatment or diagnosis of a shared patient is not intended to be prohibited by this provision; however, Surescripts shall have sole discretion to determine the bona fide noncommercial and clinical nature of all messages.
(b) Exceptions to General Limitations.
(i) Prescribing Decisions. Notwithstanding the General Limitations above, Practice may: (A) show information regarding a payer’s formulary and benefit plan design, including patient lowest cost options, on/off tier, prior authorization, step therapy, coverage status, and co-pay information; and/or (B) deliver or have delivered to End Users clinical alerts that are sourced from payers and/or are attributed to generally recognized and reputable sources providing clinical information to the prescriber, even if, in the event of either (A) or (B), such information influences the patient or prescriber’s choice of pharmacy or other prescribing decisions. Any custom lists created and maintained by End Users within an APS software product, including but not limited to: (i) an individual End User’s most often prescribed medication list; (ii) an individual End User’s most often used pharmacy list; and/or (iii) an individual End User’s most often used SIGs (i.e., instructions for the use of medications), would not be considered a violation of this Section.
(ii) Diagnostic Decisions. Notwithstanding the General Limitations above, Practice and End Users may: (A) use the CDM Services to communicate information regarding a patient’s health care coverage, including patient lowest cost options, on/off tier, prior authorization, step therapy, coverage status, and co-pay information; and/or (B) deliver or have delivered to health care providers clinical alerts that are sourced from payers and/or are attributed to generally recognized and reputable sources providing clinical information, even if, in the event of either (A) or (B), such information influences the health care provider’s treatment decisions.
(iii) Compliance with Law. To the extent that any statute or regulation specifically requires delivery of information to an End User, such delivery in compliance with such statute or regulation shall not be deemed a breach of the Commercial Messaging Rules.
iv) Prescriber Directory Information. Surescripts has unlimited rights to use all directory and related information on End Users that shall come to reside within the Surescripts network database, including all root, identity, and location-related information.
c) Additional Practice Responsibilities
i) Practice and End Users.
(1) Designation of End Users. Practice shall designate an End User (i) only after confirming that such individual or entity meets the definition of an End User set forth above, and (ii) only subject to ongoing satisfaction of the identity-proofing and other requirements set forth in this Section 4.
(2) Surescripts Data Sources. Any Data Source, in its sole discretion, may elect not to receive prescriptions and other messages from Practice and/or any End User.
(3) Audit by Surescripts. Practice shall allow Surescripts or APS to access, inspect, and audit records of Practice relating to the use of the Surescripts network, Surescripts Data, and data or information provided by Participants.
(4) Surescripts Materials. APS shall provide the Surescripts Materials to Practice (subject to the confidentiality requirements set forth in the Agreement), and Practice shall comply with them.
(5) Use of Data. Practice shall not retain a copy of, store in any medium, perform analytics on, aggregate in any manner, or otherwise perform any action with relation to any data or information sent through the Surescripts network other than as specifically permitted under this Section 4. Except as specifically set forth in this Section 4, Practice shall act solely as a passive conduit of information sent through the Surescripts network.
ii) Patient Consent and Authorizations. Practice shall ensure that each End User obtains the consent of the patient prior to requesting information for such patient through the Surescripts network. Practice shall comply with, and shall ensure that End Users comply with, any privacy and patient consent policies of Surescripts related to the delivery of Private Information and/or PHI as may be published by Surescripts from time to time, which policies shall be considered part of the Surescripts Materials. Data Sources may impose additional privacy and patient consent policies on the delivery of Private Information and/or PHI through the Surescripts network.
iii) Satisfactory Background Checks. Practice warrants and represents that Practice has obtained, at Practice’s own expense and in a manner compliant with all Applicable Law, a Satisfactory Background Screening, as defined below, for all of its employees and contractors whose job descriptions or functional duties require or contemplate access (other than incidental or infrequent access) to any Private Information and/or PHI pursuant to this Section 4 (“Practice Personnel”). As used herein, a “Satisfactory Background Screening” shall mean, collectively, the following: (1) national federal criminal database check; (2) seven (7)-year county of residence criminal conviction search (i.e., search of all counties in which individual has resided within the preceding seven (7) year period); and (3) in each of (1) and (2) above, containing no felony or misdemeanor conviction that related to fraud or theft (including but not limited to, shoplifting, larceny, embezzlement, forgery, credit card fraud, or check fraud), the disposition of which is within seven (7) years, as allowed by law. Practice agrees to update such Satisfactory Background Screening upon reasonable request by Surescripts, it being agreed that any request based upon the occurrence of any Security Incident or other illegal activity involving Practice or Practice Personnel, or the reasonable suspicion of illegal activity involving any data provided hereunder, or any regulatory requirements requiring such updates, would be deemed reasonable hereunder. Promptly upon written request, Practice shall verify in writing its compliance with the foregoing requirements by providing Surescripts with a written affidavit signed by an executive officer of Practice, certifying that Practice has obtained Satisfactory Background Checks with respect to all Practice Personnel with access to Private Information and/ or PHI in accordance with this Section.
