Terms of Service

These Terms of Service ("Terms") are a binding agreement between CareCo Solutions (Pty) Ltd, the operator of the MedCascade platform ("MedCascade", "we", "us"), and every person or organisation that accesses or uses the Service ("you"). By accessing or using MedCascade you accept these Terms. If you use the Service on behalf of an organisation, you warrant that you are authorised to bind that organisation.

These Terms are drafted in plain language consistent with the Consumer Protection Act 68 of 2008 (to the extent it applies) and the Electronic Communications and Transactions Act 25 of 2002 ("ECTA"). Provisions that limit risk or liability, create assumptions of risk, or require an indemnity are indicated by their headings — read them carefully.

Where your organisation has signed a written master services agreement, Service Level Agreement, or Pricing Agreement with us, those documents prevail over these Terms to the extent of any conflict.

If you do not accept these Terms, do not use the Service.

• "Service" means the MedCascade platform and the Service Modules made available by us from time to time.
• "Service Modules" means the modular services described in these Terms: Clinical Validation, Claim Switching, and Collections.
• "Pricing Agreement" means the written commercial agreement recording your subscribed Service Modules, commitments, rates, and fees.
• "Personal Information" has the meaning in the Protection of Personal Information Act 4 of 2013 ("POPIA").
• "Scheme" means a medical scheme registered under the Medical Schemes Act 131 of 1998, and includes its administrator.
• "CMS" means the Council for Medical Schemes.

MedCascade is a technology-assisted clinical and regulatory validation platform offered as modular services. Which modules apply to you is recorded in your Pricing Agreement:

• Clinical Validation: preparation and validation of clinically aligned coding, motivations, documentation and related decision-support outputs.
• Claim Switching: where subscribed, the electronic transmission of claims between you and Schemes via integrated switching infrastructure. When we transmit claims we do so solely as a technical conduit on your instruction.
• Collections: where subscribed and mandated in writing, the recovery of amounts owing to your practice or organisation, on the terms of the collections mandate in your master agreement.

What MedCascade is not:

• We are not a medical scheme, scheme administrator, managed-care organisation, or financial services provider, and we do not adjudicate claims.
• No output, transmission, or recommendation of the Service approves, authorises, declines, or determines entitlement to healthcare services, claims, benefits, tariffs, or payments. All such decisions remain with the responsible Scheme, provider, or other authorised party.
• We do not guarantee payment, reimbursement, benefit entitlement, PMB recognition, or authorisation outcomes.

THE FOLLOWING NOTICES ARE IMPORTANT. THEY LIMIT OUR RISK AND PLACE RESPONSIBILITY ON YOU.

• All clinical, coding, billing, and submission decisions remain the responsibility of qualified healthcare professionals and your organisation. Outputs are decision-support only and must be independently reviewed before use.
• You bear the risk of acting on any output without professional review.
• Scheme rules, tariffs, and clinical protocols change without notice; outcomes vary per scheme, plan, and option.
• Our liability to you is limited as set out in the Limitation of Liability section below.

The Service operates within South African law, including POPIA and the regulatory framework of the CMS. Use of the Service does not exempt you from any professional, HPCSA, CMS, or Scheme requirement applicable to your practice.

Where a customer outside South Africa is subject to foreign health-information law (for example the United States Health Insurance Portability and Accountability Act), supplementary terms — including a Business Associate Agreement where required — are available on request and must be in place before regulated information is processed on the Service.

• RPL and NHRPL terminology: RPL (Reference Price List) and NHRPL (National Health Reference Price List) historically refer to the same SAMA/MDCM procedure coding set. Schemes may apply their own tariffs, rules and benefit restrictions; outcomes vary per scheme and option.
• PMB (Prescribed Minimum Benefits): Diagnosis and Treatment Pairs (DTPs) and PMB rules are scheme-administered. Provider coding must be clinically justified. PMB entitlement is determined by the scheme in line with the regulations and applicable clinical protocols.
• Tariff references surfaced by the Service are indicative only and are not a quotation, guarantee, or representation of any amount payable by any scheme.

You are responsible for:

• Data accuracy and lawfulness: providing accurate, lawful data and maintaining all necessary patient consents and authorisations. You warrant that you have a lawful basis under POPIA to disclose special (health) information to us for processing.
• Review and validation: reviewing, validating and, where necessary, amending all outputs before use. You are responsible for final coding, claims, submissions and communications to Schemes, including claims transmitted through the Claim Switching module on your instruction.
• Credentials and access: keeping user credentials secure and ensuring only authorised, appropriately trained personnel use the Service.
• Regulatory compliance: complying with professional, HPCSA, CMS and Scheme requirements applicable to your practice or organisation.

You agree not to:

• Make unlawful, fraudulent, defamatory, discriminatory or misleading submissions, or use the Service to submit claims you know to be incorrect
• Upload personal information without a lawful basis (consent, contract or other POPIA ground)
• Reverse engineer, interfere with, scrape, or circumvent security or rate limits
• Use the Service to build competing datasets, models, or services from our outputs without our written consent
• Resell, sublicense, or make the Service available to third parties except as expressly agreed in writing

For patient and practice data you upload, your organisation is the POPIA "responsible party" and MedCascade acts as an "operator", processing such information on your documented instructions. For our own account, security, billing and communications data, MedCascade is a responsible party.

