Enhance Prior Authorization Management with
Intelligent Automation

Add speed and efficiency – without compromising clinician control, decision-making accuracy, or compliance standards.

Streamlined workflow management, improved patient outcomes.

Simplify the process and work smarter, not harder, significantly reducing costs and manual work while still prioritizing patient health.

Reduces administrative costs to improve profitability

Banjo Health’s CARE (Computer Assisted Review Engine) technology leverages cutting-edge AI and machine learning technologies to streamline the entire prior authorization workflow.

Enables lightening fast processing times with improved accuracy

Extracted data is matched against clinical guidelines using AI to recommend a deision–Approve, Deny, Request More Information–twice as fast as doing it manually.

Keeps clinical experts and reviewers in control of decision-making

Despite advanced automation and AI-drive assistance, Banjo Health ensures the ultimate decision remains in the hands of human experts.

Adheres to all regulatory requirements

Banjo Health’s platform offers a secure, searchable history of all PA decisions and outcomes that makes it so much easier for payers and PBMs to comply with CMS and state-level requirements.

The First Intelligent Workflow Platform for Medical and Pharmacy Prior Authorization

A solution that seamlessly integrates with your existing technology infrastructure to automatically ingest, manage, and respond to requests with both unprecedented speed and accuracy.

Intake Agnostic

Banjo uses CARE to extract pertinent information from faxed or digitally PAs

Real-Time Case Creation

The scraped data is validated and mapped to case fields to quickly create a new case within seconds.

Automated Clinical Review

Intelligent automation matches and compares the case data with predefined clinical criteria.

Simplified Decision Trees

CARE transforms dense clinical guidelines into easy-to-follow decision trees to efficiently arrive at a recommendation.

Detailed Documentation

All AI-generated recommendations are backed with both detailed evidence and clear, actionable explanations

Clinician Control

By automating routing and alerting teams to deadlines, A&G teams maintain focus, improve productivity, and accelerate case resolution times.

Separate Testing Sandbox

Test new or updated decision trees outside of the production environment to safely identify issues and avoid any interruptions to existing service or workflows.

Innovative E-Appeal Solution

Since appeals are submitted through the same ePA vendor used for the original PA, cases are seamlessly created and connected to the denied PA, streamlining the process.

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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FAQs

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.

Frequently Asked Questions