SCREEN 3 OF 14
The four papers, in plain words
Each one opens so you can read the whole thing, and each one says why it exists. Every word on this screen is a mock written for a walkthrough.
Signed 0 of 4
The counter moves as you sign, so Signed 2 of 4 means two papers are still open.
Each reading time is an estimate we made, not a measured figure. MODELLED
Business Associate Agreement
3 min to read
What this is
A written promise that NextRev protects the patient information it touches. Our software reads names, balances and payment plans out of your Ortho2 and writes receipts back, which is what makes us your business associate under the law.
Why TRX needs it
TRX never sees patient information, so it does not sign this one: it is between your practice and NextRev.
Read the full mock text of the Business Associate Agreement
Draft. Not sent, not signed. Every period and figure in this text is a draft we chose, not a measured number. MODELLED
What this agreement is, in plain words
- HIPAA is the US law that protects patient information.
- A practice that bills insurance electronically is a covered entity under that law. Most practices are.
- An outside company that reads, stores, sends or changes patient information for that practice is a business associate.
- NextRev's software reads patient names, balances and payment plans from the practice's Ortho2, and writes receipts back. That makes NextRev the practice's business associate.
- The practice may only let us touch that information if we sign a written promise to protect it. That written promise is this agreement, required at 45 CFR 164.504(e).
- One agreement per practice, signed with the practice where the practice engages NextRev directly. If someone resells the software, counsel checks who signs with whom before anything is signed.
Three clauses that change the software, not just the paperwork
- When the work ends, we return or destroy the practice's patient data.
- We report security incidents to the practice.
- We produce patient information for a patient access request inside a set time.
Where this draft came from
It is built on the sample business associate agreement provisions published by the US Department of Health and Human Services, and on the element list at 45 CFR 164.504(e)(2) and 164.314(a)(2). Their own warning travels with it: this is only sample language, it alone may not be enough to form a binding contract under state law, and it does not replace consultation with a lawyer.
Still open, and marked open on purpose
Three terms are not settled in this draft: how fast we report a problem to the practice, who tells patients after a breach and who pays for it, and how long the practice gives us to fix a breach before it can end the agreement. They are commercial choices, not requirements of the law, and counsel settles them before any practice signs.
Mock, counsel review pending.
Mutual non-disclosure agreement
2 min to read
What this is
A two-way promise to keep each other's business information private while the two sides look at working together. Both sides carry the same duty in the same words, so neither side gets the weaker half.
Why TRX needs it
TRX does not sign this one either: it lets your practice and NextRev talk openly about your figures, your setup and our software without either side being careless with it.
Read the full mock text of the mutual non-disclosure agreement
Mock text for a walkthrough. Not sent, not signed. Every period and figure in this text is a draft we chose, not a measured number. MODELLED
The two sides
Horizon City Orthodontics and NextRev Partners, LLC. Each side may be the one sharing and the one receiving, and every duty below applies to both sides in the same words.
What counts as confidential
Business and technical information one side gives the other, in any form, that is marked confidential or that a sensible person would treat as confidential. It covers pricing, card volumes, patient counts, staffing, supplier terms, software design, screens, roadmaps and anything shown in a demonstration.
What is excluded
- Anything already public, unless it became public because of a breach of this agreement.
- Anything the receiving side already held before it was shared.
- Anything the receiving side works out on its own without using what was shared.
- Anything a third party passes on with the right to pass it on.
If a court or a regulator orders disclosure, the receiving side may comply, and tells the other side first where the law allows it.
Patient information is not covered here
Patient information is covered by the Business Associate Agreement above, which sets a higher duty. Nothing in this agreement lowers it.
What it may be used for
Only to look at whether the two sides work together, and to run the service if they do. Not to build a competing product, and not to approach the other side's customers with what was learned.
How long it lasts
The duty to keep it private runs for three years from the day it is signed. Anything that counts as a trade secret stays protected for as long as the law protects it.
What happens at the end
On a written request, each side returns or destroys what it holds of the other side's confidential information, and may keep one copy inside its routine backups until those backups age out.
Both ways, with nothing hidden in it
The same words bind NextRev and the practice. This agreement is not a contract to buy anything, it does not commit either side to a deal, and either side may walk away.
Mock text for a walkthrough, and not a signed agreement.
Consent to the technology fee
1 min to read
What this is
Your written acknowledgement of the fee a family pays, in the same words the family reads. It is not a charge to the practice, and it is not taken out of what the practice is paid.
Families pay a $5.95 technology fee on each payment, shown before the payment is made. The practice never sees it and never handles it.
