Rated #1 Prior Auth Certification

Official reimbursement & prior authorization certification for healthcare and life science professionals

Become a leader in Prior Authorization

Reinforce experience and upskill

Be best in class

Enhance patient access

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The Prior Authorization Certified Specialist (PACS®) Program

PACS® professionals from over 250+ companies

  • GSK
  • ABBVIE
  • UCB
  • Neurocrine
  • CARDINAL
  • AETNA
  • CVS
  • WALGREENS
  • sanofi

The Prior Authorization Certified Specialist (PACS®) Program

The Prior Authorization Certified Specialist (PACS) program is the only program focused on the information necessary to be a successful access and reimbursement professional.

Format

100% online and self-paced for your convenience

Exam required

Yes, 4 attempts provided (online)

Time to complete

6 months (average completion time is 10-12 hours)

Support provided

24/7 live human chat avaliable

PACS® - Transforming patient access, prior authorization & reimbursement

The authority on prior authorization

What you need to know about PACS

  • It's the only accredited certification program for prior authorization, reimbursement, market access and payer policies recognized in the industry. Watch a 1 minute video explainer about PACS

  • Created for prior authorization specialists by prior authorization specialists with experience in PBMs, payers, pharma, and healthcare.

  • ACMA established the industry standard with the PACS certification - ensuring core competency for authorizers.

Take the first steps towards achieving the gold standard in the healthcare and life sciences industry.

Be more than an authorizer

The Prior Authorization Certified Specialist (PACS) professionals are expanding patient access, advocating for better patient outcomes, and leading the reimbursement and access industry.

  • Establish yourself as an expert in prior authorization

  • Increase your effectiveness while making a difference

  • Demonstrate mastery of the prior authorization and payer landscape of the healthcare system

The path to becoming an exceptional reimbursement and access professional starts with PACS.

Why should I become a Prior Authorization Certified Specialist?

Credibility

Earn the recognition of achieving the standard of excellence among reimbursement professionals

Expertise

Prior Authorization Cerified Specialist professionals are leaders and subject matter experts among their reimbursement peers

Dedication

Prior Authorization Certified Specialists demonstrate a commitment to patient access and better outcomes

Higher pay

Certified professionals earn higher pay compared to other professionals in the field

Career investment that pays for itself 10x over

24%

is earned more by certified prior authorization professionals

80%

improvement in the access & reimbursement professional's knowledge

67%

increase in estimated cost of prior authorization denials

PACS® payment options

PACS certification demonstrates your mastery of the highest standard of knowledge through experience, rigorous study, and evaluation

Full Payment

Prior Authorization Basic Training Program (PABT)

$899.99

for prior auth beginners

6 month access (online)

12 learning modules

12 pre & post knowledge checks

Resources & case studies

Final exam (4 attempts)

PACS credentials

Full Payment

Best Option

The Prior Authorization Certified Specialist (PACS®) Program

$1,199.99

for Reimbursement, MD, PharmD, & PhD Professionals

6 month access (online)

12 learning modules

12 pre & post knowledge checks

Resources & case studies

Final exam (4 attempts)

PACS® credentials

3 Month Installments

The Prior Authorization Certified Specialist (PACS®) Program

$449.66 / 3 monthly

for Reimbursement, MD, PharmD, & PhD Professionals

6 month access (online)

12 learning modules

12 pre & post knowledge checks

Resources & case studies

Final exam (4 attempts)

PACS® credentials

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Don't take our word for it.

Trust our customers

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ANSI Logo

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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Dorette Shirley

Dorette Shirley

Field Reimbursement Manager

Prior authorizations are not a multiple choice test that if you put in enough right answers you ll 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.

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Elizabeth Johnson LPN, CPC, PACS

Elizabeth Johnson LPN, CPC, PACS

Patient & Healthcare Advocate

I had a great experience! In terms of the program and design, the content is great. I am already seeing benefits in my role. There are things that I learned in the PACS program that I m using in my conversations with the physicians and nurses. There is tremendous value in the PACS program!

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Anil Bulchandani MBA, LSSBB, PACS

Anil Bulchandani MBA, LSSBB, PACS

Field Reimbursement Director

What will I learn in the PACS® program?

