Advanced Medical Pricing Solutions

What Advanced Medical Pricing Solutions does

Advanced Medical Pricing Solutions (AMPS) is a Phoenix-based healthcare cost containment company founded in 2005 that serves self-funded employers, third-party administrators (TPAs), health plans, and brokers. The company operates three integrated core solutions: PriceDynamix for reference-based medical claims repricing with a guarantee of less than 175% of Medicare rates, ClaimInsight for payment integrity combining rules-based prepay editing (Intelligent Policy Update) with physician-led High-Dollar Review, and Drexi for pharmacy benefit management with guaranteed 30-50% prescription drug savings. Underlying technology includes a cloud-based platform with proprietary engines (TruPrice, Dynamic Repricing Engine, ClaimInsight AI Platform), a member-facing portal (AMPS Connect) with mobile apps, and the Retro Review & Recovery program that recovers 3-6% of healthcare spend from prior paid claims.

AMPS generates revenue primarily through per-member-per-month (PMPM) subscription fees across PriceDynamix, ClaimInsight, and Drexi, supplemented by contingency-based fees on Retro Review & Recovery recoveries and pass-through pharmacy economics. Go-to-market combines direct enterprise field sales targeting large self-funded employers and health plans with a channel partner network of TPAs, insurance brokers, and benefits consultants who introduce clients. The company has served over 1,700 PriceDynamix clients generating $2.25 billion in cumulative savings, with 98.7% average claim repricing acceptance and 94% member satisfaction. Operations are supported by a wholly-owned India subsidiary (AMPS Healthcare India Pvt Ltd), and AMPS maintains additional wholly-owned operating subsidiaries including NBFSA, LLC for refund and cancellation services.

In 2025 the company executed a coordinated expansion push: launching ClaimInsight as a standalone payment integrity platform, launching TruPrice within PriceDynamix, securing a senior secured term loan from Crestline, adding a CFO and two sales vice presidents, and achieving HITRUST e1 cybersecurity certification. The company holds no disclosed patents and operates without public venture capital or private equity backing per the available source material.

Name

Advanced Medical Pricing Solutions

Legal name

Advanced Medical Pricing Solutions

Website

https://amps.com

Company type

Private

Founded year

2005

Operating status

Operating

Headcount range

101–250 employees

Short description

Advanced Medical Pricing Solutions is a Phoenix-based healthcare cost containment company that provides reference-based pricing, payment integrity, and pharmacy benefit management solutions to self-funded employers, TPAs, health plans, and brokers across the United States.

Ownership category

akta.pro rank

Product category

Healthcare Cost Containment Software

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK)

akta.pro secondary industries

Medication Pricing, Copay Assistance & Patient Financial Support Tools (HLACAKAN), Copay Assistance, Patient Support & Affordability Programs (HLAEAKAI)

Keywords

• Healthcare cost containment
• Reference-based pricing
• Payment integrity solutions
• Pharmacy benefit management
• Medical claims repricing

Headquarters

HQ city

Phoenix

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. PriceDynamix Reference-Based Pricing: AMPS charges a per-member-per-month (PMPM) fee for claims repricing services under PriceDynamix. The solution guarantees an annual aggregate of less than 175% of Medicare rates, providing predictable pricing without contingency fees. Revenue is recurring based on covered member population.
2. ClaimInsight Payment Integrity: ClaimInsight generates revenue through PMPM pricing models for automated claim editing and high-dollar review services. Offers predictable pricing models that maximize ROI for payers, with clients experiencing savings of $5,000,000 per 100,000 members annually.
3. Drexi Pharmacy Benefit Management: Drexi PBM delivers savings through advanced drug utilization management and deep discount negotiations. Guarantees 30-50% savings on prescription drugs. Revenue model includes administrative fees and pass-through pricing with transparent discount and rebate practices.
4. Retro Review & Recovery (RRR): RRR program reviews up to three years of paid claims to recover 3-6% of total healthcare spend lost to billing errors, overpayments, and administrative mistakes. Revenue generated through contingency-based recovery fees on funds recovered.

Pricing tiers

Go-to-market motion3 records

Distribution channels5 records

Marketing channels8 records

Core offering

Advanced Medical Pricing Solutions (AMPS) delivers healthcare cost containment services for self-funded employers, TPAs, and health plans through three core platforms: PriceDynamix (reference-based medical claims repricing), ClaimInsight (payment integrity with automated claim editing and physician-led high-dollar review), and Drexi (pharmacy benefit management). Revenue is generated primarily through recurring per-member-per-month (PMPM) fees, with additional contingency-based recovery fees for post-payment claims review.

Product overview

AMPS offers a platform-plus-modules architecture centered on three core healthcare cost containment solutions: PriceDynamix (medical claims repricing via Reference-Based Pricing), ClaimInsight (payment integrity with automated claim editing and physician-led review), and Drexi (pharmacy benefit management). These solutions work independently or together, with PriceDynamix leveraging ClaimInsight's prepay editing to validate claims before repricing. Additional modules include AMPS Connect (member portal), TruPrice (contract-based pricing within PriceDynamix), Intelligent Policy Update (IPU) and High-Dollar Review (HDR) within ClaimInsight, and Retro Review & Recovery (RRR) for post-payment recovery.

