AI-Powered Prior Authorization Management Solution

Designed by clinicians for clinicians, Banjo Health’s user-friendly solution increases efficiency and effectiveness across your teams.

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Our Customers

Solution Overview

The industry’s first intelligent end-to-end platform purpose-built to manage the medical and pharmacy prior authorization workflow from requests to appeals.

End-to-end case management solution for prior authorizations and appeals.

Prior Authorization Workflows

Leverage AI to streamline the process, reduce administrative burden, and improve decision-making speed.

Clinical Decision Tree Generator

Transform complicated clinical criteria into actionable, electronic decision trees within seconds, improving speed and accuracy.

Appeals & Grievances Tool

Efficiently manage appeals and grievances with speed and compassion to deliver a better member experience.

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Enterprise Prior Authorization Management

Streamlines the PA process across medical and pharmacy benefits with AI-powered tools and intuitive design.
Purpose-built for Payers & PBMs
AI specifically created to manage the unique complexities of prior authorization, constantly learning and adapting to ever-evolving clinical and regulatory requirements.
Effortless Integration
Banjo Health works seamlessly with EHRs, eligibility verification tools, claims management systems, ePA vendors, and many other API-ready portals, improving but not disrupting existing workflows.
No-Code, Easy-to-Use Platform
Highly configurable, user-friendly drag-and-drop interface that makes creating new workflows and updating clinical criteria and decision trees frictionless and simple – no technical expertise required.

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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Take a look at our latest articles and resources

CMS-0057 Final Rule: Frequently Asked Questions (FAQs)

CMS-0057 Final Rule: Frequently Asked Questions (FAQs)

The CMS-0057 Final Rule introduces new regulations aimed at improving healthcare interoperability and prior authorization processes for payers and providers. Below is a comprehensive FAQ to help organizations understand the new requirements, compliance deadlines, and best practices.
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Did someone Say HITRUST Certified?
Security

Did someone Say HITRUST Certified?

Banjo Health achieved HITRUST Risk-based, 2-year (r2) certification for information security. The company's comprehensive approach to data security and privacy includes robust access controls, regular security audits, and continuous monitoring to detect and mitigate any potential risks.
Banjo Health's Composer: Revolutionizing Clinical Decision-Making
Automation

Banjo Health's Composer: Revolutionizing Clinical Decision-Making

To address the growing need for efficiency in the development of decision trees and question sets from clinical criteria, Banjo Health introduces Composer,
Spotlight on: Banjo Appeals & Grievances within the BanjoPA Platform
Automation

Spotlight on: Banjo Appeals & Grievances within the BanjoPA Platform

Banjo Health is leading the way with a robust solution to handle appeals and grievances through its comprehensive BanjoPA platform.

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 continuously 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.