Streamline Compliance with Banjo Health and Ch. 2016-224 Requirements
Florida’s prior authorization (PA) legislation, outlined in Chapter2016-224 (F.S. 627.42392), sets firm expectations around transparency, provider access, and the use of standardized forms. These requirements aim to reduce administrative delays and ensure consistent access to medically necessary care.
For payers and PBMs, these regulations present both operational complexity and a clear mandate to modernize PA workflows. Banjo Health helps organizations like yours automate compliance, reduce turnaround times, and improve provider satisfaction in full alignment with Florida’s PA law.
Florida’s Standardized Prior Authorization Form
Under Florida law:
● All insurers must accept a uniform prior authorization form for prescription drugs
● The form must be approved by the Florida Office of Insurance Regulation (OIR)
● It must be accepted in both electronic and paper format
Banjo Health integrates Florida’s standard form directly into its digital intake process and supports electronic prior authorization (ePA)through NCPDP SCRIPT, reducing errors, resubmissions, and friction for providers.
Timely Decision Requirements
While Florida statute does not specify exact response times in hours or days, insurers are expected to process requests in a timely manner and avoid unnecessary delays—especially for medications that, if delayed, could adversely affect a patient’s health.
Banjo Health helps ensure compliance by automating urgency detection and routing time-sensitive requests through fast-track workflows, all while tracking and reporting against internal SLA benchmarks.
Provider Communication& Transparency
Florida law requires that payers:
● Promptly notify providers of authorization decisions
● Clearly state the reason for any denial, including information necessary for resubmission or appeal
● Make PA criteria and requirements easily accessible to providers and members
Banjo Health supports these obligations through real-time dashboards, automatic provider notifications, and secure communication tools that make it easy to collaborate and resolve issues without manual follow-ups.
Appeals and Medical Necessity Review
Though not specifically outlined in the statute, standard payer practices in Florida—and CMS guidelines—recommend:
● Use of licensed clinical reviewers for denials
● Opportunities for peer-to-peer review before final denial
● Adherence to evidence-based criteria for medical necessity
Banjo Health automates peer matching and appeal workflows to ensure every denial is backed by clinical expertise, fully documented, and easy to audit.
Why Payers and PBMs in Florida Choose Banjo Health
With growing regulatory scrutiny and provider expectations, compliance alone is no longer enough. You need speed, transparency, and a platform built to scale with your operations. Banjo Health delivers:
● Automated compliance with Florida’s PA form and communication requirements
● Real-time provider-facing tools and secure document exchange
● Built-in urgency rules and timeline tracking
● Intelligent routing for medical necessity and appeals
● Audit-ready logs and configurable workflows for commercial and Medicare Advantage plans
Banjo helps your team focus on outcomes, not paperwork.
