From Clinical Criteria to Faster Decisions: How Composer Powers Prior Authorization Automation
Discover how Banjo Health’s Composer transforms clinical criteria into AI-powered decision trees to reduce prior authorization burden, cost, and review time.
January 14, 2026
For Payers and PBMs, prior authorization automation breaks down when clinical criteria have to be manually interpreted, rewritten, and converted into logic before a decision can even be made. Clinical intent is clear, but operationalizing that intent into consistent, compliant prior authorization workflows is where delays and administrative burden multiply. Composer addresses this gap by automatically converting unstructured clinical criteria into standardized clinical decision trees, enabling faster, more accurate prior authorization reviews while significantly reducing administrative overhead for health plans and utilization management teams.
Composer is Banjo Health’s AI-powered clinical decision tree builder, purpose-built to translate complex medical and pharmacy guidelines into executable logic. Prior authorization policies are often published as lengthy PDF documents filled with conditional language, clinical nuance, and cross-references that are difficult to operationalize at scale. Composer ingests these documents using advanced optical character recognition and natural language processing, identifies the key decision points within the criteria, and converts them into structured, machine-readable decision trees. What once required weeks of manual effort by clinical analysts can now be completed in minutes, without sacrificing accuracy or clinical rigor.
The way Composer works reflects Banjo Health’s philosophy that automation should enhance, not replace, clinical judgment. After Composer generates a decision tree, clinical teams review and refine the logic using an intuitive visual interface. This allows organizations to maintain strong clinical governance while dramatically accelerating development timelines. Decision trees can be tested in sandbox environments, versioned for auditability, and scheduled for deployment to align with policy effective dates. As guidelines change, Composer enables rapid updates without restarting the process from scratch, ensuring prior authorization logic remains current and compliant.
The impact of Composer on administrative burden is substantial. Prior authorization reviews are slowed not by decision-making itself, but by the operational work required to interpret criteria, ask the right questions, and document outcomes. By embedding Composer-generated decision trees directly into prior authorization workflows, health plans and PBMs can standardize intake, reduce back-and-forth with providers, and eliminate redundant manual reviews. Reviewers are guided through clinically relevant questions in a consistent sequence, reducing variability and error while improving turnaround times for determinations.
These efficiency gains translate directly into measurable cost and time savings. Composer reduces the labor required to build and maintain prior authorization logic by up to 75 percent, while cutting update cycles by roughly half. Fewer manual hours spent interpreting criteria mean slower operational costs and faster deployment of new policies. Shorter review times also reduce delays in care, which can help prevent downstream costs associated with treatment interruptions or avoidable escalations. For organizations managing thousands of prior authorization requests each month, even modest time savings per case quickly compound into meaningful financial impact.
Composer also differentiates Banjo Health from other prior authorization automation vendors. Many competitors rely on static rules engines or require extensive custom configuration to translate clinical criteria into decision logic. These approaches are difficult to scale and costly to maintain, especially as guidelines evolve. Composer’s AI-driven methodology eliminates the need for custom coding and reduces dependence on scarce technical resources. Because Composer is natively integrated into the Banjo Health platform, clinical decision trees flow seamlessly into automated case routing, consistent approvals and denials, and end-to-end utilization management workflows. This unified approach avoids the fragmentation common in point solutions that bolt decision support onto legacy systems.
Beyond operational efficiency, Composer helps organizations prepare for a more regulated and transparent future of prior authorization. As regulatory requirements increase and expectations for timely, explainable decisions grow, having standardized, auditable clinical logic becomes essential. Composer provides a clear, traceable link between published clinical criteria and authorization outcomes, supporting both compliance and trust.
Composer represents a fundamental shift in how prior authorization logic is created and maintained. By transforming unstructured clinical guidelines into intelligent clinical decision trees, Banjo Health enables faster decisions, lower administrative costs, and a more sustainable utilization management process. The result is a prior authorization experience that works better for health plans, providers, and ultimately, patients.
