prior-auth-review-skill

Source

• Creator: anthropics
• Repository: anthropics/healthcare
• Skill file: plugins/healthcare/skills/prior-auth/SKILL.md

What it does

Automate payer review of prior authorization (PA) requests. This skill should be used when users say "Review this PA request", "Process prior authorization for [procedure]", "Assess medical necessity", "Generate PA decision", or when processing clinical documentation for coverage policy validation and authorization dec

Skill instructions

Prior Authorization Review Skill Overview This skill automates the payer review process for prior authorization (PA) requests. It processes clinical documentation, validates medical necessity against coverage policies, and generates authorization decisions with supporting rationale. Target Users: Health insurance payer organizations (Medicare Advantage, Commercial, Medicaid MCOs) Value Proposition: Reduce PA review time from 30-60 minutes to under 5 minutes. Enable auto-approval for 40-60% of clear-cut cases. --- Architecture This skill uses a simplified 2-subskill workflow: Subskill 1: Intake & Assessment ↓ (validates data, extracts clinical info, assesses medical necessity) Subskill 2: Decision & Notification ↓ (generates auth decision with provider notification) ONLY REVIEW THE SUBSKILL FILES WHEN THEY ARE NEEDED, DONT PRE-READ THE WHOLE SKILL ON BOOTUP Output: Authorization Decision Package Waypoint Files waypoints/ ├── assessment.json Subskill 1 output (consolidated) └── decision.