Healthcare technology company Banjo Health has entered into a strategic partnership with an healthcare data integration and management platform Opala to revolutionise the prior authorisation process for both healthcare providers and payers.
Leveraging Banjo Health's Composer artificial intelligence (AI) workflow builder, the collaboration aims to enhance clinical decision-making through the utilisation of advanced technology.
Composer expertly processes medical policies, creating a detailed decision tree that clinicians can use to streamline their processes.
Opala automates the data exchange process for prior authorisation by linking provider requests with health plans. This enables Composer to review and process requests for approval.
Furthermore, Opala presents relevant medical policies in an easily understandable question-and-answer format to integrate them into the provider workflow.
This feature ensures that healthcare providers have the essential tools and information needed to submit prior authorisations efficiently, following all necessary medical policies.
Banjo Health CEO Saar Mahna said: “By harnessing the power of AI and ML in prior authorization decisioning and data integration, we are set to revolutionise how healthcare providers and payers interact with and manage critical healthcare data.”
By combining Banjo Health's Composer with Opala's interoperability platform, the partnership enables auto-authorisation at the time of placing an order.
Auto-Authorisation enables providers to receive decisions in real-time while placing an order as part of their workflow and EMR.
Automating authorisation procedures will result in significant cost and time savings by removing error-prone manual tasks.
The health provider will be adequately notified about the need for authorisation by health plan, approval of treatment for payment, or denial of payment until additional patient results or treatments, such as lab results or physical therapy, are completed.
Opala CEO Ken Chandler said: “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.”
