Terms & Conditions

1. Description of the Platform

PMJAY Claim Trust Engine is a digital claim workflow and governance platform designed to assist healthcare organizations with:

• Claim-data organization
• Claim reconciliation
• Claim validation
• Deduction analysis
• Doctor payout calculations
• Hospital payout calculations
• Reporting
• Workflow governance
• Claim-related data analysis

The Platform provides software assistance and does not replace official government systems or professional decision-making.

2. Authorized Use

The Platform must only be used by individuals and organizations authorized to access and process the information they submit or analyze.

Users must comply with applicable laws, hospital policies, government requirements, contractual obligations, and data-protection requirements.

3. Account Registration

Users are responsible for providing accurate registration information and protecting:

• Login credentials
• OTPs
• Authentication information
• Devices used to access the Platform

Users should notify the Platform operator if they believe their account has been compromised.

4. Patient and Claim Information

Users are responsible for ensuring that they are authorized to process patient and claim information.

The Platform should not be used to process information obtained unlawfully or without appropriate authorization.

For supported local-processing workflows, imported claim information is processed within the user’s browser.

Users remain responsible for protecting claim files, exported reports, screenshots, downloads, backups, and other copies stored on their devices.

5. Accuracy of Data

Users are responsible for ensuring that imported or entered information is accurate and complete.

6. Calculations and Reports

The Platform may generate claim, deduction, doctor payout, hospital payout, reconciliation, and analytical reports.

These outputs are software assistance.

Users must verify calculations before using them for financial settlement, doctor payments, accounting, claim submission, government reporting, or regulatory purposes.

7. Government Claim Processing

The Platform does not replace official government claim-processing portals.

Users remain responsible for completing required submission, verification, approval, or settlement processes through applicable official government systems.

The Platform does not guarantee:

• Government claim approval
• Government reimbursement
• Claim acceptance
• Claim settlement
• Absence of deductions
• Absence of rejection

8. No Guarantee of Claim Outcome

Use of the Platform does not guarantee:

• Zero claim rejection
• Zero deductions
• Claim approval
• Faster government settlement
• Increased reimbursement
• Specific financial outcomes

9. Software Availability

We aim to maintain reliable access but do not guarantee uninterrupted or error-free availability.

10. Security

We implement reasonable technical and organizational measures designed to protect the Platform.

No Internet-connected system can be guaranteed to be completely secure.

11. Prohibited Activities

Users must not:

• Attempt unauthorized access.
• Circumvent authentication controls.
• Attack or disrupt the Platform.
• Introduce malicious code.
• Obtain another user’s credentials.
• Abuse application vulnerabilities.
• Upload unlawful information.
• Violate privacy rights.
• Use the Platform for fraudulent activity.

12. Intellectual Property

The Platform, software, interface, branding, documentation, designs, and original content may be protected by applicable intellectual-property laws.

13. User Data

Users remain responsible for information they import, enter, generate, export, or store through the Platform.

The Platform does not claim ownership of a user’s patient or claim information merely because the information is processed through the software.

14. Third-Party Services

Certain Platform functions may depend on third-party services such as hosting, payment, email, authentication, or infrastructure providers.

15. Subscriptions and Payments

Where paid plans are offered, applicable pricing, billing periods, payment terms, and cancellation conditions will be communicated to users.

16. Suspension or Termination

Access may be suspended or terminated where reasonably necessary due to security concerns, fraud, abuse, violation of these Terms, unauthorized access attempts, non-payment, or legal requirements.

17. Disclaimer

The Platform is a software tool. It does not constitute:

• Medical advice
• Legal advice
• Accounting advice
• Government approval
• Regulatory certification
• Financial advice

18. Limitation of Liability

To the maximum extent permitted by applicable law, the Platform operator will not be responsible for losses caused by incorrect user input, incorrect source files, device failures, compromised credentials, user mishandling of exported files, government portal changes, government claim decisions, third-party outages, connectivity problems, or misinterpretation of software-generated calculations.

Nothing in these Terms excludes liability that cannot legally be excluded.

19. Changes to Terms

We may update these Terms from time to time. The updated version will be published on this page.

20. Contact