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No Doesn't Necessarily Mean No: Strategies for Successful Prior Authorization Appeals for Patients with IBD

Premiere Date: Monday, April 30, 2018

This activity offers CE credit for:

  1. Physicians (CME)
  2. Pharmacists (ACPE)
  3. Other

All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Credit™

Credit Expiration Date:
Thursday, April 30, 2020
Note: Credit Is No Longer Available


Francis A. Farraye, MD, MScFrancis A. Farraye, MD, MSc 
Clinical Director, Section of Gastroenterology
Director, Inflammatory Bowel Disease Center
Boston Medical Center
Professor of Medicine
Boston University School of Medicine
Boston, MA

Michele A. Rubin, APN, CNS, CGRN Michele A. Rubin, APN, CNS, CGRN  
Associate Director, Inflammatory Bowel Disease Center
Director, Advanced Practice Nursing
University of Chicago Medicine
Chicago, IL

Toni M. Zahorian, PharmD, BCACPToni M. Zahorian, PharmD, BCACP 
Clinical Pharmacy Specialist – Ambulatory Care
Center for Digestive Disorders
Boston Medical Center
Boston, MA

Statement of Need

Payers block treatments for more than one-third of patients for their chronic disease. Practices without a sound appeals process can further increase treatment delays for individuals with moderate to severe IBD that need biologic therapy; therefore, it is important to develop an organized appeals process for prior authorizations that are inappropriately declined. A successful appeal is an exercise in organization. Often, denials are a result of clerical error, but other times, a broader appeal is needed to persuade the payer that the physician's recommendations are warranted. As with the PA process, the appeals process varies by payer, adding to the complexity and the need for a sound process and effective appeal templates.

In the third module of this CME Outfitters 3-part series on prior authorization strategies, expert faculty will focus on creating a structured appeals process for when their prior authorization request is declined. Have questions for our faculty? Use the comment box below the presentation. The faculty will be checking in to respond to learners!

We encourage learners to complete all 3 CME Snacks in this series to receive a Certificate of Excellence in Prior Authorization.

Learning Objectives

At the end of this CE activity, participants should be able to:

  • Develop a process for an organized and clinically supported appeal for PAs that are inappropriately declined.

The following learning objectives pertain only to those requesting CNE or CPE credit:

  • Describe a process for an organized and clinically supported appeal for PAs that are inappropriately declined.

Financial Support

Supported by an educational grant from Takeda Pharmaceuticals USA, Inc.

Target Audience

Gastroenterologists, physicians, nurses, nurse practitioners, physician assistants, medical assistants, and other healthcare professionals responsible for the prior authorization process.

Credit Information

CME Credit (Physicians):
CME Outfitters, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CME Outfitters designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP Credit (Nurse Practitioners):
This activity is approved for 0.25 contact hour(s) of continuing education by the American Association of Nurse Practitioners. Activity ID 18033120. This activity was planned in accordance with AANP CE Standards and Policies.

AAPA Credit (Physician Assistants):
This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid for one year from 04/30/2018. PAs should only claim credit commensurate with the extent of their participation.

CNE Credit (Nurses):
Provider approved by the California Board of Registered Nursing, Provider Number CEP 15510, for .25 contact hours

Note to Nurse Practitioners and Clinical Nurse Specialists: the content of this activity pertains to pharmacology. Earn up to 1.5 contact hours of pharmacotherapeutic contact hours.

Note to Nurse Practitioners: Nurse practitioners can apply for AMA PRA Category 1 CreditTM through the American Academy of Nurse Practitioners (AANP). AANP will accept AMA PRA Category 1 CreditTM from organizations accredited by the Accreditation Council for Continuing Medical Education. Nurse practitioners can also apply for credit through their state boards.

CPE Credit (Pharmacists):
ACPE CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 0.5 contact hours (0.05 CEUs) Universal Activity Number:
Enduring: 0376-0000-18-007-H01-P

Type: Knowledge-based

Post-tests, credit request forms, and activity evaluation must be completed online. (requires free account activation), and participants can print their certificate or statement of credit immediately (75% pass rate required). this website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, sue of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentation.

Dr. Farraye reports that he is a consultant for Braintree Laboratories Inc.; Celgene Corporation; Ferring Pharmaceuticals; Janssen Pharmaceuticals, Inc.; Merck & Co., Inc; Pfizer Inc.; Protagonist Therapeutics Inc. (DSMB); Takeda Pharmaceuticals U.S.A., Inc. He is a stock shareholder (directly purchased) of Innovation Pharmaceuticals Inc.

Dr. Rubin reports that she is on the advisory board for Pfizer Inc as spokesperson for results of patient and GI survey only.

Dr. Zahorian has no disclosures to report.

Tony Graham, MD (peer reviewer) has no disclosures to report.

Michelle H. Lavigne, PA-C (peer reviewer) has no disclosures to report.

Mae Ochoa, RPh, (peer reviewer) has no disclosures to report.

Jan Perez (planning committee) has no disclosures to report.

Sharon Tordoff (planning committee) has no disclosures to report.

Disclosures were obtained from the CME Outfitters, LLC staff. No disclosures to report.

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).


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