READ: JUDI® Client News

NEW – updated July 31, 2024

This section will be regularly updated with the most recently added JUDI client FAQs. These questions can also be found in their respective drop-down categories.

Updated July 31, 2024

Q: How was cohort 1 selected?

A: To determine cohort 1, we used a data driven approach based on client attributes.  With this approach over 70 different attributes were considered. These attributes included delegations, product selection, benefit plans, accumulator endpoints, networks, API usage and more. Prime reviewed the data across attributes to identify similarities between clients and understand complexities. This process led to the identification of cohort 1.

Q: What is the timeline for cohort 1?

A: The goal is to migrate one client from cohort 1 this year. The other four will follow in early 2025.

Q: Is there a sense of when all clients will be migrated over from an adjudication standpoint?

A: Prime is forecasting the migration to JUDI will occur over a three-year period. Business on RxClaim will be migrated first, followed by business on FirstRx.

Q: Will JUDI be replacing other green screen programs like Formulary Workplace?

A: Not currently. The JUDI program is laser-focused on migrating claims from legacy adjudication platforms to JUDI. Prime is considering the transformational opportunities JUDI offers to facilitate future strategic roadmap development.

Q: How will accumulator data get to JUDI?

A: Today, clients send accumulator data to Prime. The data is received in a system called IPS and then sent to RxClaim to be loaded to the member record. For the migration to JUDI, clients will continue to send Prime accumulator data in the same manner. Prime will load accumulator data to JUDI.

General

Q: What is JUDI and what software technology does it use?  

A: JUDI, short for “adjudication,” is the name of Capital Rx’s award-winning Enterprise Health Platform (EHP). JUDI was developed from the ground up and is a cloud-native, self-service, end-to-end solution. A highly adaptable, configurable, and modularized framework, JUDI supports all current pharmacy benefit workflows, from claims adjudication, data integration, prior authorization, patient communication, and client reporting to invoicing, reporting, and reimbursement. Additionally, its agile API-based framework offers scale, efficiency, and flexibility to allow for integrations that improve member service.  

JUDI operates 100% on Amazon Web Services (AWS) and utilizes serverless technologies like AWS Lambda and AWS Aurora. All cloud functions are managed through Infrastructure-as-Code, which means that all infrastructure is subject to the same rigorous software development lifecycle as the application layer.  

Q: How will Prime plan to use JUDI?  

A: Prime will have access to an exclusive dedicated instance of JUDI for claims adjudication; we will assess additional capabilities over time. JUDI will support the same business functions as Prime’s current adjudication applications but in a way that is more intuitive and user-friendly. Throughout the migration and with training support from Capital Rx, Prime will transition from working in legacy adjudication applications to working in JUDI.  

Q: What is the timeline of this implementation?  

A: Prime will be thoughtful in deploying these capabilities and will deliver them in a phased approach across client audiences beginning with enhanced claims processing capabilities. Working to best meet the needs of clients, Prime plans to offer and implement these capabilities over the next three years for PBM clients (Commercial, Health Information Exchange (HIM), Managed Medicaid and Medicare lines of business). Implementation for State Government (Medicaid Fee-for-Service) and Medical Specialty (Medical Pharmacy) clients are still being assessed and will likely occur after this time upon further collaboration with these clients and understanding of their needs.   

Q: Will JUDI be replacing other green screen programs like Formulary Workplace?

A: Not currently. The JUDI program is laser-focused on migrating claims from legacy adjudication platforms to JUDI. Prime is considering the transformational opportunities JUDI offers to facilitate future strategic roadmap development.

Prime Therapeutics & Capital Rx technology alliance

Q: What is the new strategic alliance between and Prime and Capital Rx?  

A: On March 13, 2024, Prime and Capital Rx announced a strategic alliance providing Prime with exclusive access to Capital Rx’s advanced pharmacy technology platform and software development expertise for the benefit of Prime clients, augmenting Prime’s scale, deep financial management, clinical expertise and member centric, transparent philosophy. This collaboration marks a significant milestone in Prime and Capital Rx’s respective journeys to reimagine pharmacy and deliver a better health care experience to patients by utilizing JUDI®, Capital Rx’s exceptional enterprise health platform, which allows each organization to provide a higher service level and lower costs to their respective clients. As a part of the strategic alliance, Prime has become a minority investor in Capital Rx.  

