Automate Compliance with A.R.S. § 20-2803 Using Banjo Health
Arizona’s prior authorization (PA) regulations, governed under A.R.S. §20-2803, focus heavily on timely care delivery, medical necessity, and limiting administrative friction during emergency and urgent care scenarios.
For payers and PBMs, meeting these expectations across medical and pharmacy PA workflows requires more than manual tracking—it demands intelligent, automated infrastructure.
With Banjo Health, you get a platform designed to help you meet Arizona’s regulatory requirements out of the box, with built-in speed, clinical integrity, and full auditability.
Arizona’s Prior Authorization Requirements
Arizona’s regulations are uniquely structured around emergency and post-emergency care, requiring that:
● If care is deemed medically necessary after an emergency screening, authorization is automatically granted
● Plans may not retroactively deny or delay medically necessary follow-up care unless they meet strict documentation and clinical review requirements
This law prioritizes continuity of care and shifts the burden to the payer to justify any denial. Banjo Health automates clinical review checkpoints and decision documentation, so you’re always aligned with the state’s “approve unless exception applies” framework.
Documentation and Medical Necessity
To comply with A.R.S. § 20-2803, health plans must demonstrate that:
● Denials are based on clear medical necessity standards
● Documentation is complete and clinically relevant
● No adverse action is taken if a provider is following standard protocols after an emergency
Banjo Health simplifies this with built-in medical necessity rules and AI-based documentation review—so you never fall short on justification.
Who Reviews PA Requests?
Arizona emphasizes the importance of appropriate clinical review. While the statute doesn’t specify specialty requirements, best practices (and payer liability) demand that peer-level review be:
● Clinically matched, and
● Timely, especially post-emergency
Banjo Health ensures peer-to-peer reviews are conducted by the right clinicians—licensed and qualified in the same or similar specialty—automatically routed and tracked.
Appeals, Denials, and Provider Communication
Banjo supports Arizona’s compliance expectations with:
● Automated denial rationale generation
● Secure provider messaging portals
● Real-time appeal tracking
You improve provider trust and reduce friction—all while staying inside regulatory lanes.
Retroactive Denials and Service Interruptions
Arizona prohibits plans from rescinding or denying care that was delivered based on emergency screening outcomes—unless the service was clearly not medically necessary or involved fraud/misrepresentation.
Banjo’s decision engine tracks initial authorization intent, clinical criteria application, and final approvals, making retroactive denials both rare and fully defensible.
Why Arizona Payers & PBMs Trust Banjo Health
Banjo Health gives you a platform purpose-built for compliance—and optimized for care continuity. In Arizona, that means:
✅Automated workflows that support emergency and urgent care scenarios
✅ Configurable rules engine for medical necessity and documentation capture
✅ Built-in reviewer credentialing and peer-matching
✅ Real-time decision dashboards and reporting
✅ Scalable to Medicaid, Medicare Advantage, and commercial lines
