prior-auth-review-skill
OfficialAutomate PA reviews with AI-guided decisions.
System Documentation
Automate payer PA review and generate structured authorization decisions with policy-aware reasoning. This skill is designed for payer organizations to process PA requests, validate clinical data against coverage policies, and produce draft decisions with supporting documentation.
What problem does it solve?
Automates the payer review process for prior authorization requests, reducing manual effort and improving consistency through AI-assisted data extraction, validation, and decision support.
Core Features & Use Cases
- Intake & Assessment: collects PA request details, validates provider credentials and codes, and extracts clinical data.
- Policy-driven decision: evaluates evidence against CMS Coverage policies and generates APPROVE/PEND/DENY recommendations with rationale.
- Decision & Notification: produces final decision content, provider notifications, and audit trails.
Quick Start
Invoke the prior-auth-review-skill and provide a sample PA input to observe the end-to-end workflow.
Dependency Matrix
Required Modules
None requiredComponents
💻 Claude Code Installation
Recommended: Let Claude install automatically. Simply copy and paste the text below to Claude Code.
Please help me install this Skill: Name: prior-auth-review-skill Download link: https://github.com/anthropics/healthcare/archive/main.zip#prior-auth-review-skill Please download this .zip file, extract it, and install it in the .claude/skills/ directory.
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