Keith LaFountaine
2023 wasn’t just a big year for Capital Rx – it was a big year for our cloud-native enterprise health platform, JUDI®. While we would love to list every new feature added to JUDI over the last year, that would be a very long blog – we've added thousands. So, we’re highlighting 9 of our favorite features and their capabilities.
All these features, in their own ways, help users increase their operational efficiency at a lower cost and within a centralized pharmacy benefit management (PBM) solution.
We spoke to Karen Dierker, Capital Rx’s Senior Vice President of Product Management, to see exactly how these features aid in the administration of a pharmacy benefit program.
By the way, if you’re wondering how JUDI can bring efficiency and accuracy to government program operations, stay tuned. We’ll be speaking with Jason Barretto, Vice President of Government Program Operations, about this very topic later this month.
Plan Management
Bulk Actions
With JUDI’s Bulk Actions, it is incredibly easy to configure hundreds of benefits with just a single file load. Not only that, but you also have the power to download configurations, make changes, and upload to a new coverage strategy – all in one system!
Why This Feature Matters: Health Plans can have thousands of different benefit offerings. With increased efficiency, the operating costs required to create and maintain benefits are reduced, and there is a lower risk of errors. Modern PBM software allows for quick reaction times and the ability to make changes, which helps improve client satisfaction.
Pharmacy Claims Administration & Management
Reasons for Adjudication/Reasons for Rejection
Within JUDI’s Reasons for Adjudication feature, users can clearly understand how and why a claim adjudicated the way it did! With this feature, users gain deeper insight into how a pharmacy claim is adjudicated, bringing clarity to an increasingly complex process and enabling front-line customer care representatives to communicate effectively with members, prescribers, and pharmacies.
Why This Feature Matters: Healthcare is confusing! Having a shorter path to understanding "why" a claim adjudicated the way it did – and being able to explain it while caring for members – results in greater customer satisfaction, reduces average call time, and improves the coordination of care.
Member-Level Claim View
With JUDI, members’ claim information and Medicare Prescription Drug Event (PDE) data are displayed concisely and intuitively, making this information easier to navigate and understand.
Why This Feature Matters: PDE values are calculated at the time of a claim’s adjudication. Values are then updated to indicate the response once the PDE is submitted and accepted or rejected. Converting rejected PDEs into accepted ones in a timely fashion is required for health plan compliance to receive subsidies.
Prior Authorization (PA) Auto-Approvals
JUDI's new auto-approval feature in its Prior Authorization Tool saves countless hours by streamlining the workflows for pharmacists and pharmacy technicians to process PAs.
Why This Feature Matters: Pharmacists’ time is expensive, and there are select cases in which clinically appropriate approvals can be processed more smoothly via the electronic PA integration with the provider’s office. In other words, this feature helps ensure less patient and physician hassle while reducing operational costs.
Data Exchange
Accumulations Transactions Management (ATM)
Yet another time saver for users! With JUDI’s Accumulations Transactions Management (ATM) tool, users can quickly identify needy pended accumulations records and tie them to the correct members, ensuring that dollars applied to accumulator buckets – like a deductible – are calculated accurately.
Why This Feature Matters: Identifying and resolving accumulation discrepancies before the next fill or service not only creates an experience the patient deserves (i.e. not overpaying and getting reimbursed later) but can also save administrative paperwork (like having to reprocess and correct claims to make the patient whole), which saves time and reduces the potential for errors.
Data Exchange’s Fixed Width Spec
This tool eases the operational burden associated with configuring custom specifications, allowing users to make dynamic adjustments through an intuitive UI and conveniently save preset formats for seamless use across various plans and clients.
Why This Feature Matters: With this tool, there is less lift required for clients to transition to JUDI’s platform, and it makes it easy for a data exchange team to support the ingestion of any layout. This helps save time and money in the process.
Related Content – Deep Dives into JUDI’s Features
- Replay – The Future of Pharmacy Claims Processing: A Deep Dive into a Modern Adjudication System
- Capital Rx’s JUDI® - The Beauty of an Open Platform
- JUDI® is a Tech-Enabler – A Case Study
Identity and Access Management
API Key Management and Generation
Thanks to a new feature within JUDI’s Identity and Access Management module, users can generate and manage API keys.
Why This Feature Matters: For a client or vendor to access data via JUDI’s APIs, an API key is needed to ensure the security of the data. JUDI’s open API framework is critical to making interoperability seamless. By streamlining client requests, this new feature reduces the turnaround time associated with requests to access JUDI’s APIs.
Finance
Ancillary Invoicing
JUDI’s Ancillary Invoicing tool facilitates efficient billing for all value-added services, saving time and helping control administrative costs.
Why This Feature Matters: Clients deserve consistent, accurate, and reliable billing information. JUDI’s Ancillary Invoicing tool is a huge step forward from “pen and paper” or “spreadsheet” invoicing (i.e. manual approaches) that could lead to costly inaccuracies.
Reporting
Data Output and Reporting
This new feature enables users to effortlessly generate and automate claims and eligibility reports. The Data Output & Reporting tool offers maximum flexibility, supporting email and Secure File Transfer Protocol (SFTP) delivery, dynamic filtering, and selection from over 3,000 attributes for customized outputs.
Why This Feature Matters: While ad hoc query tools aren’t inherently new, this powerful feature in JUDI can query claims in real time!
Want to Learn More About JUDI and How Modern PBM Software Can Help You?
Capital Rx is on a mission to build the healthcare infrastructure we need to deliver the healthcare we deserve. With JUDI’s modularity, efficiency, and scalability, plan sponsors and health plans alike can realize cost savings and better member health outcomes. And one of the best parts? With JUDI, Capital Rx’s expert implementation team makes upgrading your PBM solution as smooth a process as it’s ever been. In fact, Capital Rx has a 100% implementation satisfaction rate.
If you would like to learn more about how JUDI can help you and your members, contact us today!