May 23, 2024

Spotlight on: Banjo Appeals & Grievances within the BanjoPA Platform

In the landscape of healthcare management, Banjo Health is leading the way with a robust solution to handle appeals and grievances through its comprehensive BanjoPA platform. This integrated system is designed to streamline the complexities associated with Prior Authorizations (PAs) and the corresponding appeals and grievances processes. Here’s how BanjoPA enhances these crucial operations:

A Unified Platform for PAs and A&G Teams

By providing a seamless integration for both Prior Authorization and Appeals & Grievances (A&G) teams, BanjoPA creates a single source of truth. Teams work from the same platform and access the same essential data, such as member history and formulary, ensuring that there are no discrepancies in member data and that both teams are aligned in their processes and decisions.

Comprehensive Member View

One of the standout features of the BanjoPA platform is its ability to offer a full 360-degree view of each member. This functionality allows team members to access all cases associated with an individual, presenting a comprehensive picture of the member’s interactions across PAs, appeals, and grievances. This holistic approach not only improves understanding but also enhances the decision-making process by providing all relevant member information in one place.

Streamlined Case Comparison

When reviewing appeal cases, it's crucial to refer back to the original PA or previous appeal levels.  BanjoPA makes this comparison effortless by linking appeal reviews directly to the details of the original case or of previous levels.  This becomes particularly useful when handling multiple levels of appeals, as it allows team members to easily compare each level of appeal with the original PA and any subsequent appeals. This ensures consistency and thoroughness in reviewing and resolving cases. Encompassing all related cases ensures a more thorough case review and allows the user to make the more informed determination, effectively leading to less appeal levels.  

Automated Appeal Creation through OCR (Optical Character Recognition):

BanjoPA leverages innovative new technology through their use of OCR (Optical Character Recognition) for Prior Auth appeals. OCR scans the appeal fax at intake for the necessary member, provider, and drug information. An appeal case is then automatically created and is attached to the denied PA. This streamlines the intake of cases and ensures that a review team can address them straight away, rather than requiring manual entry and pairing of cases to PAs.  

New for the Quarter: eAppeals for Efficient Resolution

BanjoPA is set to revolutionize the appeals process with the introduction of eAppeals, enabling providers to submit their appeals through the same electronic Prior Authorization (ePA) vendor they used for the original PA. This continuity not only simplifies the submission process but also speeds up the resolution time, leading to quicker turnaround times and less administrative burden for providers.

In Summary

Banjo Health's BanjoPA platform is transforming the way healthcare providers handle appeals and grievances. By integrating these processes on a single platform, providing comprehensive views of member data, facilitating easy case comparisons, and streamlining submissions through e-appeals, BanjoPA is setting a new standard in healthcare management. This innovative approach ensures that providers can focus more on patient care and less on administrative complexities, ultimately leading to better health outcomes and enhanced patient satisfaction.