Automate Clinical Guideline Review and Decisioning Using AI

Free up your pharmacists & physicians from the tedious and time-consuming task of managing dense clinical guidelines while improving accuracy, efficiency, and
patient outcomes.

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Simplify the Creation, Management, and Integration of Clinical Guidelines

Focus your team’s skills and time where human expertise makes a real impact; use cutting-edge technology to automate

Generates simple and accurate decision trees within seconds

Using AI-powered automation, Banjo Health ingests pages of dense clinical criteria, identifies critical decision points, and creates structured question sets within minutes, saving clinicians hours of manual review.

Increases efficiency and bandwidth of clinical experts

By reducing tedious, manual work, clinicians can fully operate at the top of their pay grade and apply their skill and expertise to higher-value, strategic initiatives.

Streamlines the internal approval process for faster sign off

Banjo Health’s approval workflow Integrates with Pharmacy & Therapeutics (P&T) committees, accelerating the review and sign off process.

Enables real-time compliance with changing clinical guidelines

Ensures adherence to CMS mandates and full compliance with the latest clinical and regulatory standards. Schedule effective dates for new criteria to avoid switching lags and outdated decision trees.

Work Smarter and Faster to Build and Manage Your Clinical Criteria

AI-powered, user-friendly tool that automates the process of building and maintaining clinical criteria decision trees.

Case Workflow Management

Increase consistency by automating approvals and denial reasons

Centralized Clinical Criteria

Manage all policy documents in one place to create a single, reliable source of truth.

API-Driven Solution

Integrates health plans, PBMs, external systems (EHR/EMRs) and provider portals.

No Code Criteria Updates

Easily update and fine-tune trees using intuitive drag and drop functionality.

Detailed Audit Trail

Easily maintain an audit trail that keeps record of monthly and quarterly changes.

PA Stakeholder Transparency

Share decision trees directly with providers via ePA portals to improve criteria visibility.

Custom Reports & Analysis

Access standardized reports or create unique views to optimize your workflows.

Flexible Criteria Mapping

Share clinical criteria across LOBs, plans, and formularies and also customize as needed

Explore our technology built to modernize and simplify the prior auth process

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Our mission is to make healthcare simpler.

Every decision we make is guided by an unwavering focus on increasing efficiency, reducing friction, and improving accuracy across the entire PA lifecycle in order to achieve better patient outcomes.

50%

faster intake to decisioning speed

70%

less time drafting and updating decision trees

33%

reduction in appeals

See Banjo Health in action.

Learn more about our AI-powered solutions designed specifically to more effectively manage the medical and pharmacy prior authorization lifecycle, from requests to appeals.

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Frequently Asked Questions

What is Banjo Health?

Banjo Health empowers health plans and PBMs with AI-driven software that simplifies and accelerates Prior Authorizations, Appeals, Grievances, and Clinical Criteria Automation. Our solutions are designed to reduce costs, enhance operational efficiency, and improve patient care outcomes.

By automating complex workflows, Banjo Health delivers faster, more accurate results for patients and providers alike. Tools like BanjoPA, BanjoAppeals, BanjoGrievances, and Composer streamline processes, enabling real-time decision-making, productivity gains, and meaningful cost savings.

Our adaptable, no-code platform integrates seamlessly with existing systems, supporting real-time case management, automated compliance, and intelligent insights that evolve with your organization’s needs. With Banjo Health, healthcare organizations gain the responsiveness and innovation required to stay ahead in today’s dynamic environment.

How does Banjo Health use AI in its solutions?

Banjo Health leverages advanced Artificial Intelligence (AI) to transform the prior authorization (PA) process, streamlining workflows, improving compliance, and enabling faster, more accurate decisions. By integrating tools like Composer and CARE (Computer Assisted Review Engine), our AI-powered platform automates complex processes while continuously learning and adapting to evolving clinical and regulatory requirements.

What solutions does Banjo Health offer?

Banjo Health provides a comprehensive suite of tools designed to streamline prior authorizations, appeals, and grievances. BanjoPA automates end-to-end prior authorization workflows, ensuring efficiency and accuracy. Composer simplifies the integration of clinical criteria by converting them into decision trees that seamlessly fit into workflows. Banjo Appeals and Grievances centralize case management, enabling compliance and faster resolutions for a more effective appeals process.

What makes Banjo Health different from other PA solutions?

Banjo Health stands out with purpose-built AI models designed specifically for prior authorizations. Our solutions are fully customizable, integrate seamlessly with existing systems, and continuously learn and adapt to evolving clinical and regulatory requirements.

Can Banjo Health integrate with my current systems?

Yes, Banjo Health’s platform is designed for seamless integration with EHRs, eligibility verification tools, claims management systems, and more. Our flexible, API-supported infrastructure ensures all relevant data flows smoothly between systems, reducing duplication and improving efficiency.

Automate Clinical Guideline Review and Decisioning Using AI

Simplify the Creation, Management, and Integration of Clinical Guidelines