Health plans who implement CMS requirements before 2026 mandate will save millions by implementing now
Banjo Health, a leader in generative AI-powered prior authorization software, and Opala, an interoperability platform for seamless real-time data integration in healthcare, are excited to announce their strategic partnership. This collaboration transforms the prior authorization process, making it more efficient and effective for both providers and payers.
Through Banjo Health’s innovative product, Composer, a state-of-the-art generative AI workflow builder, the partnership will leverage advanced technology to optimize clinical decision-making. Composer expertly digests medical policies and automatically constructs a comprehensive decision tree, which clinicians can utilize to streamline their processes. This integration of generative AI into healthcare workflows represents a significant step forward in medical technology.
Opala completes the missing link by automating data exchange for prior authorization—connecting provider requests for authorization with health plans, so Composer is able to review and process for approval. Moreover, Opala delivers relevant medical policies in a user-friendly question-and-answer format directly into provider workflow. This feature ensures that providers are equipped with the necessary tools and information to efficiently submit prior authorizations, adhering to all required medical policies.
This collaboration addresses the pressing need for automation in prior authorization, as mandated in the proposed CMS rules and demanded by the healthcare market. By integrating Banjo Health’s Composer with Opala’s interoperability platform, the partnership facilitates Auto-Auth at the point of ordering.
Auto-Authorization will ultimately allow a provider to receive a decision in real-time when placing an order, all within their workflow and EMR. The provider will be informed about whether authorization is required by the health plan, whether treatment is approved for payment by the health plan, or whether payment is denied until additional patient results or treatments are completed, such as lab results or physical therapy.
This not only streamlines the submission process for providers but improves the patient experience. CMS has postponed mandate deadlines until 2026; however, payers and providers will benefit immediately upon implementation. Automating authorization processes will save millions of dollars and countless hours by eliminating manual processes that are error prone. Patient experience and patient outcomes are negatively impacted when necessary treatments are delayed by manual processes or incorrectly denied for payment due to missing or incomplete data.
“Our partnership with Opala represents a pivotal moment in healthcare technology,” said Banjo Health CEO, Saar Mahna. “By harnessing the power of AI and ML in prior authorization decisioning and data integration, we are set to revolutionize how healthcare providers and payers interact with and manage critical healthcare data.”
“Our shared vision goes beyond automating data feeds or retiring systems to save on licensing fees,” said Opala CEO, Ken Chandler. “We are embarking on this journey with grand ambition: to fundamentally improve healthcare, reduce medical spend, and unlock vast opportunities for growth. The real potential of our collaboration lies not only in cost savings but also in these transformative impacts on healthcare.”
Banjo Health and Opala are committed to continuous innovation and are excited to lead the way in transforming healthcare through advanced technology. This partnership is not just about technology integration; it’s about improving patient care and making healthcare more accessible and efficient for everyone involved.
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#AI [Source: AI Techpark]