Q: Why is Prime collaborating with Capital Rx and leveraging their technology?  

A: Prime strives to differentiate from its competitors with a modern platform that delivers superior experiences, improved integration and connectivity, and faster innovation, along with exceptional service and more accessible data. As a result, Prime has entered into a strategic alliance with Capital Rx providing us an expedited path to the most advanced platform available to realize our vision.   

Q: What are the goals of the alliance?  

A: The alliance between Prime and Capital Rx provides Prime with exclusive access to Capital Rx’s advanced pharmacy technology platform and software development expertise for the benefit of Prime’ clients, augmenting Prime’s scale, deep financial management, clinical expertise and member centric, transparent philosophy.   

• By collaborating with Capital Rx, Prime will gain access to transformative technology that will set them apart with an exclusive product offering powered by this cutting-edge technology.  

• This strategic alliance is poised to revolutionize Prime’s technology platform with JUDI, Capital Rx’s cloud-native enterprise health platform created for pharmacy benefit management and pharmacy benefit administration. JUDI connects every aspect of the pharmacy ecosystem, presenting opportunity for growth and scale tying all pharmacy benefit workflows into one efficient and scalable system.   

Q: How does this alliance provide added value to clients and differentiate Prime?  

A: Focusing on accelerating delivery of differentiated solutions and innovation ensures we stay at the forefront of the industry and accelerates our platform modernization efforts enabling value to clients through JUDI:  

• Adaptability/Reliability/Security: This collaborative approach to platform modernization enables the companies to tap into each other’s unique strengths, resulting in improved adaptability, reliability, speed and security, and ultimately better outcomes for clients and their members.  

• Nimbleness: The alliance provides access to exceptional technologies and tools. This technological advantage enables Prime to stay ahead of the curve and deliver cutting-edge solutions to clients with greater nimbleness. By leveraging these technologies, we can provide enhanced services and address complex challenges with more agility.   

• Extensive software development expertise: Both Prime and Capital Rx bring a wealth of expertise and experience to the alliance. This breadth of expertise allows us to provide tailored solutions that meet the specific needs and challenges of clients, setting us apart from competitors.  

Q: Why is Prime partnering with Capital Rx on our technology platform?  

A: Prime’s alliance goes beyond Capital Rx being just a technology alliance; we will be actively making the technology our own to enhance administration, data sharing, and care coordination. Capital Rx accelerates our path with a proven, industry-leading platform and deep software development expertise. Through this alliance, Prime aims to seamlessly enable digital patient experiences, ensuring a more streamlined and efficient health care journey. Prime’s initiative-taking approach to technology adoption enables us to stay ahead of the curve, effectively responding to changing regulatory requirements and evolving industry trends. 

Q: How is Prime going to manage its alliance with Capital Rx?  

A: To ensure a seamless rollout and flawless execution of this transition, we are standing up a dedicated Strategic Solutions team to own the partnership and interface with Capital Rx. We will also have a comprehensive program management team solely focused on the overall execution and governance of this initiative. Capital Rx will also have a dedicated migration team to support the transition of Prime’s business to JUDI, Capital Rx’s claims technology platform. Over the coming months, these groups, with the assistance of third-party industry experts, will undergo a rigorous data driven discovery process which will allow us to develop a robust project plan to serve as a template for a successful execution.   

Q: How will the Prime and Capital Rx alliance benefit clients?   

A: This strategic alliance allows Prime to focus on delivering exceptional value and tailored solutions for customers.   

Client benefits include:  

• A broader range of services, improved value, and greater flexibility   

• With the advanced technological capabilities brought by Capital Rx, Prime will be better equipped to meet and adapt to the evolving demands of the health care industry with enhanced speed to market, accuracy, security and reliability  

JUDI product details

Q: What are some client benefits of JUDI®?    

A: With JUDI, clients can experience a broader range of services, improved value, and greater flexibility. Providing differentiated and innovative solutions, JUDI’s advanced technological capabilities will enable clients to meet and adapt to the evolving demands of the health care industry.   

