clinical-review

To compile clinical evidence for prior authorization, provide a patient case to retrieve and validate ICD-10 codes, search PubMed literature, and generate a structured clinical narrative with confidence scoring.

ICD-10 code validation checks submitted codes via MCP tools to confirm their description and billable status, including hierarchy checks to flag non-billable header codes for prior authorization.

Yes, PubMed and ClinicalTrials literature searches retrieve supporting clinical evidence to establish medical necessity and validate treatment approaches for prior authorization requests.

Structuring a clinical narrative for payer policy matching involves generating a formatted output with per-field confidence scoring that integrates validated diagnostics, procedures, and literature.

CPT and HCPCS code notation is validated by the orchestrator pre-flight; the clinical evidence skill notes submitted codes and the outcomes provided by upstream steps for the final package.

Per-field confidence scoring provides audit-ready trustworthiness for prior authorization packages by quantifying the reliability of each data point for downstream payer policy matching.