PACS® program information

The Prior Authorization Certified Specialist (PACS) program is the first and only accredited certification for prior authorizations, access, and reimbursement in the world.

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Recommended

95% rate PACS good to excellent

Accredited

PACS is accredited by IACET/ANSI

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Learn at your own pace fully online

10-12 hours

Time needed to complete the PACS program

Credential

Earn a prestigious PACS credential

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PACS® program curriculum

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

Process

Centers on the functional steps of processing prior authorizations from requirement discovery to claim submission

Barriers to access

Provides the essential resources and education to develop the skills needed to handle denials and work towards claim resolution

The PACS® program provides IACET CEUs

IACET statement of accreditation

ANSI Logo
ANSI Logo

The Accreditation Council for Medical Affairs is accredited by the International Accreditors for Continuing Education and Training (IACET).

IACET CEU credit statement

As an IACET Accredited Provider, the Accreditation Council for Affairs offers CEUs for its programs that qualify under the ANSI/IACET Standard. The Accreditation Council for Medical Affairs is authorized by IACET to offer 1.2 CEUs for the PACS program. Note: All target audience members are eligible for continuing education credit upon successful completion of this course. This course does not issue certificates of attendance and does not award partial Joint Accreditation (JA) or IACET CEU continuing education credit certificates for partial completion.

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.

Program structure

Once you enroll in the PACS program, you have up to 6 months to complete the program.

Each of the 12 PACS modules includes:

Pre-quiz (optional)

Establishes your existing knowledge of the specific module's content

Module content

Consists of multiple sections that vary from module to module

Post-quiz

Determines how well you've absorbed and retained the module content

PACS is a self-paced program, and you have six months to complete the certification. On average, most learners complete the program within 2 months (approximately 10-12 hours)

Program learning outcomes

Align the goals of authorizers with the expectations of patients and payers

Understand the prior authorization landscape to improve patient access

Reinforce knowledge of federal, state, and commercial health plans

Learn how to process prior authorizations by navigating the communication expectations of payers

Broaden your knowledge of special considerations for disease states, services, and product types that can influence the patient's journey to better health

Improve confidence when handling denials and submitting appeals

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95% of industry professionals rated the PACS® program as good to excellent.

What does the PACS® Program include?

12 premier learning modules (updated quarterly)

Practical case studies

Downloadable resources

PACS toolkit

Knowledge checks

Final examination

24/7 dedicated live support

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