• Adaptability/Reliability/Security: This technology alliance and collaborative approach to platform modernization will enable improved adaptability, reliability, speed and security, and ultimately better outcomes for clients and their members. 

• Nimbleness: JUDI will enable Prime to stay ahead of the curve and deliver cutting-edge solutions to clients with greater nimbleness. By leveraging these technologies, we can provide enhanced services and address complex challenges with more agility.   

• Extensive software development expertise: The technological benefits of JUDI and Capital Rx’s extensive software development expertise will augment Prime’s existing scale, deep financial management, clinical expertise and member centric, transparent philosophy, allowing us to provide tailored solutions that meet the specific needs and challenges of clients.   

Q: How secure is JUDI and how will Prime ensure data privacy and integrity?  

A: Capital Rx’s claims processing system; eligibility, prescriber, and provider data; customer service center systems; and all secure file transfers to any third parties are secured and encrypted using standards that exceed the requirements of HIPAA regulations. Additionally, Capital Rx is SOC 2 Compliant and URAC Accredited.  

Capital Rx utilizes AWS-managed security tools. Application security controls include but are not limited to network firewalls built into Amazon VPC; connectivity that enables private, or dedicated connections; DDos technology and prevention techniques; automatic encryption of all traffic on the AWS global and regional networks; advanced user access controls; and much more.  

Q: What is the reputation of JUDI in the marketplace and what do other users have to say about the technology?  

A: JUDI has won multiple awards since its release, including both a Gold Stevie® Award (Best Healthcare Technology Solution) and the Fierce Healthcare Fierce Innovation Award in 2022. User feedback on JUDI is consistently complimentary, as its design is intuitive, and historically complicated workflows have been streamlined for speed and accuracy.  

Q: What are the Medicare capabilities of JUDI?  

A: JUDI was built after the enactment of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA); thus, it is structured to conform to CMS regulations. JUDI’s adaptability and flexibility make the platform capable of meeting changing requirements with relative ease, allowing resources to be redeployed toward servicing Medicare members’ needs.  

Capital Rx is staffed with industry-leading professionals with distinct experience managing all aspects of a compliant Medicare Part D program. These individuals support operational and technical areas governing the Medicare marketplace services. Because JUDI is intuitively designed, it is capable of aggregating data, for example, for Star Ratings or prescription drug events, handling CMS translation requirements, and streamlining reporting.  

Q: JUDI has capabilities beyond claim adjudication (e.g. prior authorization). Will these additional features be implemented now or in the future? 

A: Prime is prioritizing migrating clients to JUDI for claim adjudication. Prime will assess additional JUDI capabilities for potential future enhancement once claim adjudication migration is well underway.

JUDI implementation

Q: When will claims go live in JUDI? 

A: Prime is targeting a start to parallel testing in Q4 2024. Because discovery, development, and testing across clients and lines of business is occurring in parallel, Prime is developing the flexibility to go live with JUDI as claims adjudication accuracy is proven and operational readiness is established. Updates will be provided regularly on status and planned migrations. 

Q: Will Prime be soliciting client feedback during the JUDI transition or afterward? 

A: The JUDI program team is working closely with Prime’s account management leadership. Communication with clients is a top priority, and Prime will communicate with clients before the transition to ensure appropriate access, permissions, and training have been enabled across client users. A dedicated team is focused on readiness for Day 1 operations and will facilitate critical discussions between Prime and clients to support a successful go-live. These discussions will provide an opportunity to share feedback specific to a client’s transition to JUDI. 

Q: How will implementation order and dates be determined?   

A: We are undertaking a rigorous process to assess when clients will migrate based on their size, member demographics, program components and other factors. Our intention is to move clients in a way that minimizes patient, provider and client impact and maximizes benefits and operational efficiencies. We will partner closely with clients when it is their turn to migrate to JUDI.  

Q: Will there be any impact to client service levels or existing contracts/ agreements with Prime?   

A: Prime expects to offer the same level of service and support to our clients. As we implement this new solution, we plan to meet clients where they are today.  

Q: How does this impact or change client administration fees – will they be reduced upon the use of Capital Rx’s technology?  

