PACS Technology & Information Systems in Prior Authorization 1

Question 1

Which ASC X12 transaction set is the HIPAA-mandated standard for submitting prior authorization requests and referrals?

Accepted Answer

ASC X12 278

Answer

The ASC X12 278 Health Care Services Review transaction is the HIPAA-mandated electronic standard for submitting prior authorization requests and referrals between providers and payers.

Question 2

What is the primary purpose of an Electronic Prior Authorization (ePA) system?

Accepted Answer

To automate and streamline the PA submission and approval workflow

Answer

ePA systems are designed to automate and streamline the prior authorization submission, tracking, and approval process, reducing administrative burden and turnaround time compared to manual methods.

Question 3

Which organization develops and maintains the NCPDP SCRIPT standard used for electronic pharmacy prior authorization?

Accepted Answer

National Council for Prescription Drug Programs (NCPDP)

Answer

The National Council for Prescription Drug Programs (NCPDP) develops and maintains the SCRIPT standard, which is widely used for electronic pharmacy transactions including prior authorization messaging.

Question 4

What does 'real-time prior authorization' mean in the context of electronic PA systems?

Accepted Answer

Immediate automated approval or denial decisions generated at the point of care

Answer

Real-time prior authorization refers to immediate, automated approval or denial decisions generated at the point of prescribing or ordering care, eliminating the delays associated with manual review.

Question 5

Under the 21st Century Cures Act, CMS was directed to implement electronic prior authorization for which Medicare program?

Accepted Answer

Medicare Part D (prescription drug plans)

Answer

The 21st Century Cures Act directed CMS to implement electronic prior authorization for Medicare Part D prescription drug plans to improve efficiency and reduce administrative burden for pharmacy PA.

(PACS) Prior Authorization Certified Specialist Practice Test

(PACS) Prior Authorization Certified Specialist Practice Test

PACS Technology & Information Systems in Prior Authorization 1