Government Payers

HealthPlan Data Solutions (HDS) is a software solutions company that utilizes leading-edge technology and pharmacy expertise to analyze adjudicated prescription claims, monitor drug utilization trends, identify errors, and reclaim costs for all government payors, including Medicare, Medicaid, and Federal Employee Health Benefit Plans.

More Transparency. Better Engagement with Your PBM.

PBMs handle massive amounts of complex data, making it difficult to ensure appropriate payments are made in real time. HDS helps government payers work with PBMs to identify, fix, and monitor pharmacy claims errors, so they can demonstrate transparency and compliance with CMS standards, protect taxpayer funds, and improve health outcomes.

Identify

HDS proprietary analytics technology identifies errors and utilization trends using 100+ proprietary scans in five key domains, including contractual terms, plan design, and more.

Fix

HDS pharmacy benefit experts help you and your PBM collaborate to determine the root causes of errors, reclaim payments, and prevent future overpayments.

Monitor

HDS analysis provides ongoing, near real-time reviews of 100% of pharmacy claims to ensure optimal contract performance and compliance.

With the HDS technology platform, government payers can realize savings of 3-8% below contractual guarantee.

Ensuring PBM Payment Integrity for State and Federal Health Plans

HDS offers a holistic, post-adjudication, pre-payment solution that cuts through contractual complexities and brings order and visibility to your pharmacy spend data.

Fee-for-Service and Managed Medicaid

HDS closely partners with states and Medicaid plans to ensure every claim is billed accurately, stretching their pharmacy dollars further while continuing to improve member health outcomes.

Medicare Advantage

Aging populations, increased drug spend, and strict compliance requirements demand a stronger understanding of pharmacy spend. HDS enables the level of transparency needed to ensure optimal contract performance.

Federal Employee Health Benefit (FEHB) Plans

FEHB plans have unique requirements and cost pressures. HDS is an expert steeped in experience with our clients.

Learn How HDS Can Maximize the Value of Your PBM Relationship