100% Review of Every Claim
Complex contract terms and limited visibility can make oversight into your pharmacy benefit spend nearly impossible. This can lead to big financial losses, as well as shrinking member benefits, and eroded trust. With HDS you can apply real-time payment integrity to 100% of every pharmacy claim file—right down to the invoice line item.Explore Our Solution
Reduce Overspending and Improve Health Outcomes
Unlike other solutions, the HDS platform exists in a prepayment environment, before things get complicated. Our reimbursement experts use proprietary technology to inspect complete claims records, providing actionable insights that help you collaboratively engage with your PBM to prevent errors and recover funds, so you can invest in your members and plans.
Unlike annual and quarterly audits, HDS inspects your entire pharmacy claim file.
Potential overpayments are spotted in near-real time, before you pay an invoice, saving you money.
Actionable insights allow you to make mid-contract pivots to improve outcomes and bend the cost curve.
Reduces Administrative Burden
HDS manages the burden of overpayment so your staff can be more strategic, passing the savings onto plan members.
HDS Saved Taxpayers Millions
Read about how our partnership with Ohio Medicaid identified $180 Million in overpayments.Download the Case Study
A Fact-Based Approach to Accurate Claims Review
Our data-mining SaaS platform makes your pharmacy spend more transparent. This close level of attention identifies errors on an invoice-by-invoice basis. This gives you the ability to make corrections right away, as well as long-term adjustments. All of this, with minimal disruption to the standard payment cycle.
We compare objective data regarding pharmacy benefit performance in real-time to address:
- Contract compliance
- Plan design
- Regulatory compliance
- Market competitiveness
- Treatment protocols
"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."