JUDI Client News - Prime Therapeutics
JUDI® Client News
Your source for JUDI client news and client communications
Get a sneak peek into JUDI
Watch the latest sneak peek to see JUDI in action and learn more how Prime's exclusive version of the JUDI platform will help propel Prime to the future.
JUDI client communications and news
See below for a full list of client communications and additional news related to JUDI.
June 11, 2024
Based on the recent announcement of Prime Therapeutics (Prime)’s technology alliance with Capital Rx, we are excited to share with you some additional information on the JUDI® platform and what to be on the lookout for in the future. After Prime announced its plan to migrate claims adjudication onto the JUDI platform, integration project teams entered a rapid discovery period. This effort has informed the ongoing development of project plans that will guide the migration effort over the coming months and years.
To keep clients informed, we wanted to provide some additional information and resources on JUDI, which includes how this innovative platform will help propel us forward.
Updated Client FAQs
We are dedicated to keeping you informed as we embark on the journey to implement the JUDI platform. Check out responses to the recently added FAQs, which address common questions from our clients.
Next steps
Be on the lookout for more information about JUDI and its capabilities soon. To stay up to date on the most recent JUDI news, visit the client updates & FAQs page.
May 1, 2024
Based on the recent announcement of Prime Therapeutics (Prime)’s technology alliance with Capital Rx, we are excited to share with you a brief introductory demo of the JUDI® platform.
In this short video, you will see the JUDI platform landing page with the different adjudication features and capabilities available within the platform. This landing page can be customized based on user needs. You’ll also learn about JUDI’s API infrastructure and its value. And finally, you’ll see how to access member information including plain language claim adjudication rationale.
Check out your first look at JUDI.
We are hoping this sneak peek provides you with insights into some of the exciting capabilities JUDI has to offer and how this technology alliance will continue to propel Prime forward to better serve you.
Next steps and FAQs
Be on the lookout for more information on JUDI in the coming weeks. In the meantime, review these client FAQs regarding Prime’s technology alliance with Capital Rx.
March 13, 2024
Prime Therapeutics (Prime) is excited to announce a strategic alliance with Capital Rx, a move that will propel us forward with exclusive access to their advanced pharmacy technology platform and software development expertise. This benefits clients by augmenting Prime’s scale, deep financial management, clinical expertise and member centric, transparent philosophy.
This collaboration marks a significant milestone in Prime’s 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 clients.
By collaborating with Capital Rx, Prime will revolutionize our technology platform with JUDI. 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. This modern technology brings many benefits, enhancing adaptability, reliability, speed, and security enabling us to accelerate our pace of innovation while enhancing our core capabilities and ensuring state-of-the-art security.
We understand the importance of continuous improvement and innovation and we are excited about the possibilities that lie ahead, and the positive impact this alliance will have on clients, members and the health care industry as a whole. This is an incredible opportunity for us to proactively tackle the challenges we face and transform the way we deliver health care services.
Implementation and next steps
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. Implementation for State Government and Specialty clients are still being assessed and will likely occur after this time based upon further collaboration with these clients and understanding their needs.
We anticipate having a high-level roadmap in the coming months to review and discuss in more detail. Specific dates for when clients will move will be made after further evaluation and discovery is conducted.
Information and resources: press release and client FAQ
The following press release was announced today, March 13. Please also refer to these client FAQs to obtain additional details that may address questions regarding this strategic alliance.
We are dedicated to providing you updates and information as we take next steps to navigate this journey successfully. In the interim, if you have questions, please reach out to your account representative.
Thank you for your continued partnership as always, we look forward to collaborating and shaping the future of health care.
JUDI client FAQs
See below for the most up-to-date answers to client FAQs.
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 Oct. 30, 2024
Q: Can JUDI users update member eligibility information on the platform? Or does it need to be sent in the eligibility file?
A: Member eligibility information can be updated in JUDI, but if an update comes on the eligibility file after the manual update, then the manual update will be overridden. For instance, if the date of birth (DOB) is incorrect in JUDI and you manually update it within the system, the change will not be permanent unless the full eligibility file is also updated. The information must be updated in the full file for the change to persist in JUDI.