That figure is the price set for this mock walkthrough, not a measured number. MODELLED
Why TRX needs it
TRX processes the payment the fee travels on, so the account file has to carry the practice's acknowledgement of how the fee is shown and whose fee it is.
Read the full mock text of the fee consent
Mock text for a walkthrough. Not sent, not signed. Every period and figure in this text is a draft we chose, not a measured number. MODELLED
- The fee. Families pay a technology fee to NextRev on each payment they make through NextRev. The amount is the one printed on this card, and it is the same on every payment method.
- Who pays it. The family pays it. The practice does not pay it, is not billed for it, and does not have it deducted from its own money.
- Shown first, every time. The fee is displayed to the family before the payment is made, on the same screen where the family agrees to pay. It is never added afterwards.
- Two lines on the receipt. The family's receipt shows the practice's instalment on one line and the NextRev fee on the other, so the family can see which is which.
- The practice never handles it. The practice never sees the fee in its own money, never holds it, and never has to account for it.
- It is not a surcharge on a card. It is NextRev's fee for the software the family used to sign and to pay.
- If it ever changes. NextRev tells the practice in writing before a new amount is shown to any family.
- What the practice is agreeing. By signing, the practice acknowledges the fee and agrees that NextRev may show it and collect it in the way set out here.
Mock wording. TRX confirms the final form.
Card on file: the words the family sees
2 min to read
What this is
This is the wording the family reads and agrees to on their own phone before a card is kept on file. We show it to the practice in full, so the practice knows exactly what is being said in its name.
Why TRX needs it
TRX holds the card and runs each later payment, and the card rules allow a stored card to be charged again only where the family agreed to it in writing first.
Read the full mock wording the family sees
Mock text for a walkthrough. Not sent, not signed. Every period and figure in this text is a draft we chose, not a measured number. MODELLED
Who we are
NextRev Partners, LLC, a California limited liability company.
Address: [NextRev's registered street address goes here], California.
Phone: (747) 745-5837
What you are agreeing to
You are letting Horizon City Orthodontics and NextRev keep your card on file with the payment processor, TRX, and charge that card for the payments in your treatment plan. You can read the whole plan below before you agree.
What will be charged, and when
| Each payment | $200 MODELLED |
| The day it is taken | The 5th of each month MODELLED |
| How many payments | 16 of them MODELLED |
| What is left to pay | $3,200 MODELLED |
| The NextRev fee | plus a $5.95 technology fee on each payment, paid to NextRev MODELLED |
The amount and the dates above are the plan your practice set. Nothing else is charged to this card.
How to stop the automatic payments
Write to NextRev at the address above, call the number above, or tell your practice. We stop the automatic payments on the next working day and we confirm it to you in writing within three working days.
Stopping the automatic payments does not cancel what you owe. The balance on your treatment plan stays, and your practice will tell you the other ways you can pay it.
Refunds
Your practice decides refunds. Where your practice approves one, the money goes back to the card it came from. A refund does not change the rest of the plan, and the remaining payments carry on unless your practice stops them.
If a payment is declined
If the card is declined we tell you, and we do not try that card again for 7 days. Before we try again we write to you and tell you the date we will try and the amount. You can pay another way, or give us a different card, at any time before then.
Your right to dispute
Nothing here takes away your right to dispute a charge with the bank that issued your card.
Your copy
You get a copy of this authorisation when you agree to it, and you can ask NextRev for another copy at any time while the plan is running.
If the plan changes
If your practice changes the plan in Ortho2, we show you the new schedule and ask you to agree again before anything different is taken.
Who to speak to
NextRev takes the payments. Your practice sets the plan and the balance. Either one can start a change, and NextRev writes to you when a change is made.
What you are signing
Ticking the box and pressing Pay is your electronic signature on this authorisation.
Mock wording. TRX confirms the final form.
The address line is deliberately left as a fill-in. NextRev's registered street address is the one open item in this wording, and we will not print a made-up street on a document a family reads.
One more line is open and is marked open rather than guessed: whether the technology fee comes back when a payment is refunded. Nobody has ruled it yet, so nothing is printed here that claims an answer.
The card rules ask for wording like this to be shown on its own, at the moment the card is asked for, rather than tucked behind a link.
These are mock documents
Every document on this screen is a mock written for a walkthrough. Nothing is signed, nothing is sent, and no account exists. Counsel reviews the real versions before any practice sees them.
This page prints. Use your browser's print command and the four papers come out without the buttons and with every drop-down opened.