Prior Authorization Certified Specialist (PACS) Program Practice Exam

When an Out-of-Network waiver is denied, the next step is to move to the next consideration for the patient. This approach reflects the necessity of identifying alternative pathways to ensure that the patient receives the required care without unnecessary delays.

Following a denial, it is essential to assess other options that may be available for authorization or coverage. This could involve reviewing in-network alternatives, examining other possible treatment channels, or considering other financial avenues that may assist the patient in acquiring necessary services. By focusing on the next steps, the care management process remains proactive, ensuring that patient needs are addressed efficiently.

While documenting the decision, informing the physician, and contacting the patient accounting system are all important tasks in the overall process, they may not be the immediate next step following a denial of the waiver. Instead, pursuing alternative solutions directly impacts the patient’s care and timely access to necessary services.