Pay Per Claim 2026

Pay Per Claim

Residential Only (3-5 Day Turnaround)
Company Name*
Your Name?*

First NameLast Name
Your Email Address*
This will be used on Xactimate
Best Contact Number*

Area CodePhone Number
What Can We Help You With?*

Pay Per Claim - Supplement Claim Management ($250)Xactimate Supplement Write Service - Write Supplement against carrier scope and return to contractor ($250)Xactimate Estimate Write Service - Write estimate based on photos and satellite report and return to contractor ($150)

Payment
*
prevnext( X )
Xactimate Estimate Write ServiceProduce Residential Xactimate Estimate based on photos and satellite report and return to contractor.
$150.00



Pay Per Claim - $250 Deposit + 15% of Supplement increase$250 initial payment for comprehensive Pay-Per-Claim support including estimate evaluation, supplement development, documentation organization, carrier submission, follow-ups, rebuttals, and reinspection coordination
$250.00



Xactimate Supplement Write ServiceProduce Residential Xactimate Supplement based on carrier scope of loss photos and satellite report and return to contractor.
$250.00



Total

$0.00
PAY-PER-CLAIM PAYMENT AUTHORIZATION & SERVICE TERMS

PAS Claims – Pay-Per-Claim Service Agreement & Payment Authorization

By submitting a Pay-Per-Claim order with PAS Claims, you acknowledge and agree to the terms below regarding service delivery, fees, and payment processing.

1. Pay-Per-Claim Service Overview
This service includes the following support for each claim:
- Estimate audit and accuracy review
- Supplement development, including missing line items and F9 notes
- Photo and documentation organization
- Supplement submission to the carrier
- Carrier follow-ups, responses, and rebuttals
- Reinspection coordination (when applicable)
- Status updates throughout the process
- This is a per-file service and separate from our monthly Claim Management Program.
2. Initial Payment – $250
A $250 initial payment is required to begin work.
This covers:
- File intake and setup
- Estimate review and analysis
- Supplement preparation
- Documentation organization
- Initial submission to the carrier
- This is not the full cost of the service.
3. Success Fee – 15%
PAS Claims charges a 15% success fee based on the approved supplement increase for the claim.

Your $250 initial payment will be credited toward this success fee.

Example:
Approved supplement increase: $3,000
Success fee (15%): $450
Initial payment: – $250 credit
Remaining balance charged: $200

4. Payment Authorization
By completing the $250 initial payment, you authorize PAS Claims to:

Charge the same card used for the initial payment for the remaining success fee balance once your supplement approval has been finalized.
No additional authorization will be required.
A receipt will be emailed for every transaction.

If the card is declined, processing of the claim may pause until payment is resolved.

5. Client Responsibilities
To avoid delays, you agree to provide:

Accurate photos
Complete job details
Carrier estimate and documentation
Adjuster contact information (if applicable)
Missing or incomplete documentation may delay the supplement approval timeline.

6. Non-Refundable Terms
The $250 initial payment becomes non-refundable once PAS Claims begins work on your file.

7. Acknowledgment
By proceeding with payment and submitting a Pay-Per-Claim order, you confirm that:

You understand and agree to the 15% success fee structure
Your $250 initial payment will be applied toward the fee
You authorize PAS Claims to charge the remaining balance automatically
This agreement applies per claim submitted
Should be Empty: