HealthPlan Data Solutions
HealthPlan Data Solutions (Rivera) is a pharmacy payment integrity company that uses 750+ proprietary algorithms to monitor 100% of pharmacy claims in near real-time, independently of PBMs, to detect errors and recover overpayments for health plans, government programs, and self-insured employers.
- Company typePrivate
- Founded2010
- HeadquartersColumbus, United States
- Headcount11–50
- GTM typeB2B
- OfferingSoftware
What HealthPlan Data Solutions does
HealthPlan Data Solutions, operating commercially as Rivera, is a pharmacy payment integrity company headquartered in Columbus, Ohio. The firm monitors 100% of pharmacy claims in near real-time using a proprietary library of 750+ algorithms to detect adjudication errors, identify overpayments, and prevent error recurrence. Rivera operates independently of pharmacy benefit managers, positioning its oversight as an external verification layer that confirms whether the contract terms negotiated by health plans and employers are actually reflected at the claim level. The company reports that 100% of clients recover their investment in the first year of the contract and that it has identified and recovered more than $100 million in savings for health plans.
Rivera delivers its capability through three integrated modules: Rivera Insights, the core continuous-monitoring product that processes 100% of pharmacy claims; Rivera Analytics, an oversight dashboard and trend-reporting layer that provides executive-level visibility into pharmacy spend; and Rivera Advisory, a strategic consulting service staffed by clinical pharmacists and industry experts that addresses root causes of adjudication errors. The platform's reach is amplified by integration relationships with PBMs whose covered lives collectively represent 90% of the U.S. population.
Commercially, Rivera targets commercial health plans, government health plans (Medicaid and Medicare), self-insured employers, and channel partners through an enterprise field sales motion with quote-based pricing. Revenue is generated through subscription and recurring service arrangements tied to the savings identified and recovered for clients. The company is privately held, backed by MK Capital, Tamarind Hill, JobsOhio, and Rev1 Ventures, and in April 2025 closed a $15 million growth equity round led by MK Capital to expand the platform.
HealthPlan Data Solutions firmographics
Firmographics- Name
- HealthPlan Data Solutions
- Legal name
- Rivera, Inc.
- Website
- https://hds-rx.com
- Company type
- Private
- Founded year
- 2010
- Operating status
- Operating
- Headcount range
- 11–50 employees
- Short description
- HealthPlan Data Solutions (Rivera) is a pharmacy payment integrity company that uses 750+ proprietary algorithms to monitor 100% of pharmacy claims in near real-time, independently of PBMs, to detect errors and recover overpayments for health plans, government programs, and self-insured employers.
- Ownership category
- akta.pro rank
HealthPlan Data Solutions industry classification
Industry- Product category
- Pharmacy Payment Integrity Software
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Claims Processing, Adjudication & Payment Integrity (HLAEAKAC)
- akta.pro secondary industries
- Pharmacy Benefit Management (PBM) & Formulary Management IT (HLACAKAD), Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK)
Keywords
Where HealthPlan Data Solutions is headquartered
LocationHeadquarters
- HQ city
- Columbus
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
HealthPlan Data Solutions business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Operations, Marketing or Sales, Infrastructure
Revenue model
- PBM Oversight and Payment Integrity Services: Revenue generated through pharmacy payment integrity solutions that monitor claims and recover overpayments for health plans and employers. The company claims 100% of clients recover their investment in the first year, suggesting a performance-based or subscription model tied to savings identified.
Go-to-market motion1 record
Distribution channels2 records
Marketing channels3 records
HealthPlan Data Solutions product offering
Product offeringCore offering
HealthPlan Data Solutions (operating as Rivera) provides a pharmacy payment integrity platform that continuously monitors 100% of pharmacy claims in near real-time, independently of the PBM, using 750+ proprietary algorithms to detect adjudication errors, recover overpayments, and verify that negotiated contract terms are reflected at the claim level. The platform serves commercial and government health plans, self-insured employers, and channel partners with a unified offering of continuous claims monitoring, analytics dashboards, and clinical advisory services.
Product overview
HealthPlan Data Solutions (operating as Rivera) offers a unified pharmacy payment integrity platform consisting of three integrated modules: Rivera Insights (core product for continuous claim monitoring using 750+ proprietary algorithms), Rivera Analytics (add-on analytics dashboards for executive visibility), and Rivera Advisory (strategic consulting services). The platform monitors 100% of pharmacy claims in near real-time, independently of PBMs, to detect adjudication errors, recover overpayments, and prevent error recurrence. The company reports that 100% of clients recover their investment in the first year, and has identified and recovered over $100M in savings for health plans.
Differentiator
Problem solved
Functional benefit
Brands
- Rivera Insights: Continuous monitoring of 100% of pharmacy claims, powered by 750+ proprietary algorithms
- Rivera Analytics
- Rivera Advisory
Products and services
- Rivera Insights Continuous monitoring service that tracks 100% of pharmacy claims in real time, powered by 750+ proprietary algorithms to detect adjudication errors and recover overpayments independently of the PBM. Designed for commercial health plans, government health plans, and self-insured employers seeking independent pharmacy payment integrity oversight.
- Rivera Analytics Oversight dashboards, trend reporting, and executive-level visibility into pharmacy spend that delivers measurable savings and comprehensive analytics for health plans and employers.
