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The Prior Authorization Certified Specialist (PACS) Program
Certification Course
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Accredited by IACET/ANSI
The only program focused on the information necessary to be a successful access and reimbursement professional. Ensuring patient access can be hard work, and PACS will showcase your expertise in this area.
4.7 | (5k + Graduates)
$1199
12 Modules
6 Months Access
100% Online & Self Paced
24/7 Live Chat
Frequently Bought Together
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Total Price : $1898.98
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Buy all together : $ 1898.98
Learning Objectives
Prior Authorization Understanding
Covers what prior authorization is and how it came to be utilized across the industry
Insurance Policies and Payment
Provides a comprehensive understanding of health insurance for federal, state, and commercial plans as well as pricing, drug tiering and copay assistance
Compliance
Focuses on the compliance standards relevant to any professional working in reimbursement and access
Processes
Centers on important functional areas within Medical Affairs, such as compliant publication practices, advisory boards, continuing medical education, investigator sponsored research, and post-marketing studies
Barriers to Access
Provides the essential resources and education to develop the skills needed to handle denials and work towards claim resolution
Master These Skills
Insurance Policies
Copay Assistance
Compliance
HIPAA Standards
Reimbursement
Prior Authorization Process
Insurance Policies
Compliance
HIPAA
Fraud and Abuse
Medical Records
Service Line Request
Medication
Service Orders
Network Waivers
Denials and Appeals
All ACMA certifications are accredited by IACET/ANSI
25k+
Users
80+
Countries
250+
Companies
Module Breakdown
Module 1
The Prior Authorization Process
Module 1 lays the foundation for understanding the prior authorization landscape. This module goes over what prior authorization is, how it came to be, and who is involved in this utilization management process.
Module 2
Insurance Policies and Pricing
Module 2 covers insurance policies, payments, and copay assistance. Processing prior authorization requires knowledge of federal, state, and commercial health insurance, drug tiering, formularies, and determining insurance eligibility. To help unserved patients who cannot afford prescriptions, there are patient assistance programs and copay programs designed to help patients gain access to necessary medications.
Module 3
Compliance - HIPAA, Security, Fraud and Abuse
Module 3 mitigates risk surrounding compliance standards in the industry by reinforcing law and ethical practice. For reimbursement, it is expected that authorization professionals protect patient information to the standard of HIPAA and ensure accurate coding.
Module 4
Medical Records and the Prescription
Module 4 explains in detail the components of the medical record and prescription to aid in the authorization process. Valuable information is conveyed in these documents and can help the authorization find information efficiently and successfully.
Module 5
Fundamentals Before the Authorization Process
Module 5 focuses in the value of medical documentation and coding to apply to the prior authorization request. Understanding the ICD-10, CPT, and HCPCS codes as well as medically accepted indications and medical necessity will support the authorization process.
Customer Reviews
4.7 | (5k + Graduates)
Value For Money
4.7/5
Easy to Navigate
4.6/5
Program Content
4.7/5
PACS Credential Value
4.9/5
Reviews Mention
Easy to follow
In-depth overview
Multiple topics
Packed with information
Worth the investment
Interactive exercises
Highly recommend
Taylor Nease CPhT PACS
I found the information informative. I knew some of it from doing prior authorizations already but I also learned a lot about different insurance companies and services rather than just medications. I got through it pretty quickly. I liked how the test was laid out with different sections and was easy to follow. The information was easy to understand and follow. I like the links that were throughout the slides for more information. The exam itself was over the material read, no trick questions or hidden information. Overall, I would recommend the course.
Elizabeth Johnson LPN CPC PACS
Prior authorizations are not a multiple choice test that if you put in enough right answers you will pass and get an approval. The PACS course explained not just the why of the process, but the importance of all the pieces that make up the why I would recommend this course to anyone involved with the authorization process to better grasp the steps and refresh their skills. I thought I was pretty savvy when it came to prior authorizations but this certification allowed me to further demonstrate my knowledge and skill set.
Dorette Shirley PACS
Great certification program for the field reimbursement patient access role. This is beneficial to people in the profession. This gives them an in-depth overview of the operations surrounding reimbursement.
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