d) Suspension by Surescripts for Breach by Practice or End Users. Surescripts may suspend use of the Surescripts network (with no cure period) on behalf of Practice and/or End User if: (i) Practice and/or End User is not duly licensed or authorized under Applicable Law to use the software application for the service(s) for which Surescripts has certified the application; or (ii) an act or omission of Practice and/or End User would (if it were an act or omission of APS) constitute a material breach of the Agreement with Surescripts. Such suspension shall be effective upon Surescripts’ delivery of written notice of such act or omission, which notice shall forward to Practice and/or End User within five (5) days of receipt thereof.
e) Data. Subject to compliance with all Applicable Law and the terms of the Business Associate Agreement entered into with Surescripts, Surescripts shall be entitled to use and disclose information received from APS, Practice or End Users for the purpose of Surescripts’ business, including, without limitation, its proper management and administration and the Surescripts Services. The provisions of this Section shall survive the expiration or termination, for any reason, of the Agreement.
f) Privacy and Security
i) General. Practice acknowledge that messages transmitted via the Surescripts network for the Surescripts Services may contain Private Information and/or PHI. Furthermore, some but not all Participants in the Surescripts network are either Covered Entities or Business Associates of Covered Entities, as those terms are defined in the HIPAA regulations. To support the privacy, confidentiality, and security of the messages transmitted via the Surescripts network, Practice agrees to comply with Applicable Law, including all applicable HIPAA regulations.
ii) Safeguarding Data. Practice shall establish and maintain appropriate safeguards against the destruction, loss, or alteration of Surescripts Data or Participant data that are no less rigorous than those maintained by Practice for its own information of a similar nature, but no less than reasonable safeguards. Practice shall have in place appropriate administrative, technical, and physical safeguards to protect the privacy of Private Information and, in accordance with Applicable Law, PHI. Practice shall reasonably safeguard Private Information and PHI from any intentional or unintentional use or disclosure that is in violation of Applicable Law, and limit incidental uses or disclosures made pursuant to otherwise permitted or required disclosures.
g) Disclaimers and Certain Associated Responsibilities
i) In General. All disclaimers set forth throughout this Section shall survive termination or expiration of the Agreement.
ii) Availability of Data Sources. Surescripts makes no representation or warranty regarding the availability through the Surescripts network of any particular Data Source or other Participant in the Surescripts network. At any time, Data Sources or other Participants in the Surescripts network may be added to or deleted from the Surescripts network or may limit Practice access to their data, such changes may occur without prior notice.
iii) Limitations of the Surescripts network. Surescripts uses available technology to match patient identities in order to provide the Surescripts Services. Because patient information is maintained in multiple places, not all of which are accessible to Surescripts, and because not all patient information is kept in a standard fashion or is regularly updated, it is possible that false matches may occur or that there may be errors or omissions in the information provided by Surescripts from Data Sources pursuant to the Surescripts Services. Therefore, it is the responsibility of any treating physician or other health care provider or facility (not the responsibility of Surescripts) to verify such information through other means with each patient and/or the patient’s representatives before such information is relied upon or utilized in diagnosing or treating the patient. Surescripts is not a health plan, health care provider or prescriber. Surescripts does not and cannot independently verify or review the information transmitted through the Surescripts network for accuracy or completeness. Pursuant to the foregoing, Practice acknowledges that the prescription benefit and medication history information provided hereunder may not be complete or accurate, and that neither Surescripts nor any Data Source provides any representations or warranties with respect to the accuracy or completeness of the prescription benefit or medication history information. Except to the extent arising from the gross negligence or willful misconduct of Surescripts, Practice and End Users release and hold harmless Surescripts and any person or entity providing prescription benefit or medication history information from any liability, cause of action, or claim related to the completeness or lack thereof of the prescription benefit or medication history information. In addition, Practice shall ensure that each End User confirms the accuracy of all information obtained through the Surescripts network with his/her/its patient prior to providing any medical services based thereon, and that Practice and End User shall use his/her/its professional judgment in the provision of care. Practice and Surescripts agree that the Data Sources shall be third-party beneficiaries to this Section.
