How Our Favorite New JUDI® Features Aid Government Programs

Government programs – Medicare and Medicaid – have specific processing requirements and regulatory standards that health plans must meet. These regulatory requirements are always changing. They require a level of flexibility, adaptation, and vigilance that can be difficult to meet, especially without the right tools.

And that’s where Capital Rx’s cloud-native enterprise health platform, JUDI®, steps in.

With JUDI, health plans have a technological advantage. Launched in 2021, well after the enactment of Medicare Part D, JUDI's cloud-native design offers unparalleled flexibility. This allows it to adapt to new requirements. For example, JUDI met new Inflation Reduction Act (IRA) requirements two months ahead of the Centers for Medicare & Medicaid Services (CMS) deadline.

To learn how certain JUDI features bring efficiency and precision to government programs, we spoke with Jason Barretto, Vice President, Government Program Operations, here at Capital Rx.

Prescription Drug Event (PDE) File Tracking and Workflow Management

JUDI users can track the progress of required PDE files that they send to CMS with this feature. Additionally, users can obtain a high-level status of each submission chronologically. This makes it easy to track where the file is with CMS (and associated response).

Further, the user interface (UI) gives users quick reference to additional information, including the corresponding Acceptance Rate information.

How This Feature Helps Government Programs

CMS measures plans for program compliance and clinical quality. They then financially compensate plans based on these measures. PDE files are key to this – specifically their completeness, accuracy, and timely submission.

With this JUDI feature, users can easily access all this important information. In other words, the days of digging through folders or opening files to see what CMS accepted are gone. Further, this feature enables users to quickly prioritize PDE issue identification, remediation, and resubmission. This reduces turnaround time and ensures CMS receives corrected PDEs quickly.

Plan Finder End-to-End Tooling

Using this feature, users can configure automated plan finder pricing and pharmacy submission files. Like selecting your favorite entree for delivery, you want to know exactly what you’re selecting, right? Plus, this tool provides validation output. That lets plans know before submission the expected status they will receive from CMS.

It also informs plans when they receive that status, and it gives users a place to store it. That way, they can conveniently flag previously submitted files.

How This Feature Helps Government Programs

Health plans risk being suppressed from Medicare.gov if plan finder submissions fail. Since members shop for plans on this site, not being listed means plans won’t get enrollment.

With JUDI, users need not worry about accomplishing these submissions by hand or through spreadsheets. This JUDI feature facilitates that process – and it does so more quickly and accurately.

Related Content

• Capital Rx’s Government Programs: Behind the Scenes with Jason Barretto
• Government Programs: The True Meaning of Customization 
• JUDI® is a Tech-Enabler – A Case Study  
• Replay – The Future of Pharmacy Claims Processing: A Deep Dive into a Modern Adjudication System

See What Modern PBM Software Can Do for Health Plans

JUDI represents a paradigm shift in pharmacy benefits administration. With its flexible design, friendly UI, scalability, and adaptability, health plans can confidently meet regulatory requirements and accommodate unique member needs.  

Plus, JUDI’s future-proof design makes it easy to adapt as existing regulations change and new requirements arise.

We recently highlighted nine of JUDI’s other features that enhance users’ efficiency more broadly in How Our Favorite New JUDI® Features Aid Pharmacy Benefit Administration.

At the end of the day, what matters most is providing better care and support for members. By leveraging modern technology, resources can be effectively allocated to do that.

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Wondering how JUDI can help enhance your operational efficiency? Contact us today!