AH094 - How Unified Claims Processing Evolved from Pharmacy: Improving Member Care & Operating Efficiency

Episode 94 of Astonishing Healthcare features two members of our product team, Liya Lomsadze (Sr. Director) and Jake Mulkey (Director), who explain how building a next-generation pharmacy claim adjudication system (Judi®), known for its split-second accuracy and streamlined workflows, served as the perfect foundation for building a unified platform that now includes medical claims, and will integrate vision and dental, too. Liya and Jake explain the contrast between pharmacy’s real-time nature and medical’s weeks-or-months-long lag, and how this gap impacts the experience for members and providers of care. The discussion covers the challenges behind supporting complex plan designs, opportunities around automating prior authorizations with real clinical data, and benefits of reducing manual interventions that slow down or interfere with care coordination. Liya and Jake also share stories about launch day, lessons learned from pharmacy claim adjudication, and their vision for a real-time future with integrated benefits. This episode is a must listen for anyone interested in how enterprise health technology can improve health benefit administration and focus resources on what's most important: plan members' experience and improving health outcomes.Related ContentReplay – The Bridge to Better Healthcare: Uniting Medical and Pharmacy Services on One Platform to Achieve Value-Based CareAH080 - Health Benefits 101: The Importance of "Smart" Care Navigation, with Andy KageleiryMedicare Transition Benefits & How Judi®’s Modern Design Enables Faster Results and Reliable ComplianceHealth Benefits 101: The Importance of Clinical ProgramsThis Startup Hit A $3.25 Billion Valuation Building Software To Fix Drug Pricing (Forbes)For more information about Capital Rx and this episode, please visit Judi Health - Insights.