Third-Party Administrators | Who We Serve | HealthPlan Data Solutions

Third Party Administrators

Executing on pharmacy claim accuracy is essential to providing high quality claim adjudication service and value for your clients. HDS not only enables TPAs to stand by their guarantees, but provides an objective way to validate them.

Leverage a Technology Platform to Monitor 100% of Claims as They Adjudicate

Identify

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

Fix

Once claim errors are identified, TPAs can quickly perform a root cause analysis and expedite a fix.

Monitor

Once a fix has been implemented, the HDS Spotlight platform serves as an ongoing quality check to ensure the fix remains in place.

Looking to Add Continuous Monitoring to Your Claim Adjudication Process?

Add the Power Of Advanced Pharmacy Analytics to Your Claims Processing

Add a Key Differentiator

It is important that TPAs provide competitive bids with regard to Admin Fees. When augmented with HDS Spotlight, our TPA clients go above and beyond to offer guaranteed financial accuracy which can be the difference between winning and losing and RFP.

Validate Performance

While most TPAs offer some level of financial accuracy, many come up short when it comes to validating the proposals they signed. With HDS Spotlight, TPAs gain the ability to provide claim-by-claim analytics to show how much their clients are really saving. When payers demand for a high degree of accuracy, our TPA clients can deliver.

HDS Pharmacy Analytics Solutions for Third Party Administrators

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

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

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