Revolutionize Appeals & Grievances Management

AI-powered automation, compliance, and insight—built for faster resolutions and better member experiences.

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Comprehensive End-to-End Appeals & Grievances (A&G) Management

Cutting-edge technology dedicated to enhancing the operational efficiency, compliance, and transparency across all levels of case management
Routes cases automatically using proprietary AI technology
Intelligently triages A&G cases, extracts data, and assigns to the appropriate team with unprecedented speed, improving input accuracy and compliance while enabling faster reviews and shorter time to resolutions.
Elevates operational efficiency and accuracy through centralization
By managing prior authorization and the corresponding A&G workflows on one platform, teams can easily refer back to the original PA or previous appeal levels, leading to more thorough reviews and more informed decisions.
Enables a holistic view and single source of truth for each member
Teams can access a comprehensive member history, including all the member’s previous interactions across PAs, appeals, and grievances in one place, enhancing the decision-making process.
Builds member trust and satisfaction through speed and consistency
Automation and intelligent case management accelerates time to resolution, reducing the risk of escalation while also boosting member satisfaction and retention.

Transforming Appeals and Grievances
Through Innovation

Create invaluable transparency while streamlining A&G management using intelligent routing, centralized documentation, and real-time analytics.

Single, Unified Platform

Managing PA and A&G workflows in place makes it simple to access all relevant case documentation and history while achieving a 360 degree view of each member.

Drag & Drop Editor

Easy-to-use user interface empowers clinicians to update decision trees with new criteria and schedule when updates should take effect.

A&G Specific Workflows

Automatically trigger overrides and generate denial language based on specific decision paths to improve consistency and efficiency.

Built-In Compliance Tools

A secure, searchable history of all case interactions, decisions, and outcomes empowers teams to maintain CMS standards and prepare for audits with confidence and speed.

A&G Reporting & Analytics

Access real-time data on case volumes, resolution times, and outcome trends to pinpoint process inefficiencies and adjust strategies for continuous improvement.

Simplified Approval Routing

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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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?

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
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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 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.