- Rivera Advisory Strategic consulting service delivered by clinical pharmacists and industry experts to help clients optimize pharmacy benefit performance and address root causes of adjudication errors.
Quantifiable outcome
- 100% of clients recover their investment in the first year of the contract
- +1 more outcomes
Companies that use HealthPlan Data Solutions
Customer profileSegments4 records
Ideal customer profiles3 records
HealthPlan Data Solutions technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability2 records
Feature5 records
HealthPlan Data Solutions partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- PBM Partners (Industry Leaders)coreHealthPlan Data Solutions partners with PBMs (Pharmacy Benefit Managers) to monitor 100% of pharmacy claims. The company states that PBMs they partner with represent 90% of U.S. lives, including industry leaders. The monitoring is conducted independently of the PBM.
Scale indicators4 records
Recent moves5 records
Expansion highlights5 records
HealthPlan Data Solutions competitors and assessment
Company assessmentDirect peers
- Artemetrx: Artemetrx provides PBM contract oversight, pharmacy claim auditing, and analytics for employers and health plans. It is the closest direct competitor to Rivera in independent PBM payment integrity and analytics.
- RxBenefits: RxBenefits is a pharmacy benefit optimizer for self-funded employers that conducts PBM procurement, contract oversight, and ongoing audit services. Overlaps directly with Rivera's employer segment and PBM oversight mission.
- Pareto Intelligence: Pareto Intelligence delivers healthcare analytics, including pharmacy benefit and payment integrity solutions for payers. Directly comparable in analytics-driven payment-integrity focus, though serving a broader benefit scope.
Emerging players
- SmithRx: SmithRx is a newer-generation transparent PBM targeting self-funded employers with audit-friendly contract terms. Comparable to Rivera on the employer/payer transparency thesis, though operating as a PBM rather than as independent oversight.
Broad incumbents
- OptumRx (UnitedHealth Group): OptumRx is the largest U.S. PBM and part of UnitedHealth Group's broader payment integrity and analytics portfolio. Represents both a key data-access partner and the most powerful potential competitor/integrator of PBM oversight tools.
- CVS Caremark: CVS Caremark is one of the 'big three' PBMs serving health plans and employers. Overlaps with Rivera at the intersection of PBM operations, claim adjudication, and audit; a natural buyer or competitive threat.
- Express Scripts (Cigna): Express Scripts is a top-three U.S. PBM operating at massive scale across commercial and government programs. Comparable in pharmacy adjudication scope; potential integrator of independent oversight capabilities.
- Conduent: Conduent provides payment integrity, claims administration, and analytics across healthcare verticals. Comparable as a broader payment-integrity services incumbent, though not pharmacy-specialized.
- SCIO Health / Edifecs: SCIO Health (now part of Edifecs/Payformance Solutions) is a healthcare analytics and payment integrity provider with comparable claims-monitoring capabilities, serving payers and employers with audit and overpayment recovery services.
- MultiPlan: MultiPlan is a cost-containment and payment integrity vendor serving payers and employers. Adjacent to Rivera's payment-integrity focus, with broader medical claim scope but less pharmacy specialization.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks5 records
Key highlights7 records
Customer concentration
HealthPlan Data Solutions social profiles
Digital presenceHealthPlan Data Solutions financial estimates
Financial estimateRevenue estimate
Valuation estimate
HealthPlan Data Solutions leadership team
Management profileNumber of profiles
Profiles3 records
HealthPlan Data Solutions funding detail
Funding detailFunding overview
Funding rounds5 records
Investors4 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
HealthPlan Data Solutions M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about HealthPlan Data Solutions
What does HealthPlan Data Solutions do?
HealthPlan Data Solutions (operating as Rivera) provides a pharmacy payment integrity platform that continuously monitors 100% of pharmacy claims in near real-time, independently of the PBM, using 750+ proprietary algorithms to detect adjudication errors, recover overpayments, and verify that negotiated contract terms are reflected at the claim level. The platform serves commercial and government health plans, self-insured employers, and channel partners with a unified offering of continuous claims monitoring, analytics dashboards, and clinical advisory services.
Is HealthPlan Data Solutions a public or private company?
HealthPlan Data Solutions is a private company. It is classified as venture growth investor backed and is currently operating.
When was HealthPlan Data Solutions founded?
HealthPlan Data Solutions was founded in 2010. It employs 11 to 50 people.
Where is HealthPlan Data Solutions based?
HealthPlan Data Solutions is headquartered in Columbus, United States, in the North America region.
How does HealthPlan Data Solutions make money?
One revenue line is on record: PBM Oversight and Payment Integrity Services.
Who are HealthPlan Data Solutions's main competitors?
Direct peers on record are Artemetrx, RxBenefits and Pareto Intelligence. SmithRx is listed as an emerging player. Broad incumbents are OptumRx (UnitedHealth Group), CVS Caremark, Express Scripts (Cigna), Conduent, SCIO Health / Edifecs and MultiPlan.
Does HealthPlan Data Solutions have an API?
No public API is recorded for HealthPlan Data Solutions.
What industry is HealthPlan Data Solutions in?
HealthPlan Data Solutions's product category is Pharmacy Payment Integrity Software. Its primary akta.pro industry code is HLAEAKAC, Claims Processing, Adjudication & Payment Integrity, with a secondary code of HLACAKAD, Pharmacy Benefit Management (PBM) & Formulary Management IT. Its NAICS code is 524292 and its SIC code is 6324.