iv) No Substitution for Written Prescription or Documentation. The Surescripts network is not intended to serve as a replacement for: (i) a written prescription where not approved as such by the appropriate Governmental authorities or where such written prescription is required for record keeping purposes; or (ii) applicable prescription documentation. Use of the Surescripts network is not a substitute for a health care provider’s standard practice or professional judgment. Any decision with regard to the appropriateness of treatment, or the validity or reliability of information, is the primary responsibility of a patient’s health care provider.
h) Indemnification by Practice. Except to the extent arising from the gross negligence or willful misconduct of Surescripts, and subject to the limitations set forth below, Practice agrees to indemnify, defend and hold harmless APS and its affiliates, officers, directors, employees, agents, successors and assigns from and against any and all actual or threatened losses, liabilities, damages, and claims, and all related costs and expenses (including reasonable legal fees and disbursements and costs of investigation, litigation, settlement, judgment, interest and penalties) arising from, or in connection with, or based on allegations of third-party claimants of any claims relating to: (i) any breach by Practice or End Users of this Section 4, or (ii) information provided to Surescripts by Practice or End Users, or arising out of the use of information provided by Surescripts to Practice, End Users or to other third persons at Practice’s request, or to officers, employees and agents of Practice.
i) Record Retention and Audit Rights. Practice shall maintain data and records relating to the Surescripts Services and to the use of the Surescripts network by Practice and End Users during the term of the Agreement and for a period of seven (7) years after the effective date of any termination or expiration of the Agreement, or for such longer time as is required by Applicable Law. Practice shall permit Surescripts to access, inspect, and audit such data and records for the purpose of verifying fees, adherence to Service Levels or compliance with other terms and conditions of this Section 4. Any such inspection or audit may be performed following reasonable prior written notice, but not more often than twice in any twelve (12) month period. All expenses of any such inspection or audit shall be paid by Surescripts, including the internal personnel costs of the other party associated with providing access to the requested data and records.
j) Surescripts Services
i) Surescripts Core Services. The “Surescripts Core Services” include the Prescription Routing Service and the Medication History and Benefit Services – Ambulatory, set forth in Sections (2) and (3) of this Section 4.j)i).
The Surescripts Core Services may be accessed only by End Users that are individual physicians, nurse practitioners, physician assistants, or other clinical or administrative personnel that are properly and duly licensed, registered, or otherwise authorized with the appropriate Governmental authority to issue prescription orders (“Prescriber End Users”) and only through the software that has been certified by Surescripts for the Surescripts Core Services. Practice shall be legally responsible for any and all of the Prescriber End Users’ actions and inactions to the full extent that Practice would be liable if such actions and inactions were committed by Practice itself.
(1) General Provisions Applicable to the Surescripts Core Services. The following are applicable to the Surescripts Core Services provided hereunder:
(a) Foundation Infrastructure. Foundation infrastructure including interface specifications, transaction routing infrastructure, Participant-management services, and error management services.
(b) Patient Identification Services. Patient identification services in which Surescripts uses membership information provided by Data Sources to build a Master Patient Index (“MPI”) database. Surescripts utilizes a search process with basic demographic information submitted by Practice or Prescriber End Users to identify the patient in Surescripts’ MPI. Service Levels for all services described hereunder are set forth in the Surescripts Network Operations Guide.
(c) Encryption-Related Services. Encryption-related services, including network level encryption which is employed by Surescripts for all transactions through the Surescripts network, which must be determined between the Participants to a transaction and for which they are solely responsible.
