Faster Prior Authorization Results through Artificial Intelligence.


Virtuoso AI, Harmony, Composer, and Concerto Suite solutions set Banjo Health apart, creating the next evolution of an efficient PA process:

  • Leveraging AI with exceptional features that accelerate the PA process.

  • Improved compliance.

  • Delivering consistence criteria with improved outcomes.

  • Overall better user experience.

  • Lower costs.

  • Integration with a large ePA vendor, enabling a fully electronic and fast PA solution.

VIRTUOSO AI.

Virtuoso AI is a microservice that can integrate into existing PA Management platforms and EHR systems, providing a comprehensive and cohesive PA process from submission to decision, resulting in numerous efficiencies for both payers and providers, without disrupting existing incumbent platforms. 

Addressing the greatest PA challenges faced by Health Plans and PBMs: narrow turn-around times and review of complex PA criteria. 

 

How it Works:
Virtuoso extracts clinical information from PA requests, compares the clinical data and information against the payer’s clinical criteria and then accurately predicts if the request should be approved or denied.  The AI model determines if there is missing information or additional supportive documentation is needed to complete the review and can flag PAs which require further clinician review. 

HARMONY.

Harmony is a comprehensive PA Management platform, for both medical and pharmacy prior authorizations (PA) designed by clinicians for clinicians. 

Harmonious integration is achievable with all existing software solutions offered by a Health Plan or PBM.

 

The Harmony Solution:

  • Optimizes the reviewer’s ability to complete a PA review in a fraction of the time required.

  • Instantaneously searches, identifies, and lists all relevant clinical information pertaining to specific PA criteria from hundreds of pages of supplemental documents submitted by providers.

  • Real-time monitoring of all PA’s with multiple built-in alerts to help ensure compliance with all regulatory and internal requirements.

  • Communicates denial reasons(s) to the provider and creates an uncomplicated appeals process.

  • Creates a full clinical data pathway continuum from the prescriber to the payer.

COMPOSER.

Today’s medical necessity reviews and prior authorizations are based on a set of complex clinical criteria developed and approved by the payer’s clinician teams. Composer is designed to alleviate the burden created by clinical criteria.

Publish, via low-code environment, clinical criteria and associated decision trees.

Through Composer, payers will be able to:

  • Author medical necessity and prior authorization rules & requirements with guided auto-drafting support  

  • Automatically convert free form text based clinical criteria into a decision tree 

CONCERTO SUITE.

Concerto Suite is a complete PA intake and submission tool that can integrated into any PA Management platform or EHR system on the market today.

Concerto saves critical resources of time and money by creating a one stop shop where all PAs submitted are transformed into a searchable format regardless of submission type.

Concerto benefits:

  • Concerto cuts PA reviewers time by 20%

  • All PAs upon submission are converted to searchable documents instantaneously.

  • Meet strict Turn-Around-Time requirements.

  • Greatly improve overall PA productivity.

           

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