Efficiency and transparency in claims processing are crucial to today’s healthcare environment, and Banjo Health is leading the way with its seamless integration capabilities. By extending beyond mere API support to include workflows and user interfaces, Banjo Health reduces administrative burdens, provides a holistic view of patient information, and ensures timely access to care while delivering a unified and time-saving experience.
Four Key Ways Banjo Health Integrates with Claims Systems
1. Claims History Integration
Claims history integration involves servicing all of a patient’s claims and surrounding details, including payment information, drug details, prescriber information, pharmacy information, reject codes, benefit information, and diagnosis.
Why it matters: By integrating claims history, Banjo Health allows reviewers to have a comprehensive view of a member’s medications history. Clinical reviewers can quickly determine if a patient has previously received a specific drug or alternative treatments, leading to more informed and accurate clinical decisions.
2. Test Claims
Banjo Health’s test claim capabilities enable users to leverage previous claims in the claim history while also submitting new test claims. Users can edit fields in test claims and receive all applicable response codes.
Why it matters: This feature ensures that prior authorization (PA) operations can verify that members receive timely access to care, thus avoiding administrative delays. By running test claims, potential issues can be identified and resolved before impacting patient care, ensuring smoother and faster claim processing.
3. Claims Override
The claims override feature is highly customizable to meet the unique needs of each client’s claims processors. The Override Template Manager allows users to build override rules and automatically adjudicate based on their workflows.
Why it matters: This customization ensures that clinicians can focus on their clinical review rather than administrative tasks such as notifications and overrides. The ability to update and rerun overrides without needing to log into multiple systems further enhances efficiency and accuracy, focusing on medical necessity and reducing the chances of errors.
4. Override History
Banjo Health provides a comprehensive view of all claims overrides, including those submitted by the clinical team and call center overrides.
Why it matters: Users gain a complete view of the patient’s history and can ensure that submitted overrides are successful and do not conflict with existing ones. This transparency supports more accurate and effective clinical decisions, driving efficiency by having all information streamlined in one place.
Benefits of Seamless Integration
Efficiency and Time Savings: With all data available in one login, there is no need to navigate multiple systems to find necessary information, therefore saving clinical reviewers valuable time and reducing the risk of errors.
Complete Member Picture: By integrating all aspects of claims processing, clinical reviewers have a complete view of member activities and actions. This leads to better-informed decisions and improved patient outcomes.
Transparency and Communication: Full integration ensures seamless communication across various workflows, reducing administrative tasks and allowing for the most timely access to member care.
Customization and Flexibility: Banjo Health’s modular workflow supports a highly customizable environment, allowing each client to tailor the integration to their specific needs while maintaining seamless interoperability.
In conclusion, Banjo Health’s seamless integration with claims systems drives efficiency, transparency, and better clinical outcomes. By focusing on a holistic view of patient information and reducing administrative burdens, Banjo Health is revolutionizing the claims processing landscape.
