Summary
This automates prior authorization reviews for health insurance payers, cutting review time from 30-60 minutes down to under 5 minutes. It validates provider credentials, checks diagnosis and procedure codes, searches CMS coverage policies, extracts clinical info from medical documents, and generates approve/deny/pend decisions with supporting rationale. Needs three MCP connectors: CMS Coverage for policy lookup, ICD-10 for diagnosis validation, and NPI for provider verification. The decision logic follows a rubric you can customize (strict mode auto-denies invalid codes, lenient mode pends when evidence is thin). Comes with sample files for a lung biopsy case if you want to test it out. Built for Medicare Advantage, commercial insurers, and Medicaid MCOs.
Install to Claude Code
npx -y skills add anthropics/healthcare --skill prior-auth-review-skill --agent claude-codeInstalls into .claude/skills of the current project.
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SKILL.md
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Plug Mailtrap into your AI workflow and let it handle the email.
Connect Mailtrap MCP →Agent, run crypto. Access onchain data & trade routes via 1inch.
Install now →Make coding agent sessions - Searchable, Shareable, Vendor-neutral & Scored.
Try For Free →Your agent targets a perfect 10 Code Health score. Deterministic. Every commit.
Try For Free →Integrate web data into your AI product. One API to scrape website & brand data.
Get API Key Now →belt cli automatically finds the best tools and skills for your agent. image, video, music, tts...
one prompt install →
