Our Solutions

HDS Solutions to Obtain Payment Integrity

Claims Insight

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.

Contact us to learn more about our pharmacy benefit management solutions.

Claim Scan

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

BENCHMARKET™

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.

Self-Insured Employers

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.

Retailers

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.

Our Customers

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."

- Randy Stoughton, President of Compass Rose Benefit Group

"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."

- Mark Pettit, President & CEO of Preferred Benefit Services, Inc.

"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."

- Johnnie L. Hanna, R. Ph, Pharmacy Program Director Ohio Bureau of Workers Compensation

Other Solutions

Provider Insight™

A data-driven approach to measuring provider performance and prescribing behaviors.

Care Insight™

The insight you need to manage pharmacy care and measure health outcomes.

RFPs™

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.

Request a demo of our pharmacy benefit management solutions.