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Center for Curriculum and Transfer Articulation
Prescription Prior Authorization I
Course: CSR145

First Term: 2025 Spring
 Lec + Lab   4.0 Credit(s)   4.0 Period(s)   4.0 Load  
Subject Type: Occupational
Load Formula: T - Lab Load


Description: Prescription prior authorization procedures for federal employees. Covers account access, documentation, and eligibility as well as claims process and claims adjudication. Computerized databases and automated phone systems emphasized.



MCCCD Official Course Competencies
1. Explain the Federal Employee Program (FEP). (I)
2. Identify various specialized prior authorization processes for federal employees. (I-VI)
3. Demonstrate the standard protocols for completing prior authorization procedures. (I-VI)
4. Demonstrate effective customer service skills. (I-VI)
5. Summarize eligibility. (II)
6. Verify an individual`s eligibility in the FEP. (II)
7. Access member accounts. (II-IV)
8. Demonstrate procedures for using different features and functions of the automated phone system. (III)
9. Differentiate between the types of FEP databases. (IV)
10. Identify various database screens and menus. (IV)
11. Demonstrate ability to access FEP databases. (IV)
12. Explain Generic Product Identifier (GPI) numbers. (V)
13. Summarize the claims process. (V)
14. Demonstrate case documentation procedures. (V)
15. Explain claim adjudication. (V)
16. Research existing and rejected claims. (V)
MCCCD Official Course Competencies must be coordinated with the content outline so that each major point in the outline serves one or more competencies. MCCCD faculty retains authority in determining the pedagogical approach, methodology, content sequencing, and assessment metrics for student work. Please see individual course syllabi for additional information, including specific course requirements.
 
MCCCD Official Course Outline
I. Federal Employee Program (FEP)
   A. Overview
   B. Insurance
II. Eligibility
   A. Overview
   B. Verification
   C. Database
      1. Menus
      2. Codes
   D. Dependents
   E. Insured`s data
      1. Name
      2. Date of birth
      3. Address
   F. Pharmacy information
   G. Confidentiality
   H. Privacy
III. Automated phone system
   A. Overview
   B. Logging on/off system
   C. Receiving calls
   D. Placing calls on hold
   E. Conference calls
IV. Computerized databases
   A. Logon
   B. Menus
   C. Codes
   D. Screens
   E. Logoff
V. Claims
   A. Overview
   B. Prescriptions
   C. Co-pays
   D. Claims adjudication
   E. Generic product identifier
   F. Processing
   G. Online claims system
      1. Menus
      2. Fields
      3. Searches
      4. Running claims
      5. Rejection codes
   H. Documentation
VI. Communication skills
   A. Overview
   B. Greeting
   C. Tone
   D. Inflection/emotion
   E. Questioning techniques
   F. Listening skills
   G. Positive phrases
   H. Negative phrases
 
MCCCD Governing Board Approval Date: November 26, 2024

All information published is subject to change without notice. Every effort has been made to ensure the accuracy of information presented, but based on the dynamic nature of the curricular process, course and program information is subject to change in order to reflect the most current information available.