(2) Surescripts Prescription Routing Services. The Surescripts Prescription Routing Services are designed to allow Prescriber End Users to transmit Prescription Routing Messages, including new and renewal prescriptions (as well as prescription cancellations and prescription change requests), to participating pharmacies of the patient’s choosing, including mail order pharmacies. A “Prescription Routing Message” means the transmission of an electronic prescription representation, in the format and with the content required for processing through the Surescripts network, of: (i) a prescription drug order issued by a duly licensed practitioner (such as a physician, nurse practitioner or physician’s assistant); (ii) a request for a refill order issued by a pharmacy; (iii) any other message type supported by the NCPDP SCRIPT standard; or (iv) other message types mutually determined between the parties.
(a) Description of Services. The following additional services are applicable to the Prescription Routing Services.
(i) NCPDP SCRIPT Transaction Services. NCPDP SCRIPT transaction services, including routing a standard NCPDP SCRIPT new prescription transaction, a standard NCPDP SCRIPT prescription refill/renewal request transaction, a standard NCPDP SCRIPT prescription change request transaction, a standard NCPDP SCRIPT prescription fill status transaction, or a standard NCPDP SCRIPT prescription cancel transaction, from the Prescriber End User’s office to a connected pharmacy, selected by the Prescriber End User and patient, via the Surescripts network.
(ii) Transmission by Surescripts. Transmit Prescription Routing Messages from Practice to intended pharmacy recipients (through applicable intermediaries), and from such entities to Practice via pre-determined message protocol and transmissions edits.
(iii) Confirmation by Surescripts. Confirm from Prescription Routing Messages that electronic prescription orders originate from locations registered with Surescripts for electronic prescriptions and confirm, to the extent practicable, that Prescriber End Users are authorized to transmit such Messages.
(iv) Facsimile Services in the Event of a Communication Failure to Pharmacy Participants and Format Monitoring. In the event of a temporary/transient communications failure between Surescripts and a pharmacy Participant to receive Prescription Routing Messages through the Surescripts network in the normal course of Surescripts operations, Surescripts shall send Prescription Faxes (defined to mean NCPDP SCRIPT messages) in the standard Surescripts computer-generated prescription fax format during such temporary/transient communications failure to such pharmacies. Surescripts will monitor and support specific fax format requirements as specified by the regulatory requirements within each state where prescriptions are transmitted via this Service.
(b) Practice Elections. Practice has the right to elect not to use the Surescripts network to transmit prescriptions to a particular pharmacy chain or PBM, provided that Practice must elect to delete the entire pharmacy chain and all pharmacies owned or controlled by such chain, or the entire PBM and all associated health plans under the PBM. By way of example only, Practice may delete WalMart in its entirety, but not certain (i.e., less than all) WalMart pharmacies. Surescripts will take reasonable steps to terminate the connection in the Surescripts network between Prescriber End Users and the applicable pharmacy chain or PBM deleted pursuant such election no earlier than thirty (30) days following such notice and no later than ninety (90) days following such notice.
(3) Medication History and Benefit Services – Ambulatory. The Surescripts Medication History and Prescription Benefit Services – Ambulatory are designed to allow Prescriber End Users to access benefit and other information only in connection with and in conjunction with the treatment of a specific patient in a scheduled visit or walk-in outpatient visit or another specific treatment event.
(a) Description of Services. The following additional services are applicable to the Medication History and Prescription Benefit Services - Ambulatory.
(i) Formulary Distribution Services. Formulary distribution services, which allow downloading of formularies and basic benefit coverage information if available. The formulary files are organized by the Data Sources and contain file identifiers which should allow linking of information to a particular patient referenced in an eligibility transaction.
(ii) Patient Visit/Treatment Event Services. The following services are available only, and Practice and Prescriber End Users shall not attempt to access these services except, in connection with and in conjunction with the treatment of a specific patient in a scheduled or walk-in outpatient visit or another specific treatment event. Practice and its Prescriber End Users shall not access or attempt to access these services for an inpatient or other acute service or for any institutional service.
1. Eligibility Status Transaction. Eligibility status transaction allows Prescriber End Users to match a patient to his/her pharmacy benefit through a request/response transaction based on X12 270/271 transaction standards.
2. Medication History Transaction. Medication history transaction allows Prescriber End User to request medication history for a specific patient utilizing the National Council for Prescription Drug Programs (“NCPDP”) transaction segment syntax then implemented by Surescripts.
