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Banjo Health Quarterly Update – Q1 2020


Have questions for Banjo Health? Contact us.


Who is Banjo Health and what do we do?

Banjo Health is a health industry solutions provider dedicated to providing optimal patient care through the use of innovative, effective, and efficient technological solutions. Banjo coordinates with health plans, Pharmacy Benefit Managers (PBMs), and providers to improve upon existing practices and reduce current burdens and barriers by utilizing artificial intelligence (AI) to expedite tasks. The primary company focus is to alleviate the administrative complexities of Prior Authorization (PA) management for both medical and pharmacy benefits. Harmony PA, Virtuoso AI, and Concerto Suite are all solutions that improve upon existing PA practices by being developed with clinician input in every aspect of design. Beyond PA management, Banjo is working to empower enterprises through developing customized products using all various types of emerging technologies that fall under the term artificial intelligence. These include machine learning/deep learning, natural language processing, pattern recognition, and many more.


  • Harmony PA is a comprehensive PA Management platform for both medical and pharmacy PAs designed by clinicians to streamline the PA workflow in a simple and logical way. Harmony PA comes pre-bundled with Virtuoso AI and Concerto Suite.

  • Virtuoso AI is a PA decision support tool that utilizes AI to accurately predict if a PA request should be approved or denied based on information within a PA request or by integrating into Electronic Health Record (EHR) systems. Virtuoso is a microservice that can seamlessly blend into existing PA Management platforms and EHR systems in the market.

  • Concerto Suite is a complete PA intake and submission tool (also a microservice) which can be integrated into any existing PA software. The design was concentrated on enhancing efficiencies in order to meet strict Turn-Around-Time requirements. Concerto validates PA information, creates searchable documents, and creates a hub that manages PAs from all submission pathways including fax, email, and electronic PAs.

Banjo consists of a team of eight hard-working individuals who come from a wide variety of backgrounds. The team is expanding in order to tackle more inefficiencies and issues in today’s healthcare industry.


If you would like to learn more about Banjo and what we stand for, please visit BanjoHealth.com for more information.

A Message from CEO, Saar Mahna:

With the ongoing response to the COVID-19 pandemic, I wanted to take a few moments to share some gratitude. Banjo was launched as a remote-only business. This decision was made for business purposes; however, it has enabled Banjo to continue business operations while proved to keep our team safe during this time. I am extremely thankful that we are able to continue our work safely despite the challenges presented by the pandemic. Our team has continued to work diligently, which has proven to be instrumental to our success as we work through the launch of our pilots and continued enhancements of our products. We appreciate all of your support and hope we can be helpful to your teams as well. Feel free to get in touch with me if you have questions or comments.

Company Updates

The start of 2020 has been full of energy ramping up the momentum from last quarter. It has not only been a time of growth in regard to team size but for product developments and achievements as well.


Q1 Achievements:


  • Banjo is focused on demonstrating that combining clinical solution design with AI can reinvent the PA process from top to bottom. Banjo is moving forward with the partnership with a large PBM client from last quarter, pilots for Virtuoso AI and Concerto Suite have begun to highlight the value of Banjo’s solutions vs existing practices.

  • New projects have been launched targeting the automation of PA criteria updates and simplified PA entry validation. The target is to free up employee hours spent on redundant administrative tasks which will aid investments in innovation and AI in other areas of the business.

  • BanjoHealth.com has been officially launched. If you want to see our solutions, explore our leadership team, apply for a job, or read more information about Banjo, take a look at the redesigned and updated site here.


In this phase of expansion and progress for Banjo, a quote by Andy Rooney, known for his weekly segment “A Few Minutes with Andy Rooney” as part of the program 60 Minutes, sums up the 2020 mindset of the company.


“Everyone wants to live on top of the mountain, but all the happiness and growth occurs while you're climbing it.” - Andy Rooney, journalist

This burgeoning quarter represents Banjo’s spirit as there has been an increased effort by everyone to improve the solutions daily, develop new insightful ideas, learn new techniques and technologies, and diversify into new ventures. Constant evolvement is what makes Banjo different as the team never rests on its laurels but continues to push the boundaries of what can be done to reinvent PAs. This is the beginning of the journey to becoming an immense force in the healthcare technology marketplace. With lofty aspirations combined with a diverse and talented team, 2020 aims to be a pivotal year of “happiness and growth.” If you have any further questions, contact us at contact@BanjoHealth.com or visit Banjohealth.com to Get In Touch.


Open Positions

Development Positions:

  • No current open positions


Clinical Positions:

  • No current open positions


Business/Operations Positions:

  • VP Sales


If you would like to learn more about current and future positions at Banjo, please visit the careers section at BanjoHealth.com.

Market Prospective

During the first quarter of 2020, quite a few changes occurred that will alter the future shape of the PA landscape for both medical and pharmaceutical PAs.


CAQH Core (Council for Affordable Quality Healthcare) approved a new time limit on requests for supporting information and final determinations of PAs. This operating rule is intended to accelerate the Prior Authorization process in order to prevent delays in patient care. Below are some of the key requirement additions in the CAQH CORE 278 Prior Authorization Infrastructure Rule:


  • A health plan, payer, or its agent now has a two-business day time limit to review a PA request from a provider, and then respond with additional supporting documentation needed for completion of the request.

  • The health plan, payer, or its agent will have two business days to send the final determination response notification once the requested additional information has been received.

  • If the additional information requested has not been received from the provider within 15 business days, the health plan, payer, or its agent has the option to close out the PA request.


Additionally, within these new requirements, these new timelines must be met 90% of the time for each calendar month in the year. Virtuoso AI with its instant PA determinations will greatly assist in meeting this timeframe by allowing providers, health plans, and PBMs to visualize if additional information is required for PA approval/denial. After receipt of the additional information, Virtuoso AI will again suggest approval or a denial aiding the PA reviewer in the final PA decision.


Another potential change in PAs in 2020 could come directly from CMS. CMS is prioritizing PAs this year in its goal to reduce administrative burden and improve innovation in healthcare. After conducting 35 listening sessions and receiving more than 2,000 stakeholder comments regarding PA management, CMS plans to look for ways to automate PAs in 2020.


All of these changes in PAs are well needed since according to the 2019 annual CAQH Index report which was released in January; there are potential savings of $454 million by transitioning to electronic prior authorizations in the medical industry alone. This is increasingly important as the cost of prior authorization requirements on physicians was up 60% in 2019 to manually generate a PA. Also, the use of ePA only increased from 12% to 13% in 2019 for medical plans. It continues to be critical to automate PAs as providers on average spent nearly $11 per PA transaction when fully manually submitted versus approximately $4 for a web portal and $1.88 for an electronic PA.

Check out BanjoHealth.com for more information or contact Banjo directly at contact@BanjoHealth.com

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