A: Prime does not anticipate any changes to client administration fees at this time. Initially we will focus on discovery and establishing a successful implementation without customer disruption.  

Q: Will Prime review/create new performance guarantees for clients? (i.e., Prime to Blue contracts, Blue to employer group contracts?)  

A: Prime will stand by all existing performance guarantees and contractual agreements will remain in place.  

Q: What support or resources will be available to help clients navigate this change?  

A: We will provide regular updates with our communication channels for clients (email, digests, and Client News Central), as well as an FAQ that will be updated throughout implementation to help ensure a smooth transition.  

Q: How will data flows to/from JUDI look different than data flows to/from RxClaim/FirstRx today? 

A: Minimizing client disruption and limiting complexity are two guiding principles in the JUDI implementation program. Clients will send and receive the same files in the same formats after go-live as they do today. Clients may receive two files while parallel adjudication is completed (one from RxClaim or FirstRx and another from JUDI), but the content and format will be consistent. 

Q: When we say Prime will have access to an exclusive dedicated environment of JUDI – what does that mean?  

A: Prime will have its own dedicated environment of JUDI on Amazon Web Services (AWS) exclusively dedicated for the use and benefit of Prime and our clients. Established firewalls will separate our environment from all of Capital Rx’s other business and clients, which will be stored in a separate environment. Furthermore, any enhancements requested by Prime will be made exclusively in our environment and will be available only for Prime’s business.     

Q: Based on the previous client implementation timing that was communicated – what is the definition of PBM, State Government and Medical Specialty?   

A: Prime’s plan is to migrate our PBM business first – specifically this includes Commercial, Health Information Exchange (HIM), Managed Medicaid and Medicare lines of business. We will assess State Government (Medicaid Fee-for-Service) and Medical Specialty (Medical Pharmacy) business migrations after we have a proven pace of PBM claims implementation.  

Q: How will we handle new business, and new groups from existing clients? 

A: Prior to go-live for a client / business segment, new business and new groups will be implemented on current systems.  Once a client / business segment goes live on JUDI, all future new business and groups will implement directly on JUDI. 

Q: Can clients expect to receive documentation for validation, parallel testing, etc.?  

A: Prime’s goal is to share results with clients on validation and parallel testing. We will share more specific details around what will be shared as we progress further in the development of the overall testing plan.  

Q: JUDI is a pharmacy claim platform, but is there any possibility of that type of platform running the legacy Magellan Rx medical management offerings?  

A: Our primary focus at this time is to effectively implement claims processing and adjudication for PBM claims processing. However, Prime’s vision and end goal is one unified medical and pharmacy drug platform. Additional planning and assessments will be conducted over time to fully define the approach, timing and next steps.  

Q: RxRenu was going to be replacing RxClaim. Is JUDI now going to be replacing RxClaim instead? Or will they be doing separate functions?  

A: Over time Prime’s goal is to replace RxClaim with JUDI. However, we will continue to support RxClaim until migrations are successfully conducted and any runout activities are complete.   

Q: When will Prime advise clients on details to notify CMS that they are changing platforms?   

A: Once we complete our detailed assessment and determine timelines for migration of our Government Programs (Managed Medicaid and Medicare) business, we will engage directly with clients to ensure the appropriate notifications take place. 

Q: What is the timeline for cohort 1?

A: The goal is to migrate one client from cohort 1 this year. The other four will follow in early 2025.

Q: How was cohort 1 selected?

A: To determine cohort 1, we used a data driven approach based on client attributes.  With this approach over 70 different attributes were considered. These attributes included delegations, product selection, benefit plans, accumulator endpoints, networks, API usage and more. Prime reviewed the data across attributes to identify similarities between clients and understand complexities. This process led to the identification of cohort 1.

Q: Is there a sense of when all clients will be migrated over from an adjudication standpoint?

A: Prime is forecasting the migration to JUDI will occur over a three-year period. Business on RxClaim will be migrated first, followed by business on FirstRx.

Q: How will accumulator data get to JUDI?

A: Today, clients send accumulator data to Prime. The data is received in a system called IPS and then sent to RxClaim to be loaded to the member record. For the migration to JUDI, clients will continue to send Prime accumulator data in the same manner. Prime will load accumulator data to JUDI.