Pricing

Priced on outcomes. Never on making the gap look bigger.

A platform subscription for the always-on engine, plus ~20% of the dollars we defend above the Qualifying Payment Amount. The fee is anchored to the QPA — it can't be inflated by making a demand look bigger — and you keep ~80% of everything defended. Start free with an exposure view.

Founding-customer rate — 15% of defended dollarsvs 20% list · locked for your contract term
First 10 plans · through Dec 2026

Platform subscription + ~20% of defended dollars

The platform base covers the always-on work — eligibility scanning, regulated-deadline defense, the governed agent, QPA defense, and document generation. The success fee applies only to dollars actually defended above the QPA, so our incentives point the same way yours do: a defensible number, filed on time. No cut of fictional "savings," no charge for making the demand look larger.

One dispute, illustrated
$5,478 $1,336
Provider demand defended to the QPA = ~$4,100 held out of provider hands. A 20% fee ≈ $820; the plan keeps ~$3,300. Founding rate (15%) ≈ $615. Multiply across the book.
Plans

Choose by book size and workflow depth.

Exposure
Employers & brokers — see what you're losing
Free
No card, no contract
  • IDR exposure analytics
  • Default-loss & win visibility
  • Runs off a claims/remittance export
  • Broker-distributable
Most TPAs
Fair-Value Defense
Independent & mid-tier TPAs
Platform base + 20% defended
Founding rate: 15% · floor applies
  • Eligibility scanning & deadline defense
  • QPA defense + document generation
  • Governed agent, batching, IDRE selection
  • Intelligence, scorecards & negotiation
  • Multi-plan · fee anchored to QPA
Enterprise
Large payers & national TPAs
Annual license + capped fee
Predictable spend, bounded success fee
  • Everything in Fair-Value Defense
  • SSO / SCIM · RBAC · audit UI
  • API & webhooks · custom SLAs
  • SOC 2 report · signed BAA
  • Optional performance guarantee
Data & Intelligence
Standalone feed — both sides & IDR entities
Subscription · standalone
The market data behind the defense
  • Benchmark rate feeds
  • IDRE-behavior analytics
  • Initiator win-rate & calibration
  • “Bloomberg for IDR”
Un-gameable by design

How we measure defended dollars.

Overpayment avoided

For every dispute we work: the provider's demand minus the final settled or awarded amount — capped at the amount above the QPA. We only claim credit for defensible reductions, never for the demand itself.

Default losses prevented

Regulated deadlines we surface and you meet — each one avoids a payout that a missed window would have forced. Timeliness is money in IDR.

Two guardrails keep it honest: we only count disputes the platform actually touched (no “you'd have won anyway”), and credit is capped at the amount above the QPA. Every figure is drawn from Avertyn's tamper-evident ledger and billed on a set cadence with a customer-visible savings report.
By buyer

Where each plan fits.

Indicative annual anchors — final terms are set per order.

Independent / mid-tier TPAs
The core hybrid — a known platform number plus a self-funding success fee.
~$2k–$10k/mo (or ~$0.10–$0.40 PEPM) + 20%
Self-funded employers
Savings-share led; often reached through their TPA as a channel.
Lighter base + 20% of defended · floor
Large payers / national TPAs
A predictable license plus a bounded success fee; security artifacts are the gate.
~$50k–$250k/yr + 15% (capped)
IDR entities · neutral engine
The neutral eligibility-determination engine + data feed. No contingency.
~$50k–$150k/yr flat, per entity

Getting started

Explore the live demo today on click-through terms — no contract required. To run your own claims, we complete the paperwork before any protected health information touches the platform: a subscription agreement (MSA) and Order Form, plus a signed Business Associate Agreement.

Demo (Terms of Service) → MSA + Order Form + BAA → live data

Why it pays

Providers initiate ~99.9% of disputes and win most of them, at 3–9× in-network rates. Every ineligible dispute defeated and every deadline met is a payout avoided — hard-dollar ROI, not a seat license. Priced to keep our incentives aligned with yours.

See your exposure before you spend a dollar.

Start with a free exposure view off a claims export. When you're ready to defend real dollars, the founding-customer rate is waiting.

See your exposure — free Read the FAQ