3. Formulary Coverage Status Transaction. Formulary coverage status transaction allows Prescriber End Users to use information on the eligibility status transaction response to request formulary and coverage status for a specific drug for a specific patient utilizing the NCPDP transaction segment syntax then implemented by Surescripts.
ii) Fax Gateway Services. Surescripts provides the following Fax Gateway Services, solely in conjunction with the Surescripts Core Services, in accordance with the following terms and conditions. The Surescripts Fax Gateway Services may be accessed only by End Users that are individual physicians, nurse practitioners, physician assistants, or other clinical or administrative personnel that are properly and duly licensed, registered, or otherwise authorized with the appropriate Governmental authority to issue prescription orders (“Fax Gateway End Users”) and only through software that has been certified by Surescripts for the Surescripts Fax Gateway Services. Surescripts and Practice agree that Surescripts may terminate the Fax Gateway Services (without terminating the Agreement) at any time upon written notice to Practice.
(1) Fax Gateway Service to Pharmacies Not Participating in the Surescripts network. Surescripts shall send prescription faxes in the standard Surescripts prescription fax format to pharmacies not activated by Surescripts to receive electronic Prescription Routing Messages through the Surescripts network, so long as such pharmacies are licensed under Applicable Law and are registered with NCPDP.
iii) CompletEPA Services. The CompletEPA® Service is a series of real-time messages based on the National Council for Prescription Drug Programs (“NCPDP”) electronic prior authorization transaction standards. Each transaction supports a particular step in the prior authorization process that electronically supports the exchange of information necessary to facilitate the completion of a prescription under the patient’s pharmacy benefit. The CompletEPA® Service includes the following real-time transactions listed below (or, alternatively, Surescripts’ interface functionality provided to EHR vendors in response to a PA Initiation Request and PAInitiation Response): PAInitiationRequest and PAInitiationResponse; PARequest and PAResponse; PAAppealRequest and PAAppealResponse; PACancelRequest and PACancelResponse; and PACancelRequest and PACancelResponse (collectively referred to as the “CompletEPA® Messages”). The CompletEPA® Service will only communicate with a PBM, health plan, or other PA processor who has been certified by Surescripts to transact on the Surescripts network for the CompletEPA® Service.
(1) COMPLETEPA.
(a) Services. The CompletEPA® Service includes:
(i) Foundation Infrastructure. Foundation infrastructure, including interface specifications, transaction routing infrastructure, participant management services and error management services.
(ii) Patient Identification Services. Patient identification services in which Surescripts uses membership information provided by pharmacy benefit manager participants to build a Master Patient Index (“MPI”) database. Surescripts utilizes a search process with basic demographic information submitted by the requestor to identify the patient in Surescripts’ MPI.
(iii) Encryption Related Services. Encryption related services, including network level encryption which is employed by Surescripts for all transactions through the Surescripts network as further detailed in the Surescripts Materials.
(b) Implementation Services. Implementation of the CompletEPA® Service with software is intended to include the following services: (i) Staging environment setup; and (ii) Production environment setup.
(c) Use of CompletEPA. Practice must use its best efforts to ensure that End Users only initiate the CompletEPA® Messages when the selected pharmaceutical requires a prior authorization for that patient. Surescripts will monitor and audit for Practice the ratio of PAInitiationRequests to PAInitiationResponses where the PBM response is “no PA is needed” in a given month (the “PA Ratio”). If the Surescripts’ compliance team determines, in its sole discretion, that Practice has not sufficiently prevented unnecessary CompletEPA® Messages, Surescripts will notify Practice in writing of Surescripts’ audit and research results. Thereafter, Practice must resolve the problem within 90 days following receipt of the written notification. If Practice fails to do so, in Surescripts’ discretion, the Practice may be prohibited from using the CompletEPA® Service until the issue is resolved to Surescripts’ reasonable satisfaction.
(2) THIRD PARTY PROCESSOR. Surescripts has contracted with a third-party processor to provide Practice the option to access a library of PDF prior authorization forms and traditional and electronic faxing capabilities as a method of communicating with pharmacy benefit managers (“PBMs”) that are not otherwise participating in the CompletEPA® Service (the “Supplemental PA Service”).
The Supplemental PA Service is provided “as is” to Practice. All warranties are disclaimed by Surescripts as it relates to the Supplemental PA Services. In addition, Surescripts’ sole liability to Practice and End Users for claims of any type arising from the use of the Supplemental PA Services shall be to use commercially reasonable efforts to correct any errors or omissions in the Supplemental PA Services as soon as possible after Surescripts’ discovery of any such error or omission or written notification to Surescripts thereof by Practice.
