MCCCD Program Description

Advocate-Driven Medication Procedures II

Course: CSR128

First Term: 2007 Fall

Lecture 2 Credit(s) 2 Period(s) 2 Load
Subject Type: Occupational
Load Formula: S

Description: Further examination of procedures for advocate- driven medication customer service representatives. Medication authorizations and changes as well as medical insurance, claims, and customer correspondence covered

MCCCD Official Course Competencies
1. Summarize procedures for authorizing medications. (I) 2. Identify various types of medications available through an advocate-driven medication program. (I) 3. Summarize procedures for handling emergency medication authorizations. (I) 4. Explain how to process changes to a patient`s medications. (II) 5. Differentiate between various types of customer correspondence. (III) 6. Summarize procedures for handling customer correspondence. (III) 7. Distinguish between publicly funded and private insurance programs. (IV) 8. Describe the claims process, including rejected claims and reversed 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. Medication Authorizations A. Overview B. Procedures 1. When to Authorize 2. Dosage Instructions 3. Duration of Therapy 4. Day Supply C. Medication Types 1. Retail Only Medication Products 2. Inhalers 3. Nasal Sprays 4. As Needed Medications D. Emergency Medication E. Medication Shipped Direct F. Cancellations II. Medication Updates A. Overview B. Adding New Medication C. Change in Strength of Medication D. Dosage Changes E. Refills III. Customer Correspondence A. Overview B. Enrollment Forms C. Health Condition Form D. Allergy Form E. Proof of Income F. Prescription for Medication G. Insurance Documentation H. Referral Documentation I. Types of Outgoing Correspondence 1. Enrollment Acceptance Letter 2. Incomplete Enrollment Form 3. Alternate Fund Document Replacement 4. Referral Exception Letter 5. Annual Re-Enrollment Form and Letter 6. Re-Enrollment Reminder Letter 7. Re-Enrollment Acceptance Letter 8. Verification of Income Request 9. Zero Income Letter 10. Prescription Request IV. Medical Insurance A. Overview B. Auto-Referral C. Reimbursements D. Publicly Funded Programs 1. Medicare 2. Medicaid 3. AIDS Drug Assistance Programs (ADAP) 4. Elderly Drug Assistance Program (EDAP) 5. Veteran`s Administration 6. State Children`s Heath Insurance Program (SCHIP) 7. Indian Health Services (IHS) 8. Hospice E. Private Programs 1. Private Insurance Plans 2. Medicare Supplement Plans 3. Medigap Plans V. Claims A. Overview B. Process C. Reimbursing Pharmacies D. Rejected Claims E. Reversing a Claim

MCCCD Governing Board Approval Date: 4/24/2007

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.