Case Study: a mid-sized regional health service provider achieves $6.8M in pharmacy savings with HealthPlan Data Solutions' Claim Scan

How HDS implemented Claim Scan real-time payment integrity to help one plan save $6.8M in the first year

A mid-sized regional health service provider was facing significant challenges with its pharmacy benefit oversight, relying on slow and inefficient traditional PBM audits. Frustrated by delays of over 18 months for findings and a five-year reconciliation process, the provider turned to HealthPlan Data Solutions (HDS) to implement a new approach using the Claim Scan real-time payment integrity service.

HealthPlan Data Solutions implemented its Claim Scan platform, which provided continuous monitoring by mapping over 1,000 plan designs and contracts to review claims every invoice cycle. This solution enabled weekly meetings to review findings and drive accountability with the PBM. As a result, HDS helped the client identify $20 million in savings opportunities and realize $6.8 million in recoveries within the first year, dramatically improving oversight and the client's relationship with its PBM.