Medical Benefits Training - Provider & Health Plan Version

Pricing: $399 for members and $499 for non-members

Training a team? 
Save with bulk pricing. Contact amcplearn@amcp.org for group rates. 

Program Overview

Unlock new opportunities with medical benefit expertise 

The Medical Benefit Medication Management program gives life sciences teams the insider knowledge to navigate payer conversations, contracting, and coverage decisions with confidence. 8 focused modules, 40 minutes each. 

What You'll Master: 

✔ Medical vs. pharmacy benefits and market trends 
✔ Employer benefit design and health plan coverage processes 
✔ Medical benefit medication contracting and payer rules of engagement 
✔ Medical policies and utilization management techniques 
✔ Pre-certification, prior authorization, approval and denial management 
✔ Buy-and-bill methodology and medication distribution models 
✔ Medical benefit reimbursement, billing, and coding 
✔ Patient support services, HUB services, and provider reimbursement support 
✔ Field team support roles and real-world case studies 

Perfect for: 
Brand and payer marketers • Account executives • Field and HQ-based HEOR leads • Payer medical directors • Life sciences professionals navigating medical benefit landscape 

Training a team? 
Save with bulk pricing. Contact amcplearn@amcp.org for group rates. 

 

Learning Objectives

  1. Describe the foundational components of medical and pharmacy benefits and market trends impacting medical and pharmacy benefits
  2. Identify employer benefit design and coverage processes and discuss health plan versus PBM medical and pharmacy coverage
  3. Describe medical benefit medication contracting and integration and payer rules of engagement
  4. Discuss medical policies and utilization management techniques
  5. Describe pre-certification versus prior authorization and other medical benefit utilization management techniques and approval and denial management
  6. Identify buy and bill methodology, and medication distribution models
  7. Discuss medical benefit reimbursement and claims, including reimbursement billing overview and coding for medical benefit billing
  8. Provide overview of patient support services, HUB services, patient assistance and provider reimbursement support services
Course summary
Available credit: 
  • 7.00 Certificate of Completion
Course opens: 
01/01/2024
Course expires: 
12/31/2027
Cost:
$499.00

Part 1:   Medical and Pharmacy Benefits Overview

  • Medical and pharmacy benefits comparison
  • Foundational components of medical and pharmacy benefits
  • Market trends impacting medical and pharmacy benefits

 

Part 2:   Medical Benefit Overview

  • Employer benefit design and coverage process
  • Health plan versus PBM medical and pharmacy coverage
  • Medical benefit medication contracting and integration

 

Part 3: Medical Benefit Management

  • Payer Rules of Engagement
  • Medical Policies
  • Utilization management techniques

 

Part 4: Medical Benefit Medication Approval

  • Pre-certification versus prior authorization
  • Other medical benefit utilization management techniques
  • Approval and denial management

 

Part 5: Medical Benefit Medication Acquisition

  • Buy and bill methodology
  • Specialty pharmacy overview
  • Distribution models

 

Part 6:   Reimbursement: Billing and Coding

  • Reimbursement billing overview
  • Coding for medical benefit billing
  • Medical benefit reimbursement and claims

 

Part 7:   Patient Services for Medical Benefit Medication

  • Patient support services overview
  • HUB services
  • Patient assistance
  • Provider reimbursement support services

Instructor: 

Fred Goldstein, AMCP Faculty Member

Accountable Health, LLC, Graduate Faculty, John. D. Bower School of Population Health, University of Mississippi Medical Center

Please note that this course is not accredited for continuing pharmacy education credit.

Available Credit

  • 7.00 Certificate of Completion

Price

Cost:
$499.00
Please login or register to take this course.

Required Hardware/software

Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities, you should have a basic comfort level using a computer and navigating websites. View the minimum technical and system requirements for continuing education online activities.