Both plans check every claim every day, find the money you are losing or owed, and give you a clear fix for each claim. The difference is who does the reverse-and-rebill. Pricing is a fixed fee, never a percentage of recovery.
RXLens finds the problem claims and hands your team a step-by-step fix for each one. You file the reverse-and-rebill in your own pharmacy system. No connectivity or data submission by AYAANIS.
Everything in Prime, plus AYAANIS prepares and manages the reverse-and-rebill for eligible, documented clerical errors on your behalf, under your authorization.
| Capability | Prime | Advance |
|---|---|---|
| Audit | ||
| Every claim audited, every day, with alerts before a filing window closes | ✓ | ✓ |
| Scheduled pull from your pharmacy system | ✓ | ✓ |
| Underpayment and below-cost claims found | ✓ | ✓ |
| Long-term care, specialty and compounding books covered | ✓ | ✓ |
| Fix and rebill | ||
| Correction worksheet and certificate per claim | ✓ | ✓ |
| Rebill tracked until the payer actually pays | ✓ | ✓ |
| Who files the reverse-and-rebill | Your team | AYAANIS |
| Managed reverse-and-rebill (payer transmission in certification) | – | ✓ |
| Defend | ||
| Audit notices, deadlines and appeals in one place | ✓ | ✓ |
| Challenge a demand projected from a small sample | ✓ | ✓ |
| Audit-ready record, already assembled | ✓ | ✓ |
| Who writes and files the appeal | Your team | AYAANIS |
| Money owed to you | ||
| Money owed to you by manufacturers, found and chased | ✓ | ✓ |
| Purchasing review against what you were paid | ✓ | ✓ |
| Insight | ||
| Monthly owner brief | ✓ | ✓ |
| Trends, audit likelihood, every location in one view | Add-on | ✓ |
| Service and terms | ||
| Dedicated analyst and monthly recovery review | – | ✓ |
| BAA + written agency authorization | – | Required |
| Fixed-fee, not a % of recovery | ✓ | ✓ |
Pricing is a fixed fee scoped to claim volume and locations, never a percentage of recovery. The Insight add-on can be added to Prime at any time and is included in Advance. Advance requires a signed Business Associate Agreement and written agency authorization before any claim is filed.
Ten minutes on Zoom, screen shared. Nothing to install and no claims data needed. We will show you what RXLens finds and how the rebill gets done.
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