Case Study: a state employee health plan achieves $1.4 million in pharmacy savings with HealthPlan Data Solutions' Claim Scan

How implementing Claim Scan payment integrity saved tax payer dollars and returned money to patients

A state employee health plan, representing nearly 300,000 covered lives, sought greater transparency and accountability for its rising pharmacy benefit costs. Following new state legislation mandating increased PBM oversight, the plan selected HealthPlan Data Solutions (HDS) through an RFP process to implement its Claim Scan continuous pharmacy claims monitoring service.

HealthPlan Data Solutions implemented its Claim Scan platform to monitor 100% of the plan's pharmacy claims in real-time. The solution identified multiple contract and adjudication errors, leading to over $1 million in recoveries and $400,000 in avoided costs in the first year. HDS also helped the client recover nearly $100,000 for members due to incorrectly calculated copayments and strengthened the plan's PBM contract for future savings.