Where the Claim Switching module is subscribed, claim data is exchanged with Schemes and switching infrastructure as necessary to transmit your claims. Where the Collections module is subscribed, we process debtor and payment information under your written mandate. Our Privacy Policy (at /privacy) describes these flows, our safeguards, and your rights, and forms part of these Terms.

Fees, commitments, and rates are recorded in your Pricing Agreement, which may provide for:

• Monthly volume commitments per subscribed module tier (e.g. a committed number of reports or claims per month), with usage above commitment charged at the agreed overage rate
• A prepaid credit package as an alternative commercial model
• A once-off onboarding fee for implementation, configuration and training
• Module-specific fees, including per-claim switching fees and collections rates

Unless your Pricing Agreement provides otherwise: fees are payable in advance, are exclusive of VAT, and are non-refundable save where required by law. We may suspend access for non-payment after notice, and charge default interest on overdue amounts at the rate recorded in the Pricing Agreement. A certificate signed by one of our directors is prima facie proof of the amount owing.

If you breach these Terms we may, without prejudice to any other remedy: require the breach to be remedied within a stated period; suspend access to some or all of the Service; or terminate your access immediately for material or repeated breach, unlawful use, or non-payment.

You may terminate your account at any time by contacting us. Upon termination, we will follow the data return/deletion process described in our Privacy Policy and any operator/processing terms in place.

All provisions of these Terms which by their nature should survive termination shall survive, including ownership provisions, warranty disclaimers, indemnities and limitations of liability.

• Clinical and coding disclaimer: content may contain errors or be incomplete. It is intended for use by qualified professionals and must be independently reviewed.
• No warranties: save as expressly stated in a signed agreement, the Service is provided "as is" and "as available" without warranties of any kind, express or implied, including warranties of merchantability, fitness for a particular purpose, or non-infringement.
• Third-party content and infrastructure: scheme rules, tariffs, clinical protocols, switching infrastructure and clearing-house availability may change or fail without notice. We are not responsible for the accuracy, currency, or availability of third-party information or systems.

TO THE MAXIMUM EXTENT PERMITTED BY LAW:

• We shall not be liable for indirect, incidental, special, consequential or punitive damages, including loss of profits, revenue, data, goodwill, or business opportunity.
• We shall not be liable for any claim, benefit, authorisation, payment, or adjudication decision made by you, a Scheme, or any third party, nor for losses arising from inaccurate, incomplete, or delayed input data, third-party systems, or your failure to review outputs.
• Our total aggregate liability for all claims in any 12-month period is limited to the fees you actually paid for the Service in that period.
• Nothing in these Terms excludes liability that cannot lawfully be excluded, including liability arising from fraud or wilful misconduct, or limits any right you have under the Consumer Protection Act where that Act applies to you.

You indemnify and hold harmless MedCascade, CareCo Solutions (Pty) Ltd, and their officers, directors, employees and agents against all claims, liabilities, damages, losses, costs, expenses and fees (including reasonable legal fees on an attorney-and-client scale) arising from:

• Your unlawful processing of personal information
• Your breach of these Terms or misuse of the Service
• Claims submitted, transmitted, or pursued on your instruction, including through the Claim Switching or Collections modules
• Claims by patients, Schemes, regulators or other third parties related to your use of the Service or its outputs

These Terms are governed by the laws of the Republic of South Africa.

Disputes relating to medical scheme benefits (including PMB) must be pursued through the relevant scheme’s dispute processes and, where applicable, the Council for Medical Schemes.

Any other dispute arising out of or relating to these Terms or the Service shall first be addressed through good-faith negotiation between the parties’ representatives. If unresolved within ten (10) business days, the dispute shall be referred to mediation in Johannesburg before a mediator agreed between the parties or, failing agreement, appointed by the Arbitration Foundation of Southern Africa ("AFSA"); and if not resolved by mediation within fifteen (15) business days of the mediator’s appointment, to arbitration in Johannesburg under the AFSA commercial rules by a single arbitrator. Nothing prevents either party from approaching a competent court for urgent interim relief.

These Terms, and any notice, acceptance, or signature exchanged electronically, are valid and enforceable under ECTA. We may give notices via the platform, by email to your registered address, or by posting on our website; material changes to the Service or these Terms will be communicated in one of these ways, and continued use after the effective date constitutes acceptance.

If any provision of these Terms is unenforceable, the remainder remains in force. No failure to enforce a provision is a waiver. You may not cede or assign your rights under these Terms without our written consent.

For legal notices, queries about these Terms, or general support questions, contact legal@medcascade.com.

By using MedCascade, you acknowledge that you have read, understood, and agree to be bound by these Terms of Service. For how we handle your data, please review our Privacy Policy at /privacy.