Ensure Compliance with SB 80, SB 341, and GA Code § 33-64-8 Using Banjo Health
Georgia’s prior authorization (PA)laws—outlined in SB 80 (2021), SB 341, and GA Code Ann. § 33-64-8—represent a major shift toward increasing efficiency, transparency, and fairness in healthcare decision-making. These rules impose specific turnaround times, disclosure mandates, and exemptions that directly impact how payers and PBMs manage utilization review.
With rising pressure to improve speed, reduce provider burden, and comply with layered legislation, Banjo Health gives organizations a modern, intelligent PA platform built for Georgia’s exact requirements.
Georgia’s Prior Authorization Timelines
Under current law, Georgia requires payers to meet strict response deadlines:
● Non-Urgent Requests:
- Must be reviewed and completed within 15 calendar days
- Beginning in 2023, this shrinks to 7 calendar days
● Urgent Requests:
- Must be reviewed within 72 hours
Banjo Health’s automation-first platform prioritizes and routes each request by urgency level, ensuring on-time processing, full traceability, and zero compliance risk.
Prior Authorization Duration and Continuity of Care
For chronic or ongoing conditions:
● Authorizations for medication or services must remain valid for the duration of treatment or for up to one year, unless the patient changes plans or coverage
Banjo Health’s system automatically manages authorization lifecycles—preventing unnecessary resubmissions and preserving continuity of care for members.
Clinical Criteria and Medical Necessity Requirements
Georgia law mandates that:
● All PA determinations must be based on evidence-based clinical guidelines
● These criteria must be provided at the time of determination, especially for denials
● Plans must allow access to the criteria used in the decision-making process
Banjo Health integrates and applies clinical rules within each review step, ensuring that every outcome is defensible, compliant, and accessible to providers on demand.
Data Reporting and Public Disclosure
Payers are required to publish and maintain:
● A list of services and medications that require prior authorization
● Aggregate statistics on authorization approval and denial rates
● Criteria and review processes on their public websites
Banjo Health includes configurable dashboards, exportable reports, and always-on audit logs—making compliance reporting fast, simple, and accurate.
Provider Exemptions and Emergency Services
Georgia’s law restricts the use of PA in certain situations:
● No PA can be required for emergency or urgent services
● Insurers must publish exemption criteria and reassessment policies
● Step therapy and PA limitations are in place for select behavioral and chronic care medications
Banjo Health’s platform supports logic-driven PA exemptions and includes embedded rules to automatically bypass unnecessary approvals based on plan-specific criteria and state mandates.
Peer Review and Appeals
● All denials must be reviewed by a licensed provider in the same or similar specialty
● The peer review process must allow for timely communication and reconsideration
● Patients and providers must receive clear, actionable reasons for any denial
Banjo Health automates clinician matching and enables seamless peer-to-peer reviews, appeals, and escalation workflows, ensuring a compliant and transparent process for all stakeholders.
Why Georgia Payers and PBMs Choose Banjo Health
Banjo Health helps payers and PBMs meet Georgia’s high bar for prior authorization performance. Whether you’re managing Medicaid, commercial, or Medicare Advantage plans, Banjo equips you with:
● Automated timing enforcement for72-hour and 7-day rules
● End-to-end transparency for clinical criteria and decision rationale
● Lifecycle tracking for chronic care authorizations
● Configurable exemption and gold card logic
● Reporting tools for GA-specific compliance mandates
Banjo turns prior authorization from a bottleneck into a competitive advantage.
