Commercial Payers

By combining hard data with human intelligence, HealthPlan Data Solutions (HDS) translates complex pharmacy benefit data into insight, enabling you to maximize the value of your PBM services, identify mid-contract opportunities for cost savings/avoidance, and ensure compliance. The HDS Spotlight platform offers services which are additive to existing commercial PBM oversight and monitoring.

Pharmacy Analytics that Continuously Review 100% of Paid Claims to Ensure Accuracy

Identify

HDS proprietary pharmacy analytics technology identifies claim-level errors and using 250+ scans in five key domains, including contractual terms, plan design, and more.

Fix

Through our SaaS, Hybrid, or HDS-Serviced model, impacted claims are continuously identified and error resolution is expedited with the PBM.

Monitor

Once a fix has been implemented, the HDS platform continues to monitor the change over time to ensure its durability for the life of the contract.

Looking to Add Continuous Monitoring to Your Claim Adjudication Process?

Ensuring Payment Intelligence for the Nation's Largest Commercial Payers

HDS is a software solutions company that offers a holistic, post-adjudication, prepayment solution that cuts through contractual complexities and brings visibility and accuracy to your pharmacy spend data.

Commercial Plans

Commercial plans continue to see pharmacy costs increase 5–7% per year. HDS solutions and expertise help arrest those costs by ensuring full transparency and appropriate payment for every claim.

Blue Cross Blue Shield Plans

Blue plans feel obligated to contract with a PBM owned by a competitor. HDS brings greater visibility to these transactional agreements to reduce spending and more efficiently manage plans.

HDS Pharmacy Analytics Solutions for Commercial Payers

HDS provides additive solutions that can be customized to suit the unique needs of your pharmacy team.

Pharmacy Data
Insights

Rx Oversight & Analytics

Payment
Integrity

HDS Claim Scan

Campaign Management & Compliance

HDS RevealRx

Customized
Services

Audit | RFP | Contract Analysis

Pharmacy Data
Insights

Rx Oversight & Analytics

Payment
Intelligence

HDS Claim Scan

Campaign Management & Compliance

HDS RevealRx

Customized
Services

Audit | RFP | Contract Analysis

"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."

President & CEO, Controlling Partner

Brokerage Firm

"[HDS] is a strong communicator on difficult topics. We appreciate the laconic approach. It was clear their team is very experienced in the pharmacy benefit space and were essential in helping our team navigate the error resolution process efficiently."

Director of Pharmacy Operations

Multi-State Health Plan

"This is the most detailed and thorough audit we’ve ever received from an auditor. The 100% review of claims gave insight far beyond what other groups have been able to provide. You've done a great job! Thank you for taking the time to work through the calculations with us."

Manager, Health Insurance Benefits

State Retirement System