Banjo Health

What Banjo Health does

Banjo Health Inc. is a Washington, DC-based healthcare technology company, founded in 2019, that builds an AI-powered, cloud-native prior authorization platform for health plans and pharmacy benefit managers (PBMs). The platform automates the end-to-end PA lifecycle — from fax-based intake through eligibility verification, clinical decisioning, determination letter generation, and appeals — and is delivered as four integrated modules: BanjoPA (core PA workflow), Composer (no-code clinical criteria and decision-tree management), CARE (AI-assisted clinical evidence retrieval for human reviewers), and BanjoA&G (appeals and grievances case management). Underlying capabilities include OCR for fax ingestion, NLP for converting clinical guidelines into structured criteria, knowledge retrieval for reviewer evidence surfacing, and FHIR-based integrations with EHRs, eligibility systems, claims platforms, and ePA vendors. The platform is HITrust r2 certified and explicitly engineered around CMS-0057, CMS-0062, and state-level PA regulations (Washington RCW 48.43.830, California SB 41).

Banjo Health operates a sales-led, consultative enterprise go-to-market targeting health plans and PBMs, with no publicly disclosed pricing tiers — all contracts are custom-quoted based on member population size, transaction volume, workflow complexity, and integration requirements, billed on annual subscriptions. Its named flagship customer is Navitus, the nation's first and largest transparent, pass-through PBM, and the company announced five additional client wins in November 2025 alongside the launch of new product modules. The company is venture-backed, having raised a $5 million Series A led by Epsilon Health Investors in July 2021 plus an additional ~$2 million in September 2022, and is led by founder/CEO Saar Mahna with a C-suite including a dedicated CRO (Shawn Kearl, February 2026), CTO/Privacy Officer, COO/CISO, and CFO.

Name

Banjo Health

Legal name

Banjo Health Inc.

Website

https://banjohealth.com

Company type

Private

Founded year

2019

Operating status

Operating

Headcount range

11–50 employees

Short description

Banjo Health builds an AI-powered, cloud-native prior authorization platform for health plans and PBMs, automating the full PA lifecycle from fax intake through appeals via modules BanjoPA, Composer, CARE, and BanjoA&G.

Ownership category

akta.pro rank

Product category

Healthcare Prior Authorization Software

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821)

SIC

Services-Prepackaged Software (7372)

akta.pro primary industry

Utilization Management, Appropriateness Criteria & Prior Authorization CDS (HLACAGAM)

akta.pro secondary industry

Evidence-Based Guidelines, Knowledge Management & Content Authoring (HLACAGAD)

Keywords

• Prior authorization software
• Healthcare AI platform
• Clinical decision support
• Appeals and grievances
• Pharmacy benefit management

Headquarters

HQ city

Washington

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Marketing or Sales, Infrastructure, Operations

Revenue model

1. SaaS Subscription Pricing: Banjo Health operates on a subscription-based model with consultative, customized pricing tailored to each organization's specific needs. Pricing factors include member population size, transaction volume, workflow complexity, and integration requirements. No specific pricing tiers are publicly disclosed; prospects must complete a form and schedule time with sales team.

Pricing tiers

Go-to-market motion2 records

Distribution channels1 record

Marketing channels4 records

Core offering

Banjo Health provides a cloud-native, AI-powered prior authorization decision support platform for health plans and pharmacy benefit managers (PBMs). The platform automates the end-to-end prior authorization workflow from intake through appeals, including clinical decision tree management, eligibility verification, and audit-ready documentation. Core products include BanjoPA (the main prior authorization workflow platform), Composer (clinical criteria management), BanjoA&G (appeals and grievances), and CARE (AI-assisted clinical evidence retrieval).

Product overview

Banjo Health offers a unified, cloud-native AI-powered prior authorization platform designed for payers and pharmacy benefit managers (PBMs). The platform comprises BanjoPA as the core prior authorization workflow engine, supplemented by Composer for clinical criteria management and decision tree generation, BanjoA&G for appeals and grievances management, CARE for AI-assisted clinical evidence retrieval, plus integrated features for automated intake, letter generation, and claims system integration. The modular architecture allows payers and PBMs to deploy individual capabilities while operating within a cohesive ecosystem, with AI embedded throughout the workflow from intake through appeals resolution.

