HDS Solutions to Obtain Payment Integrity
The power to monitor claims and flag issues before you overpay
Claims Insight gives you more negotiating leverage by putting objective data tools at your fingertips.
With Claim Scan, you have the ability to withhold partial or full payment on Rx claims that are processed inappropriately. Ongoing monitoring and an automated quarterly analysis allow you to:
Identify cost savings opportunities like Therapeutic Alternatives
Monitor PBM performance on a monthly basis
Analyze drug-utilization trends by drug class
Understand the market competitiveness of your pricing
Educate yourself and your team prior to PBM quarterly reviews
Fraud, Waste and Abuse
Your PBM, pharmacies, prescribers, and patients are audited against 20+ criteria for suspected FWA, including:
High-risk opioid use
Pharma-influenced prescribing behavior
Patients selling test strips
Our proprietary, survey-based pricing analysis tool provides the market-average price for generic drugs and empowers you during negotiations with your PBM.
Who We Serve
State and Federal Government Agencies
Maintain the integrity of your healthcare programs with unmatched insight into PBM performance. HDS Claim Scan monitors claims in ten critical areas, using over 60 critical data elements to provide a post adjudication, prepayment analysis of all claims. Analyzing every claim in near real-time allows you to address issues and errors not typically identified in a retrospective audit.
Managing the quality and cost of healthcare for a diverse workforce is easier when you have a partner like HDS on your side. Our solutions give you the insight to make better choices and data that ensures adherence to the terms of your contract. Our clients see an average savings of 25% on drug spend, and a typical 1,000 employee company can save $200,000 per year or more.
Our auditing tools are effective for recovering income in the retail sector, too. We will identify, fix and monitor areas in which your grocery store, retail chain or specialty store is losing revenue through overpayment or other issues.
Healthcare Providers and Payers
When discrepancies in cost and care arise, they must be addressed quickly to ensure the best care for patients. Our tool, Provider Insight™ can help providers reach prescribing goals set by their plans and alert payers to providers with dangerous prescribing patterns.
Insurance Brokers and Channel Partners
Our proprietary tools help ensure every claim adheres to contracted pricing terms, so you can manage ROI with clarity and consistency. As your auditing partner, HDS will even help with negotiations when discrepancies are discovered to secure recovery as quickly as possible.
What Our Clients Say
"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."
"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."
"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."
A data-driven approach to measuring provider performance and prescribing behaviors.
The insight you need to manage pharmacy care and measure health outcomes.
HDS offers a more automated solution to managing and scoring PBM RFP proposal submissions. The HDS RFP Submissions analysis enables the accurate measurement, comparison, and score-carding of RFP submissions using the client’s actual claims history and the submitted PBM contract terms.