Q: How can JUDI reduce member friction?
A: JUDI improves Prime and client workflows by supporting member experience. When considering member services, JUDI provides plain language adjudication reasons which reduces the amount of time that member service agents must dedicate to researching why a claim was paid or rejected. See the image below for an example of JUDI’s plain language adjudication reasons for a test claim.
Q: When searching for a claim, how can a JUDI user view information on accumulation, cost share, pricing, etc.?
A: From “claims search” or “member search” results, a JUDI user can access individual claim records. Within a claim record, a user can review adjudication information, including details about cost share, pricing tiers, accumulations and more.
Q: Does JUDI provide options for customizing a claims search and sorting result?
A: Within JUDI’s claims module, claims can be searched by a variety of fields including, but not limited to, member first name, member last name, member ID, claim, claims status, service provider ID, prescriber NPI, NDC, and more. Results are provided in a data grid format and sorted by the “received_at” date, which reflects the date the claim arrived in JUDI. For a live claim, this will be the date a claim was sent from the switch vendor. For historical claims, this will be the date the claim was loaded into JUDI.
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.
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.
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.
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
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.
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.
In September 2024, JUDI earned the HITRUST i1 Certification. The HITRUST i1 Validated Assessment and Certification helps organizations address cybersecurity challenges and remain cyber resilient over time. This 1-year certification demonstrates that JUDI leverages a set of curated controls to protect against current and emerging threats.
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.
Q: Can the user run trial claims in JUDI?
A: Yes. JUDI has a test adjudication module where users can enter a set of attributes and test the adjudication of the inputs for either a single claim or a batch set of test claims.
Q: When a client is cutover to JUDI, will clients’ benefit coders now use JUDI for account setup instead of the Benefit Edit Tool (BET)?
A: BET will persist for the near-term. Today, client benefit plan information is entered in BET via client submission or mapped from the client’s source system data to BET. This same process will continue post-cutover. Prime will translate client benefit plan information from BET to JUDI.
Q: When will claims go live in JUDI?
A: Prime began parallel testing a subset of claims in mid-August 2024. Full volume parallel testing for Blue Cross Blue Shield (BCBS) Kansas began in November 2024. Additional client claim testing will begin on a rolling basis throughout Q4 2024. With discovery, development and testing happening simultaneously across clients and lines of business, Prime is building the flexibility to migrate clients to JUDI once claims adjudication accuracy is confirmed and operational readiness is achieved. 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. Prime is completing data mapping activities within workstreams to minimize client disruption across data inflows and outflows. Additionally, surrounding tools and systems will persist, including Benefit Edit Tool (BET), Formulary Workplace (FWP), and Clinical Operations Review Engine (CORE).
Q: When we say Prime will have access to an exclusive dedicated environment of JUDI – what does that mean?
A: Prime will have a dedicated JUDI environment on Amazon Web Services (AWS), exclusively for the use and benefit of Prime and our clients. Established firewalls will separate Prime’s environment from Capital Rx’s other business and clients, which will be stored in a separate environment. Furthermore, the contract established between Prime and Capital Rx ensures Prime’s proprietary assets (e.g., products and programs) are only available 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 Insurance Marketplace (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: Our first client migration is scheduled for Q1 2025. Other cohort 1 clients will follow in early to mid-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.
Q: Will updates/releases happen in JUDI more frequently than legacy adjudication systems?
A: Yes. One of the benefits of JUDI is that iterative changes can happen more frequently to respond to efficiency opportunities or compliance/regulatory changes. Prime will communicate release updates to clients. As with legacy adjudication systems, testing will be completed in JUDI QA before updates are pushed to the production environment.
Q: Will the JUDI implementation impact the member’s MyPrime.com experience?
A: JUDI implementation will not impact the member’s MyPrime.com experience. JUDI data will be available within MyPrime.com and the user interface remains the same.
Please refer to the updated JUDI terms and definitions document.
Have questions for the JUDI team?
We are committed to keeping you informed with updates regarding JUDI. If you have questions you'd like answered, please send us an email.