In the event that Surescripts no longer offers or supports the Supplemental PA Service, Surescripts and Practice agree that Surescripts may terminate the Supplemental PA Service upon no less than sixty (60) days prior written notice to Practice.
(3) SERVICE LEVELS. Each party will comply with the applicable Service Levels that are applicable to the CompletEPA® Service in the Surescripts Network Operations Guide.
5. ProviderFlow
a) ProviderFlow Services and Definitions. DRNS Software Solutions, LLC. d.b.a. ProviderFlow (“ProviderFlow”) provides certain Internet-based document imaging and document management services (“ProviderFlow Services”) that are available for use with the Software and subject to this Section 5. For the purposes of this Section 5, the following capitalized terms have the meanings given to them below:
“Scanned Files, Uploaded Files and Uploaded Data” means any files and data that Practice scans or uploads into the ProviderFlow Services for storage or transfer to third parties.
“User Account” means an individual’s account for use of the ProviderFlow Services that is affiliated with Acumen Epic Connect.
b) Improvements. ProviderFlow is constantly improving its product to provide its customers with the best possible experience, and thus reserves the right to update the ProviderFlow Services at its discretion and to add or delete features, from time to time.
c) Privacy. Use of the ProviderFlow Services shall be subject to the ProviderFlow Privacy Policy which is available at https://www.providerflow.com/index.php/privacy/.
d) User Accounts and Responsibilities. A User Account is required for an individual to access and utilize the ProviderFlow Services. To establish a User Account, the user (or Acumen on behalf of user) must complete a registration process by providing ProviderFlow with current, complete and accurate information as prompted by the registration form. In registering users for the ProviderFlow Services, Practice agrees that it and its users will submit accurate, current and complete information and promptly update such information as appropriate. Should ProviderFlow suspect that any user information is not accurate, current or complete, ProviderFlow reserves the right to suspend or terminate Practice’s and/or the user’s usage of the ProviderFlow Services until such issue is remedied. Each user must choose a personal, non-transferable password. User accounts cannot be shared or used by more than one individual. All users must exit or log-off from the ProviderFlow Services at the end of each session of use and Practice and its users must have all necessary rights in and to the files and data submitted to the ProviderFlow Services. Practice shall notify Acumen immediately of any unauthorized use of a User Account or any user password or any other breach of security that is known or suspected by Practice. Practice agrees to indemnify and hold ProviderFlow and Acumen harmless against any claim and/or liability resulting from Practice’s failure to comply with the responsibilities set forth in this Section.
e) Scanned Files, Uploaded Files and Uploaded Data. ProviderFlow may access Practice’s user accounts, including Scanned Files, Uploaded Files and Uploaded Data, to respond to service or technical problems or as required by applicable law. Practice shall have sole responsibility for the accuracy, quality, integrity, legality, reliability, appropriateness and copyright of all Scanned Files, Uploaded Files and Uploaded Data, and ProviderFlow shall not be responsible or liable for the deletion, correction, destruction, damage, loss or failure to store any Scanned Files, Uploaded Files and Uploaded Data.
f) User Conduct and Restrictions. Except to the extent permitted by applicable law, Practice may not modify, distribute, prepare derivative works of, reverse engineer, reverse assemble, disassemble, decompile or otherwise attempt to decipher any code used in connection with the ProviderFlow Services and/or any other aspect of the ProviderFlow’s technology. Practice shall not market, offer to sell, sell and/or otherwise resell the ProviderFlow Services to any third party. Practice agrees, on behalf of itself and its users, not to use the ProviderFlow Services
(a) in connection with sending unsolicited or unauthorized advertising, promotional materials, junk mail, spam, chain letters, pyramid schemes or any other form of duplicative or unsolicited messages, whether commercial or otherwise; (b) to harvest, collect, gather or assemble information or data regarding other users, including email addresses, without the consent; (c) to transmit through or post on the ProviderFlow Services unlawful, harassing, libelous, abusive, fraudulent, tortious, defamatory, threatening, harmful, invasive of another’s privacy, vulgar, obscene or otherwise objectionable material of any kind or nature or material which is harmful to minors in any way; (d) to transmit through or post on the ProviderFlow Services any material that may infringe the intellectual property rights or other rights of third parties, including trademark, copyright or right of publicity; (e) to transmit any material that contains software viruses or other harmful or deleterious computer code, files or programs such as trojan horses, worms, time bombs, cancelbots; (f) to interfere with or disrupt servers or networks connected to the ProviderFlow Services or violate the regulations, policies or procedures of such networks; (g) to attempt to gain unauthorized access to the ProviderFlow Services, other accounts, computer systems or networks connected to the ProviderFlow Services through password mining or any other means; (h) to harass or interfere with another user’s use and enjoyment of the ProviderFlow Services; and (i) to make any representations with respect to ProviderFlow. ProviderFlow reserves the right, at all times, to access, acquire, use, delete, monitor, review, retain and/or disclose any information as necessary to satisfy any applicable law, regulation, legal process or governmental request, and such action is considered to be authorized by Practice.