Differentiator

Problem solved

Functional benefit

Brands

• PriceDynamix: Reference-based pricing solution for medical claims repricing, delivering savings through precise claim review and dynamic repricing strategies.
• ClaimInsight
• Drexi
• AMPS Connect
• TruPrice

Products and services

• PriceDynamix Medical claims repricing solution using Reference-Based Pricing (RBP) powered by proprietary technology. Delivers precise claim reviews and dynamic repricing with an annual aggregate guarantee of less than 175% of Medicare rates. Includes proactive member advocacy, dynamic repricing, legal/negotiation teams, and Care Navigation. Targets self-funded employers, TPAs, and health plans.
• ClaimInsight Payment integrity platform combining automated rules-based claim editing (Intelligent Policy Update/IPU) with physician-led High-Dollar Review (HDR) and Retro Review & Recovery (RRR) for comprehensive claims auditing and cost containment. Designed for payers, TPAs, and health plans seeking compliant and defensible savings.
• Drexi Pharmacy benefit management (PBM) solution transforming prescription cost management with transparent pricing, International Rx Program for FDA-approved medications, and drug utilization management. Guarantees 30-50% savings on prescription drugs through advanced drug utilization management and deep discount negotiations. Targets self-funded employers and health plans.
• AMPS Connect Member-facing portal providing 24/7 access to balance billing insights, friendly provider search, Care Navigation access, and claims viewing. Available via web app and mobile app on iOS and Android. Enables members to make smarter healthcare decisions with proactive tools.

Quantifiable outcome

• $2.25 billion in savings generated for PriceDynamix clients
• +7 more outcomes

Named customers5 records

Segments5 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability3 records

Feature6 records

Partnerships

Six partnerships are on record, tiered minor and core.

• AriseHealthminorStrategic or Co-development PartnerAriseHealth Rapid Response is offered as an add-on service with PriceDynamix, providing additional rapid response capabilities for healthcare cost management.
• OE (Optimization Experts)minorStrategic or Co-development PartnerOE AMPS America Plus is offered as an add-on service with PriceDynamix, expanding the AMPS America provider network and contracting capabilities.
• 2020INCminorStrategic or Co-development Partner2020INC Member Defense is offered as an add-on service with PriceDynamix, providing enhanced member defense and advocacy services.
• EphicientminorStrategic or Co-development PartnerEphicient Intelligent Pricing Wrap is offered as an add-on service with PriceDynamix, providing intelligent pricing wraparound services.
• Health SharescoreStrategic or Co-development PartnerAMPS partners with Health Shares to manage contracting efforts on behalf of their members. Collaborates with hospitals, ambulatory surgery centers, physician offices, and clinics across the United States to build a network of preferred providers.
• AMPS America NetworkcoreChannel Partner/ Reseller/ DistributorStrategic contracts with providers nationwide through AMPS America to reduce member abrasion and streamline care access. Providers receive preferred status and steerage from AMPS Care Navigation team.

Scale indicators9 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• ELAP Services: ELAP Services is a reference-based pricing and healthcare cost management firm serving self-funded employer plans. It competes head-to-head with PriceDynamix on RBP for medical claims and operates a similar member advocacy model.
• Captive Resources: Captive Resources provides group captives and self-funded medical plan management services to mid-market employers, including cost containment and PBM coordination. It serves the same self-funded employer and broker channels as AMPS.
• RxBenefits: RxBenefits is a PBM that partners with benefit consultants and TPAs to deliver prescription drug benefits to self-funded employers. It is the most direct PBM peer to AMPS's Drexi subsidiary, with a similar go-to-market through brokers and TPAs.
• Healthcare Bluebook: Healthcare Bluebook provides reference-based pricing and transparency tools to self-funded employers and payers, using fair-price benchmarks to power claim repricing. It is a direct functional competitor to PriceDynamix in RBP and bundles member-facing navigation.
• Zelis: Zelis provides healthcare claims cost management and payment integrity solutions including repricing, claim editing, and overpayment recovery to payers, TPAs, and self-funded employers. It directly competes with ClaimInsight and PriceDynamix on payment integrity and claims cost containment.
• Phia Group: Phia Group delivers reference-based pricing, balance bill defense, and cost containment services for self-funded health plans. It is a close peer to AMPS in RBP deployment and provider dispute resolution.
• MultiPlan: MultiPlan is the largest independent healthcare cost management company in the US, offering PPO networks, repricing, and payment integrity services to payers, TPAs, and self-funded employers. It is the most direct comparable to AMPS, operating at significantly greater scale across the same customer base.

Emerging players

• WellRithms: WellRithms provides analytics-driven reference-based pricing and claims cost management for self-funded health plans. It overlaps with PriceDynamix on RBP and offers complementary transparency analytics, positioning it as a niche emerging peer.
• SmithRx: SmithRx is a transparent PBC PBM offering pass-through pricing and clinical programs to self-funded employers. It competes with Drexi in the transparent-PBM segment and shares the same self-funded employer customer profile.

Broad incumbents

• Optum (Change Healthcare): Optum, the UnitedHealth Group services arm, owns Change Healthcare and offers claims processing, payment integrity, and broader payer-services capabilities. It is a broad incumbent whose claims editing and repricing stack overlaps with ClaimInsight and PriceDynamix.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubevimeo.com/ampsvideos
• LinkedInlinkedin.com/company/advanced-medical-pricing-solutions
• Xx.com/AMPS_04
• Facebookfacebook.com/advancedmedicalpricingsolutions

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Subsidiaries5 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Advanced Medical Pricing Solutions