prior-auth-packet-builder

Prior authorization packet compilation extracts case details from scenario.json and transcript.txt, searches payer policy documents for matching criteria, and outputs policy findings with a human review checklist.

Payer-specific prior auth checks extract case details from local files, query the policies directory for matching guidelines, and produce a policy findings report detailing determinations and missing information.

A prior auth review or referral validation is needed when a healthcare case requires payer-specific policy checks, imaging review, or referral validation before treatment approval. This skill identifies the necessary guidance from local policy documents.

Yes, you can automate generating a human review checklist. The skill outputs a human_review_checklist.md file alongside a policy findings report to guide reviewers through prior authorization determinations and missing case information.

To start the prior authorization workflow, provide local case files specifically named case/scenario.json and case/transcript.txt, along with a policies directory containing payer policy documents for targeted searching.

Automating prior authorization packet assembly requires structured local case files and a policies directory. It generates findings and a checklist for human review, meaning a human must still validate the final prior auth determination and handle missing information.