Pharmacy Benefits Meet Payment Integrity
Too many companies are managing pharmacy costs without clear insight into how Pharmacy Benefit Managers are performing. At HealthPlan Data Solutions (HDS), we leverage the power of objective data to identify billing problems, fix the issues that lead to overpayment, and monitor to minimize future discrepancies.
In 2017, our software audits identified over 180 million dollars (7.1%) in overpayments for Ohio Medicaid. Imagine what it can do for you.
Our Pharmacy Payment Integrity System performs real-time, claim-by-claim audits against your contract terms and plan design to identify billing errors, coverage errors, savings, and opportunities for improvement in PBM performance.
You may not always know what’s causing cost discrepancies, but it’s tough to argue with hard data. When our software identifies issues, it also exposes the cause, making it easier to fix the problem, prevent it going forward, and speed the process of recovering associated costs.
Everyone performs better when guardrails are in place—including PBMs. That’s especially true when data is continually monitored in real-time, and everyone has the opportunity to adjust processes before isolated incidents become ongoing issues.
What Our Clients Say
"In the first year, Rx costs for the group were reduced by 22%. They experienced another 5% reduction in the second year with flat utilization. I would recommend HDS because of their unflagging determination in bettering the understanding and culture of their clients, while also helping them realize year-to-year cost savings."
"As President of Compass Rose Benefits Group, I highly endorse HealthPlan Data Solutions (HDS) in performing PBM analytical, auditing and RFP services. Using HDS services has given us great insight into our pharmacy spend at a level that I had not seen before engaging with them."
"The six pricing anomalies detected resulted in an annual savings of over $1.2 million dollars. I strongly recommend HDS be considered for application in the larger prescription benefit programs operated by the State of Ohio."