Case Study: National Health Company achieves $12.3M in pharmacy savings with HealthPlan Data Solutions' Claim Scan

How HDS launched an innovative payment integrity solution and realized $12.3M in savings for their client in just two years

A major Medicaid health plan, National Health Company, was facing limitations with its traditional pharmacy benefit manager (PBM) oversight methods. These challenges included a lack of timely data access, claims errors slipping through retrospective audits, and a need to differentiate itself in the marketplace. The company partnered with vendor HealthPlan Data Solutions to implement its continuous claim monitoring product, Claim Scan, for better payment integrity and PBM oversight.

HealthPlan Data Solutions implemented its Claim Scan platform to monitor 100% of pharmacy claims weekly. This solution provided the customer with unprecedented visibility and identified numerous costly processing errors. The results were significant, with HealthPlan Data Solutions helping the client realize $12.3 million in savings over two years, including the recovery of millions from specific issues like coordination of benefits and pricing errors.