Claim Scan
Always-on oversight that delivers more
Claim Scan reviews 100% of paid pharmacy claims in real time — catching errors and savings opportunities as they occur. Our platform combines your PBM contract, plan design details, and pharmacy claims to create a central source of truth. That means actionable insight across plan operations, compliance, and financial performance.
Features include:
- Continuous review of every paid claim
- 700+ proprietary pharmacy payment integrity algorithms
- One million claims processed in 11 minutes
- Plan design and contract term validation
- Pre-built and custom reports for every team
- PBM-agnostic and HITRUST r2 certified
100% claim-level pharmacy oversight
We help payers protect every pharmacy dollar by continuously reviewing adjudicated claims for pricing errors, plan design mismatches, and contract misalignment. With 700+ proprietary algorithms and unmatched throughput, our platform identifies issues faster and drives measurable value across any line of business.
Filling the gaps left by legacy oversight
Traditional PBM audits are retrospective and narrowly scoped, often conducted only once every few years. By the time insights surface, overspending has already occurred and recoveries are limited. We take a different approach.
Integrating seamlessly with minimal lift
Whether data comes directly from your PBM or your team, Claim Scan is easy to implement. We require no system changes and offer a fully managed onboarding process that takes as little as 10 total client hours.
Driving value from day one
From the start, our oversight delivers measurable impact. For example, one commercial plan saw $6.8M in value in the first year, including $3.8M from contract improvements uncovered through continuous claims monitoring.
