Understanding the Peer to Peer Process with Payors

Description:

This course, taught by PALH President-Elect Paola Gonzalez, MPAS, PA-C, will provide a comprehensive overview of medical benefits managers and their role in benefits authorization. Participants will gain an understanding of the various types of medical benefits managers and their specific responsibilities within the healthcare system.

The course will also cover the key ways that insurance benefits managers use NCCN and other medical guidelines to create their own healthcare clinical guidelines. This will include a deep dive into the process of creating and implementing guidelines and the importance of proper documentation to decrease peer to peer frequency.

Additionally, the course will explore key strategies for minimizing clinician frustration with the benefits authorization process and increasing the success rate of obtaining approval for patient care requests.

Overall, this course will equip participants with a thorough understanding of the medical benefits management landscape and provide them with the tools they need to navigate it effectively and efficiently.

Learning Objectives: 

1. Understand the various medical benefits managers and their role in benefits authorization.
2. Learn the key ways that insurance benefits managers use NCCN and other Medical guidelines to create their own healthcare clinical guidelines.
3. Understand the importance of documentation to decrease peer to peer frequency.
4. Understand key ways to minimize clinician frustration with the process and be more successful in obtaining approval for patient care requests

This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 1 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation. Approval is valid from 2/28/2023 to 2/28/2023. AAPA reference number: CME-208767.