prior-auth-readiness-checker

What problem does it solve?

This Skill streamlines the prior authorization (PA) process by meticulously validating requests against payer requirements, significantly reducing denials and accelerating patient care.

Core Features & Use Cases

• Completeness Verification: Checks administrative and clinical documentation against payer-specific rules.
• Medical Necessity Assessment: Evaluates if clinical evidence strongly supports the need for the service.
• Use Case: Before submitting a PA for a high-cost medication, use this skill to confirm all necessary clinical notes, lab results, and prior treatment histories are included and meet payer criteria, preventing a denial due to missing information.

Quick Start

Use the prior auth readiness checker skill to validate a prior authorization request for CPT code 72148 with Aetna insurance.