(And How Banjo Health Simplifies Compliance at Scale)
Kentucky has taken a proactive stance on improving the efficiency and transparency of prior authorizations (PAs), especially for prescription drugs and chronic conditions. The state’s legislation—KRS § 217.211 and SB 54 (2019)—aims to reduce administrative delays and protect ongoing care for patients.
For payers and PBMs, this means tighter timelines, automation mandates, and exemptions for specific therapies. With Banjo Health, you can automate your compliance and optimize for speed, accuracy, and provider satisfaction.
Kentucky’s Required PA Response Times
Health plans operating in Kentucky must meet specific timelines:
● Prescription Drug PAs:
○ Must be reviewed and completed within 24 hours for urgent requests
○ 5 business days for standard (non-urgent) requests
Banjo Health's real-time engine routes requests by urgency and processes them within required windows, helping you eliminate compliance risk and improve provider trust.
ePA Requirements & Form Standardization
Kentucky mandates the use of an electronic prior authorization (ePA) process for prescription drugs using the NCPDP SCRIPT standard. Paper forms are discouraged except when explicitly requested.
Banjo Health integrates directly with ePrescribing platforms, delivering frictionless ePA workflows that reduce delays, manual entry errors, and provider abrasion.
Special Provisions for Chronic Therapy & Step Therapy
Kentucky law includes protections for patients with chronic or ongoing medication regimens. Once an authorization is granted for maintenance medications, payers cannot revoke it for the duration of the therapy or plan year, unless the patient changes plans or coverage.
Additionally, the law limits the application of step therapy protocols, especially for patients who are stable on a given medication.
Banjo’s clinical rules engine automatically applies these exemptions, ensuring your organization doesn’t violate patient protection mandates while streamlining recurring approvals.
Appeals, Denials, and Reviewer Qualifications
If a PA is denied:
● The appeal must be reviewed by a licensed physician in the same or similar specialty
● Decisions must be clearly documented and shared with the requesting provider
Banjo Health routes appeals to licensed clinical peers and auto-generates compliant denial explanations—ensuring full traceability and streamlined escalations.
The Cost of Non-Compliance in Kentucky
Payers or PBMs that fail to meet Kentucky’s PA rules may face:
● Regulatory scrutiny and legal risk
● Increased provider pushback and churn
● Member dissatisfaction due to delayed care
Banjo Health = Always-On Compliance for Kentucky
Banjo Health’s prior authorization platform is designed for payers and PBMs who want to move fast—without cutting corners.
We help you:
✅Automate decision-making with urgency-aware workflows
✅ Integrate seamlessly with ePA standards
✅ Apply chronic care protections and step therapy rules
✅ Deliver real-time reporting for compliance teams
✅ Reduce appeals, denials, and time to care
