BanjoPA - Driving Prior Auth Compliance for PBMs

For Pharmacy Benefit Managers (PBMs), the complexity of prior authorization (PA) has always been a balancing act between ensuringcompliance, managing costs, and delivering timely care. With the new CMS-0057rules mandating faster, more transparent prior authorization processes by January 1, 2026, the time to modernize your PA infrastructure is now. BanjoPA,the industry’s first AI-powered, cloud-native platform, was designed to address these very challenges, helping PBMs meet regulatory demands while drivingoperational excellence.

A Unified Approach to Prior Authorization

Traditional PA systems often force teams to navigate multiple platforms for eligibility checks, claims management, and approvals.BanjoPA eliminates this fragmentation by consolidating every step into oneseamless platform. By centralizing workflows, PBMs gain an all-in-one solution hat reduces administrative burden, accelerates turnaround times, and improvesthe accuracy of every decision.

This unified structure allows staff to manage higher volumes of requests without additional strain, empowering teams to focus on patientcare and high-value tasks rather than repetitive manual processes.

Seamless Integration with Core Systems

PBMs rely on accurate, real-time data to make authorization decisions that impact both patients and providers. BanjoPA integrates directly with eligibility, claims, and other critical systems, ensuring that every decision reflects the most current information. By eliminating data silos and reducing synchronization delays, BanjoPA prevents costly errors and denials, while enabling compliance with audit-ready documentation.

Flexible and Scalable for Growing Demands

BanjoPA’s cloud-native infrastructure makes it a future-ready investment. As PBM workloads increase or regulatory requirements evolve, the platform scales effortlessly without costly upgrades. Customizable, no-code workflows give PBMs the agility to adapt quickly, ensuring that compliance and efficiency go hand in hand.

Intelligence That Drives Better Outcomes

When paired with Banjo Composer, BanjoPA leverages adaptive AI to intelligently route cases down the right decision pathways based on diagnosis codes, clinical criteria, and case specifics. This ensures that every request follows the most accurate, evidence-based criteria from the start, reducing variability and strengthening compliance. The result is faster decisions, fewer errors, and improved provider satisfaction.

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Why PBMs Can’t Wait Until 2026

The upcoming CMS-0057 mandate requires payers and PBMs to implement streamlined, electronic prior authorization processes, significantly tightening turnaround requirements. Waiting until the last minute to modernize creates the risk of operational disruption, compliance penalties, and strained provider relationships. PBMs that adopt BanjoPA today not only get ahead of the deadline but also position themselves as leaders in efficient, patient-centered care delivery.

Take the Next Step Now

BanjoPA is more than just a compliance solution—it is the future of intelligent prior authorization. By reducing complexity, increasing accuracy, and embedding real-time compliance into every decision, BanjoPA helps PBMs prepare for tomorrow while excelling today.

Don’t wait until 2026 to modernize your prior authorization platform. Contact Banjo Health today to schedule a demo of BanjoPA and ensure your organization is ready for CMS-0057 compliance.

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