From Intake to Resolution: Reimagining Appeals & Grievances with a Complete Patient View
BanjoA&G unifies patient context and end-to-end case management to help health plans resolve appeals and grievances faster, with less manual effort and greater confidence.
December 17, 2025
Banjo Health is redefining how health plans and Pharmacy Benefit Managers manage appeals and grievances with the launch of BanjoA&G, a purpose-built solution designed to bring clarity, efficiency, and intelligence to one of the most operationally complex areas of utilization management. Appeals and grievances are not isolated administrative events. They are deeply connected to the full clinical and administrative history of a member, and managing them effectively requires far more than task tracking or deadline reminders. BanjoA&G was created to address this reality by unifying data, workflows, and decision-making into a single, end-to-end experience that supports reviewers from intake through resolution.
At the core of BanjoA&G is the concept of a complete patient view. Appeals and grievances often stall or escalate because critical information is fragmented across systems, forcing reviewers to hunt for prior authorizations, clinical documentation, correspondence, and historical decisions. This disjointed experience not only increases review time but also raises the risk of inconsistent outcomes and compliance gaps. BanjoA&G eliminates these challenges by consolidating all relevant member, clinical, and case data into a single, longitudinal record. Reviewers can immediately understand the full context of an appeal or grievance, including what services were requested, how previous decisions were made, what clinical evidence was reviewed, and how the member has interacted with the plan over time. This holistic patient view fundamentally changes how work gets done. Instead of reconstructing a case from multiple systems, reviewers begin with a clear, comprehensive picture that allows them to focus on clinical and policy judgment rather than administrative retrieval. The result is faster reviews, fewer handoffs, and higher confidence in decisions, especially for complex or time-sensitive cases.
BanjoA&G also delivers true end-to-end case management, ensuring that appeals and grievances are managed as cohesive processes rather than a series of disconnected tasks. From the moment a case is received, the platform uses intelligent automation to route it appropriately based on urgency, type, and complexity. Deadlines are automatically tracked, required actions are surfaced at the right time, and stakeholders are kept aligned throughout the lifecycle of the case. This orchestration removes the need for manual spreadsheets, inbox monitoring, and redundant follow-ups that traditionally consume reviewer and operations team time. For prior authorization and appeals reviewers, this streamlined case management translates directly into efficiency gains. Automated workflows reduce repetitive administrative steps, while built-in alerts prevent missed timelines that can trigger compliance issues or unnecessary escalations. Reviewers are supported by real-time access to case status and next steps, allowing them to manage higher volumes without sacrificing accuracy or consistency.
Documentation and traceability are equally critical in appeals and grievances, particularly in an environment of increasing regulatory scrutiny. BanjoA&G maintains a complete, searchable record of every action, decision, and communication associated with a case. This comprehensive audit trail supports CMS and state compliance requirements while dramatically reducing the burden of audit preparation. Instead of assembling documentation after the fact, organizations using BanjoA&G operate in an audit-ready state at all times, with confidence that decisions are transparent, defensible, and consistently applied.
Beyond operational efficiency, BanjoA&G provides powerful analytics that turn appeals and grievances data into actionable insight. Health plans and PBMs can identify trends in overturn rates, resolution timelines, and case drivers, enabling continuous improvement across utilization management processes. These insights help organizations address root causes upstream, refine clinical guidelines, and allocate resources more effectively, all while improving the experience for members and providers.
The impact on the member experience is significant. Faster, more informed decisions reduce frustration and build trust, particularly when members feel their cases are evaluated thoroughly and fairly. By equipping reviewers with the tools and context they need to act decisively, BanjoA&G helps organizations resolve cases efficiently while maintaining empathy and transparency.
BanjoA&G is not simply an enhancement to existing appeals and grievances workflows. It represents a strategic shift toward integrated, intelligent case management that recognizes the importance of context, continuity, and automation. By combining a complete patient view with end-to-end workflow orchestration, BanjoA&G saves time and effort for reviewers, strengthens compliance, and enables organizations to manage appeals and grievances with greater confidence and control. As regulatory pressure and case complexity continue to grow, solutions like BanjoA&G will be essential for organizations seeking to scale efficiently without compromising quality or accountability.
