Automate Compliance with Public Act 102-0409 Using Banjo Health
Illinois is among a growing number of states tightening regulation around prior authorization (PA). With the implementation of Public Act 102-0409, effective January 2022, Illinois has set clear expectations for PA decision timelines, clinical fairness, transparency, and provider communication.
For payers and PBMs, these requirements demand a high level of operational discipline. Banjo Health delivers the automation infrastructure you need to stay compliant—without sacrificing speed, accuracy, or provider satisfaction.
Key Requirements of Public Act 102-0409
Illinois' prior authorization reform law applies to both medical and pharmacy services. Core requirements include:
● Response Timelines:
○ Nonurgent PA requests must be processed within 5 calendar days
○ Urgent or expedited requests must be resolved within 48 hours
● Extended Authorizations:
○ Once approved, PAs for chronic conditions must remain in effect for at least 90 days, and may be extended up to 12 months
● Fair Clinical Review:
○ Denials must be reviewed by a physician licensed in Illinois and in a comparable specialty
Banjo Health automates every step—from intake to clinical review routing to appeals—ensuring that no deadline is missed and every decision is fully documented and defensible.
Provider Communication & Transparency Requirements
Under Illinois law, health plans must:
● Make clinical criteria publicly available
● Provide clear rationale for all denials
● Include information about how to resubmit or appeal
● Notify providers of any changes to PA requirements with at least 60 days’ notice
Banjo Health simplifies compliance through:
● Secure provider-facing portals
● Auto-generated denial rationales and appeals instructions
● Configurable notifications to alert providers of policy changes
● Transparent workflows for every authorization event
This results in fewer provider complaints, faster resolutions, and a more predictable operational environment.
Annual Reporting and Oversight
Illinois requires health insurers to:
● Report prior authorization metrics annually to the state
● Include data on approval/denial rates, turnaround times, and frequently denied services
Banjo Health’s platform includes:
● Real-time dashboards
● Automated performance tracking
● On-demand export of all required PA metrics
So, when reporting season arrives, you're already prepared.
Special Provisions for Step Therapy and Continuity of Care
Illinois also places limits on:
● Step therapy protocols, requiring exceptions in specific clinical cases
● Retrospective denials, especially after services are rendered in good faith based on an approved PA
● Disrupting ongoing treatment for chronic conditions unless clinically justified
Banjo Health allows you to embed these exceptions into your logic engine—ensuring patients receive uninterrupted care while maintaining full regulatory compliance.
Why Banjo Health is the Right Partner for Illinois Payers
Banjo Health gives payers and PBMs operating in Illinois the ability to:
● Comply with strict 48-hour and5-day review deadlines
● Route denials to specialty-matched, Illinois-licensed clinicians
● Extend and track authorizations for chronic therapies
● Maintain transparency across all PA workflows
● Generate required annual reports automatically
Banjo Health isn’t just a compliance tool—it’s a platform for operational excellence.
Final Thoughts
Illinois’ PA reforms are designed to promote patient care and reduce provider burden. With Banjo Health, you meet every requirement automatically—while improving decision quality, team efficiency, and provider relationships.
