Regulatory & Compliance

As payers and PBMs navigate evolving regulatory requirements, California’s prior authorization (PA) laws—governed under 28 CCR § 1300.67.24 and HSC § 1367.01—represent both a challenge and an opportunity.

Delaware’s prior authorization (PA)rules—outlined in HB 381 (2016)—are designed to improve transparency, reduce delays, and streamline care delivery across the state. At Banjo Health, we help modernize your prior authorization workflow to meet Delaware’s rules effortlessly.

The CMS-4201-F Final Rule brings significant updates to Medicare Advantage (MA) and Part D plans, emphasizing improved beneficiary protections, streamlined prior authorizations, and enhanced transparency. Banjo Health provides actionable insights specifically for payers and PBMs, clarifying how these changes directly impact your operational and compliance strategies.

Everything you need to know about the Senior's Timely Access to Care Act and it's new MA requirements for Payers and PBAs.

The CMS-0057 Final Rule introduces new regulations aimed at improving healthcare interoperability and prior authorization processes for payers and providers. Below is a comprehensive FAQ to help organizations understand the new requirements, compliance deadlines, and best practices.