The #1 Leader in Prior Authorization Training
Prior Authorization Certified
Specialist (PACS) Curriculum
2020
Overview
At a Glance
Establishes a minimum level
of core competencies
Online and self-paced
About 10 hours to complete
12 modules, each with learning
objectives and a post-quiz
Includes case studies,
glossary and a toolkit
PRIOR AUTHORIZATION CERTIFIED SPECIALIST
1.
Overview
Prior Authorization Certified Specialist
(PACS) program
The Prior Authorization Certified The program also includes case The PACS certification is the
Specialist (PACS) program is a studies, and a glossary of terms most comprehensive training
comprehensive, 12-module, self-paced, and a toolkit. PACS certification program for professionals
online program designed to foster demonstrates that professionals managing prior authorizations
the professional development of have met rigorous standards through processes in the world. Achieving
Prior Authorization Specialists. Each intensive study, self-assessment PACS certification demonstrates
module contains a post-quiz, goals and and evaluation. the highest standards of
learning objectives. The post-quizzes knowledge and excellence in
serve as progress indicators. the field.
It also sets the stage for continual professional development through values centered on lifelong
learning. The curriculum serves to provide intermediate-level material which is meant to establish a
minimum level of core competencies we believe are important for all prior authorization professionals.
PRIOR AUTHORIZATION CERTIFIED SPECIALIST
2.
Overview
The curriculum focuses on 5 key areas:
I. Prior authorizations including definitions, history and the
evolution of the prior authorization process, defining the roles
of the prior authorization professionals, understanding the
complete process from provider through payer to patient
2. Fundamentals before the Prior authorization including
medical compendia, ICD- 10 codes, CPT and the medically
accepted indication
3. Insurance guidelines, researching the plan effectively,
communication and initiating a prior authorization request
from the provider’s office
4. Coverage Determinations of the medication prior
authorizations and processing the request from the
payer’s side
5. Authorization denials and appeals and other authorization
needs and tasks
PRIOR AUTHORIZATION CERTIFIED SPECIALIST
3.
Overview
Who Can Take the Course?
• Provider Office Clerical Specialists • Customer Service
• Medical Assistants • Representatives
• Nurses (LPN) (RN) • Pharma Professionals
• Pharmacy Technicians • Nurse Practitioners
• Case Managers • Physician Assistants
• Nursing Students • Physicians (MD, DO)
• Pharmacy Students • Drug Rep
• Pharmacists • Accounts Receivable Specialists
• Patient Care Coordinators • Field Reimbursement Managers
• Medical Coders • Patient Access Liaisons
• Home Health Aides
PRIOR AUTHORIZATION CERTIFIED SPECIALIST
4.
Course Listing & Topics
Course Listing & Topics
The Prior Authorization Process
Insurance Policies
Compliance - HIPAA, Security, Fraud and Abuse
Medical Records and the Prescription
Fundamentals Before the Authorization Process
Communication Methods
Service Line and Medication Process and Submission
Inpatient and Outpatient Services
Coverage Determination Types in Medication
Out of Network Waivers
Denials and Appeals
The Future of Prior Authorizations and Job Opportunities
PRIOR AUTHORIZATION CERTIFIED SPECIALIST
6.
Call us at 1-201-688-2230 or visit us at [Link]/
The #1 Leader in Prior Authorization Training
Are you dedicated to advancing your career in
health care? Contact us to learn more about the
PACS program. Distinguish yourself by becoming a
Certified Prior Authorization Specialist.
Accreditation Council for Medical Affairs
700 Kinderkamack
Oradell, NJ 07649
info@[Link]
The PACS Certification demonstrates that professionals have met rigorous standards through intensive study, self-assessment and evaluation. The PACS
certification is the most comprehensive training program in the world. Achieving the PACS demonstrates the highest standards of knowledge, and
excellence in the prior authorization field. It also sets the stage for continual professional development through values centered on lifelong learning.