g) Indemnification. Practice agrees to indemnify, defend and hold harmless, ProviderFlow, its parents, its affiliates and their respective officers, directors, employees, attorneys, representatives, licensors, third party providers and agents, from and against any and all claims, costs, damages, losses, liabilities and expenses (including reasonable attorneys’ fees and costs) arising out of or in connection with the Uploaded Data, Practice’s use of the ProviderFlow Services in an impermissible manner, or Practice’s breach of this Section 5.
h) Compliance with Laws. Practice and its users shall comply with all applicable local, state, national and foreign laws, rules and regulations in connection with their access and/or use of the ProviderFlow Services. Practice shall comply with all legal duties applicable to Practice as a data controller by virtue of Practice submitting Scanned Files, Uploaded Files and Uploaded Data or storing Scanned Files, Uploaded Files and Uploaded Data within the ProviderFlow Services. Specifically, Practice or its users shall provide the relevant persons and/or participants with all information or notices Practice or its users are required by applicable privacy and data protection law to provide and, if necessary, obtain the consent of or provide choices to such persons and/or participants as required by such laws.
i) Removal for IP Infringement. ProviderFlow reserves the right to delete or disable the accounts of users who ProviderFlow believes to be infringing the intellectual property rights of others and to remove any such infringing materials.
j) Third Party Interaction; Links to Third Party Sites. In connection with Practice’s use of the ProviderFlow Services, Practice may enter into correspondence with, purchase goods and/or services or participate in promotions of advertisers or sponsors showing their goods and/or services through the ProviderFlow Services. Any such activity and any terms, conditions, warranties or representations associated with such activity, are solely between Practice and the applicable third-party. ProviderFlow shall have no liability, obligation or responsibility for any such correspondence, purchase or promotion between Practice and any such third-party.
k) Providerflow Purge Agreement. ProviderFlow will store documents processed in User Accounts for sixty (60) days, at which point they will be purged automatically. Audit logs and document metadata will be retained by ProviderFlow consistent with its policies and procedures.
l) Temporary Suspension. If at any time continued provision of the ProviderFlow Services would compromise the security of the ProviderFlow Services due, without limitation, to hacking attempts, denial of service attacks, mail bombs or other malicious activities, Practice agrees that ProviderFlow may temporarily suspend the ProviderFlow Services.
6. Acumen Physician Solutions SMS Terms and Conditions
When you sign up for text messages services, you are signing up to receive text messages related to your relationship with Acumen Physician Solutions and its participating practices, including updates related to your visits, MyChart account, one-time passcode, billing notifications, prescription/appointment reminders, and care management.
You can opt-out of SMS messages by texting STOP to respective short code. Your opt-out request will generate one final message confirming that you have been unsubscribed. You will no longer receive SMS messages from the short code you opted out from. If you want to join again, sign up using MyChart or text HELP to the short code for instructions.
If you are experiencing issues with the messaging program you can reply with the keyword HELP for more assistance, or you can get help directly at 866.398.1474 or by email: acumensupport@interwellhealth.com
Carriers are not liable for delayed or undelivered messages.
Message and data rates may apply for any messages sent to you from us and to us from you. Message frequency may vary.
Acumen provides this SMS short code service via Infobip on behalf of our participant provider practices. You can find a copy of our Privacy Policy at www.interwellhealth.com. You may also contact us directly at 866.398.1474 or acumenSMS@interwellhealth.com. Contact your physician practice provider directly for specific questions related to your care or to obtain a copy of your Notice of Privacy Practices.