Automate PA Compliance with Banjo Health
Connecticut has enacted several key reforms to improve transparency and reduce delays in the prior authorization (PA) process. While specific statutes governing PA continue to evolve, Connecticut sets clear expectations for response times, continuity of care, and clinical review requirements.
For payers and PBMs, staying compliant while keeping up with growing volumes of PA requests is a significant operational challenge. Banjo Health simplifies this by delivering automated, rule-based workflows that align directly with Connecticut’s requirements—reducing risk, turnaround time, and provider friction.
Prior Authorization Timelines in Connecticut
Although Connecticut’s legislation doesn’t lay out PA timelines in the same detail as other states, standard industry expectations, payer contracts, and best practices apply. Health plans operating in Connecticut are expected to:
● Review and respond to non-urgent PA requests within a reasonable time frame (typically 2 business days)
● Ensure that urgent or expedited requests are prioritized and processed without undue delay
● Avoid retroactive denials for services rendered in good faith with valid authorizations
Banjo Health enforces timing rules through automated workflows, ensuring that every request—urgent or standard—is processed within appropriate windows.
Provider Access and Communication
To reduce provider burden and improve care continuity, Connecticut requires:
● Timely communication of PA decisions
● Clear explanations for denials
● The ability for providers to contact a reviewer or initiate an appeal
Banjo Health enables providers to submit, track, and communicate about PAs in real time through secure portals, configurable notifications, and direct access to clinical decision data.
Clinical Criteria and Medical Necessity
Connecticut supports efforts to ensure that PA decisions are made based on:
● Clearly defined medical necessity standards
● Criteria that are transparent, evidence-based, and publicly accessible
● Fair and timely clinical review
Banjo Health embeds evidence-based guidelines into every step of the PA workflow—enabling consistency, defensibility, and clarity across all determinations.
Electronic Prior Authorization (ePA)
While not mandatory in all cases, Connecticut increasingly supports the move toward electronic prior authorization, particularly for pharmacy benefits.
Banjo Health supports ePA using industry standards like NCPDP SCRIPT, helping PBMs and payers reduce fax and phone-based processing while improving speed and data quality.
Appeals, Peer Review, and Reviewer Qualifications
Connecticut’s prior authorization reforms emphasize that:
● Denials must be reviewed by a licensed physician or healthcare provider
● The reviewer should have similar training or specialty as the provider who initiated the request
● Peer-to-peer review options should be made available, especially before final denial
Banjo Health automates this process by routing appeals to appropriate clinicians and ensuring that each case includes a clear audit trail, reviewer documentation, and decision rationale.
Why Banjo Health is the Ideal Partner for Payers in Connecticut
Whether you operate in commercial markets, Medicare Advantage, or Medicaid Managed Care in Connecticut, Banjo Health helps you:
● Meet regulatory expectations for timeliness, documentation, and transparency
● Eliminate unnecessary delays with AI-powered routing and clinical matching
● Empower providers with a frictionless PA experience
● Ensure every determination is auditable and aligned with state guidance
Banjo Health is built to help you automate what’s required, streamline what’s possible, and improve what matters most—outcomes and satisfaction.