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 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 understand patients who cannot afford prescriptions, there are patient assistance programs and copay programs designed to help patients gain access to necessary medications.
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 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 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.
Module 6 provides in-depth explanations of the communication methods for the prior authorization process. Effective communication with the payer is imperative for submitting a prior authorization and receiving updated status for the patient.
Module 7 takes a step-wise approach to the submissions of prior authorization for both medical benefits and prescription benefits. This approach is from the provider perspective to ensure all steps are appropriately taken and the risk of denial is minimized.
Module 8 covers the broad scope of specialties and clinical practice which require authorization. Some services require additional attention, including diagnostic and interventional radiology, oncology, specialty medication, infusion services, J code medications, durable medical equipment, and various therapies. The function is not to memorize the special cases, but to critically think through the workflows.
Module 9 provides guidance on how to request and achieve an out of network waiver for special cases. This is particularly important for patients who experience limited accessibility and mobility or require particular specialists.
Module 10 discusses the frequent coverage determinations for medication claims that require additional considerations. This includes quantity limits, tier exceptions, step therapy, step therapy exceptions, and non-formulary exceptions. Considerations are also made for high-risk medications, opioids, Medicare Part B vs Part D, End Stage Renal Disease, hospice, and Drug Utilization Reviews.
Module 11 describes the denial process and how to overturn the decision with an appeal. Strategic methods exist to review the application for authorization and to appeal with success.
Module 12 presents the future of prior authorizations on a macro level and opportunities in the field as an individual. Prior authorizations continue to expand as the healthcare industry adapts to new challenges.

Looking to learn as a team?

GSK
ABBVIE
sanofi
WALGREENS

Why certify with ACMA?

Experienced

10+ years of experience and proven track record in the life sciences industry

Robust learning management system

Robust training platform features with on-demand, immersive, and cohort-based learning

Personalized training

Personalized learning and actionable learner insights

Engaging content

Engaging content using research-driven pedagogical techniques

Secure

Secure and reliable next-gen technology

Support

24/7 live human chat avaliable

Explore how PACS® was crafted to transform the industry

1

Advisory board

Several advisory board meetings held with leaders and subject matter experts.

2

Accreditation

ACMA received IACET accreditation, whose processes helped us build a rigorous curriculum.

3

Development

Prior Authorization Certified Specialist program designers developed content using psychometric analysis to ensure that graduates are held to the highest standards of learning and assessment.

4

Industry standard

Prior Authorization Certified Specialist program established standards for knowledge, technical skills and professional practice for those working within the payer landscape.

5

Expert insights

ACMA works with experts from PBMs, payers, pharma, and healthcare to develop the newest and best content for the prior authorization certified specialist curriculum.

6

Updated content

Content is always updated to reflect new business practices, technologies, market challenges and regulatory changes.

Frequently asked questions (FAQs)

The Prior Authorization Certified Specialist Program (PACS) is an official certification accredited by the International Accreditors for Continuing Education and Training/ American National Standards Institute (IACET/ANSI). ACMA is also a member of the Institute for Credentialing Excellence.
The Prior Authorization Certified Specialist program (PACS) content was developed by over 30 subject matter experts from academia, managed care, benefit managers, health plans, and experts from the pharmaceutical industry.
Every 3 years you are required to maintain your certification. You can do this by either (1) completing 10 hours of continuing education credits approved by the ACMA or (2) taking the exam.
The Prior Authorization Certified Specialist program (PACS) takes on average about 10-12 hours to complete. It is self-paced, so everyone will be different. Once you enroll in the PACS program, you have up to 6 months to complete it.
Yes. The ACMA offers a flexible payment plan where you can pay in 3 easy installments. Additionally, you can use PayPal credit if you qualify.
To enroll / purchase the PACS program please click on one of the 'Enroll Today' buttons. Sign up for an account and proceed to checkout.

Documentation & policies

Credits policy

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Become excellent in prior authorization, reimbursement & market access: Become a prior authorization certified specialist

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Phone : (855)-255-7137
Location : 700 Kinderkamack Road, Suite 204, Oradell, New Jersey 07649 USA