One Astonishingly Efficient and Scalable Pharmacy Benefits Administration Platform
One platform is all you need. Judi® handles customization requests and configurations for new regulations or requirements, resulting in faster outputs, better outcomes, improved operational efficiency, exceptional member experience, and future-proof flexibility.
Claims
View claims at all levels of details and gain complete insight into PDE values, D.0 elements, and simplified adjudication explanations.
Clinical Programs
Manage member-targeted clinical programs through JUDI, reducing costs and increasing efficiency.
Data Exchange
Seamlessly manage both inbound and outbound data for eligibility, accumulations, reporting, file delivery, and retrieval while leveraging a wide array of industry standard formats and fully configurable options in all domains.
Data Output and Reporting Application
Build and manage your own reports with real-time, accurate data. Easily make changes, run reports, fix issues, and set specific parameters with a few keystrokes, and pull those reports within 90 seconds.
Eligibility
Oversee the pharmacy network while keeping track of pharmacy rates and MAC and specialty lists.
Formulary Management
Manage formulary ingestion to adjudication with increased efficiency, saving you precious time.
Identity and Access Management
Access data while maintaining security and ensuring seamless interoperability through JUDI-generated and managed API keys.
Invoicing
Easily and efficiently manage claims and ancillary invoicing for clients.
Modeling
Gain actuarial insights into claims data and produce deliverables for RFPs and underwriting.
Network Management
Oversee the pharmacy network while keeping track of pharmacy rates and MAC and specialty lists.
Plan Management
Align Benefit Workflow arrangements, load over 400 unique benefit configurations in a single step, and batch upload in under 10 minutes.
Prior Authorization (PA)
Administer and manage prior authorizations (PA) in one system. The Capital Rx team diligently sets rules for, or reviews, PAs to ensure proper decisions are made in the best interest of each member, while taking drug alternatives for cost savings into consideration.
Utilization and STARs Dashboards
Gain simplified and comprehensive access to key metrics and data related to claims, members, monthly and quarterly reporting, and Medicare star ratings.
Claims
View claims at all levels of details and gain complete insight into PDE values, D.0 elements, and simplified adjudication explanations.
Invoicing
Easily and efficiently manage claims and ancillary invoicing for clients.
Clinical Programs
Manage member-targeted clinical programs through Judi, reducing costs and increasing efficiency.
Modeling
Gain actuarial insights into claims data and produce deliverables for RFPs and underwriting.
Data Exchange
Seamlessly manage both inbound and outbound data for eligibility, accumulations, reporting, file delivery, and retrieval while leveraging a wide array of industry standard formats and fully configurable options in all domains.
Network Management
Oversee the pharmacy network while keeping track of pharmacy rates and MAC and specialty lists.
Data Output and Reporting Application
Build and manage your own reports with real-time, accurate data. Easily make changes, run reports, fix issues, and set specific parameters with a few keystrokes, and pull those reports within 90 seconds.
Plan Management
Align benefit workflow arrangements, load over 400 unique benefit configurations in a single step, and batch upload in under 10 minutes.
Eligibility
Support hours of banking and billing for TPA services through the source-of-truth eligibility management platform.
Prior Authorization (PA)
Administer and manage prior authorizations (PA) in one system. The Capital Rx team diligently sets rules for, or reviews, PAs to ensure proper decisions are made in the best interest of each member, while taking drug alternatives for cost savings into consideration.
Formulary Management
Manage formulary ingestion to adjudication with increased efficiency, saving you precious time.
Utilization and STARs Dashboards
Gain simplified and comprehensive access to key metrics and data related to claims, members, monthly and quarterly reporting, and Medicare star ratings.
Identity and Access Management
Access data while maintaining security and ensuring seamless interoperability through Judi-generated and managed API keys.
Countless Capabilities, Centralized and Simplified
Gain control over your health plan and leverage intuitive features that increase your operational efficiency. Judi® was designed to be seamless and user-friendly – no hard coding, no jumping between systems. Plus, health plans can start with a full-service model with Judi and become self-service over time.
Tags and Overrides
Gain deep insight into, and control over, claims within Judi and leverage limitless functionalities.
Real Time Claims Investigation
Export and manage your members’ adjudicated claims in real-time using our member/claims view and reporting applications.
Benefit Batch Testing
Leverage unparalleled efficiency, process multiple claim scenarios within one file, and fully test an entire client benefit in under 15 minutes.
Benefit Configuration Testing
Gain total control over benefit configuration testing, leaving behind long wait times, and autonomously conduct batch testing at the plan administrator’s convenience.
Bulk Actions
Save countless hours by leveraging Judi’s bulk action capabilities. Make large updates and add changes to plans, benefits, groups, and overrides.
Learn more about Judi powerful features.
Modernizing Medicare & Medicaid Backend Pharmacy Claims Processing
Developed from the ground up to be the modern standard for healthcare administration, Judi is designed to enhance Medicare and Medicaid compliance, including Medicare Part D. Instead of shoehorning older platform functionalities to meet regulatory standards, Judi's streamlined processes and adaptable design ensures regulatory requirements can be updated and configured easily as they arise.
A Seamless Implementation to a Better Pharmacy Administration Solution
With a 100% implementation satisfaction rate, Capital Rx handles the heavy lifting during the process to ensure a smooth and seamless implementation to a flexible, simplified platform.
Constant Oversight and Transparency
Ensure operational readiness and quality assurance through rigorous, comprehensive testing with ongoing visibility.
Expert Guidance
Leverage cross-functional support from designated industry experts to gain insights and guidance on complex issues.
Swift Risk Mitigation and Resolution
Maintain operational continuity and minimize disruptions for members through proactive go-live monitoring and rapid issue resolution.
Dedicated Service
Address complex member needs through Capital Rx’s high touch member experience driven by a human-first strategy.
Read our Latest Industry Insights
The Upside of Modern Technology vs. Legacy Claims Processing Systems
CDPHP Selects Capital Rx as New Pharmacy Benefit Manager
Pharmacy Benefits 101: Successful Implementations
Judi® Redefines the Role Technology Plays in the Administration of Medicare, Medicaid, and Commercial Pharmacy Programs
Experience the power of Judi today.
Contact us to learn how you can take your pharmacy benefits to the next level.