Differentiator

Problem solved

Functional benefit

Brands

• BanjoPA: AI-powered prior authorization platform for payers and PBMs with automated workflows, case routing, and decision support.
• BanjoA&G
• Composer
• CARE (Computer-Assisted Review Engine)

Products and services

• BanjoPA AI-powered, cloud-native prior authorization platform that unifies eligibility checks, claims integration, and prior authorization workflows in a single interface. Delivers real-time data synchronization, flexible no-code customization, and scalable cloud infrastructure for payers and PBMs.
• Composer Clinical criteria management solution that automates creation, management, and updating of clinical decision trees using OCR and NLP. Features integrated testing sandbox, version control, real-time editing, and formulary-linked criteria management.
• BanjoA&G (Appeals & Grievances) Purpose-built appeals and grievances management solution that unifies patient context and end-to-end case management. Provides complete patient view, intelligent case routing, deadline tracking, automated stakeholder alerts, and audit-ready documentation.
• CARE (Computer-Assisted Review Engine) AI-powered clinical evidence retrieval tool that surfaces relevant clinical documentation for reviewers during prior authorization reviews. Reduces rework and turnaround time by eliminating manual evidence hunting while keeping clinicians fully in control of decisions.

Quantifiable outcome

• 50% faster intake to decisioning speed
• +3 more outcomes

Named customers1 record

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability8 records

Feature6 records

Partnerships

One partnership is on record.

• NavitusflagshipStrategic or Co-development Partner · 6 January 2026Navitus, the nation's first and largest transparent, pass-through PBM, announced an expanded partnership with Banjo Health over the 2025 holiday period. The partnership leverages Banjo Health's AI-powered prior authorization platform to automate and streamline Navitus's PA workflows across their pharmacy benefit management operations.

Scale indicators6 records

Recent moves7 records

Expansion highlights6 records

Direct peers

• Cohere Health: Direct competitor offering AI-powered prior authorization and utilization management for health plans. Closely comparable in target customer (payers), core workflow (PA), and AI/clinical decision support approach.
• Xsolis: AI-driven utilization management and clinical decision support platform for health plans and providers. Directly comparable in serving payers with CDS and authorization workflow automation.
• Myndshft: Prior authorization automation platform for payers and providers, focused on automating medical benefit PA workflows. Comparable in workflow automation approach and payer/PBM target segment.
• Infinx Healthcare: Provides prior authorization, patient access, and revenue cycle automation for healthcare providers and payers. Comparable in PA workflow automation and integration with eligibility/claims systems.

Emerging players

• Olive AI: Healthcare AI automation company building workflow automation products for payers and providers. Adjacent competitor in healthcare AI workflow automation, though with broader scope than PA specifically.

Broad incumbents

• InterSystems: Major healthcare data and interoperability platform vendor (HealthShare, IRIS). A broad incumbent providing clinical data, FHIR interoperability, and workflow capabilities that overlap with Banjo's payer-facing offerings.
• Change Healthcare (Optum): Large incumbent healthcare technology vendor offering eligibility, claims, and prior authorization solutions to payers. Part of Optum, providing broad workflow tools that overlap with Banjo's payer-side offerings.
• Waystar: Healthcare revenue cycle and patient access platform with eligibility, prior authorization, and claims management capabilities. Comparable in payer-facing workflow automation though broader in scope.
• Experian Health: Healthcare data and automation vendor with eligibility verification, prior authorization, and patient access capabilities. Comparable in payer/provider workflow tools though as part of a broader data and analytics portfolio.
• Cotiviti: Healthcare analytics and payment accuracy vendor serving payers with utilization management and clinical decision support capabilities. Comparable in payer-focused CDS and PA-adjacent workflow offerings.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat6 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/BanjoHealth

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Funding overview

Funding rounds3 records

Investors3 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Banjo Health