prior-auth-review-skill

prior-auth-review-skill is a skill for Claude Code, Codex from Agent-Threat-Rule/agent-threat-rules. It costs 63 tokens per session (2,885 once invoked), scanned A, original, MIT.

A workflow for reviewing health-insurance prior authorization requests, which are requests for approval before some care is covered. It checks clinical documents against coverage policies and prepares a decision with reasons.

In plain words
What is it for?
Use it to intake clinical documentation, assess whether requested care meets a policy, and produce an authorization decision and provider notification.
Why use it?
It organizes the review of medical necessity and supporting records so coverage decisions can be made consistently.

Skill for Claude CodeCodex

Written for no agent in particular: nothing here depends on one.

Good fit Use it to intake clinical documentation, assess whether requested care meets a policy, and produce an authorization decision and provider notification.

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Install with agentmods
npx agentmods add skills/agent-threat-rule/agent-threat-rules/prior-auth-review
Install

Getting it into your agent

One page per mod, every tool's command on it. A separate URL per tool would split the same page into five that compete with each other.

Any agent
npx skills add Agent-Threat-Rule/agent-threat-rules --skill prior-auth-review
Clone the repo
git clone --depth 1 https://github.com/Agent-Threat-Rule/agent-threat-rules

Made for: Claude Code, Codex.

Wrote this? Show the measurements

A badge with what this costs and how it scanned, read live from this page, so it follows the numbers instead of freezing them. Markdown for a README, HTML for a documentation site or a project page.

agentmods badge for prior-auth-review-skill

README.md
[![agentmods](https://agentmods.dev/badge/skills/agent-threat-rule/agent-threat-rules/prior-auth-review/github.svg)](https://agentmods.dev/skills/agent-threat-rule/agent-threat-rules/prior-auth-review)
Your own site
<a href="https://agentmods.dev/skills/agent-threat-rule/agent-threat-rules/prior-auth-review"><img src="https://agentmods.dev/badge/skills/agent-threat-rule/agent-threat-rules/prior-auth-review/github.svg" alt="Measured on agentmods" height="20"></a>

Or the 80×15 button, for a site that already has a row of RSS and ATOM ones. Only the verdict fits; the numbers stay here.

agentmods 80×15 button for prior-auth-review-skill

Your own site · 80×15
<a href="https://agentmods.dev/skills/agent-threat-rule/agent-threat-rules/prior-auth-review"><img src="https://agentmods.dev/badge/skills/agent-threat-rule/agent-threat-rules/prior-auth-review.svg" alt="Reviewed on agentmods" width="80" height="20"></a>
Per session 63 Skills are progressive disclosure: only the name and description are preloaded; the body loads when the skill is used.
When invoked 2,885 The whole file, excluding the scripts and references it only reads on demand.
Security scan A 0 findings. A grade says what 26 rules found in the file — not that it is safe.
Origin original No closer match found in the catalogue.
Token cost

What it costs to keep this loaded

Counted locally with the o200k_base tokenizer, which is exact for GPT models; Claude uses its own tokenizer and its counts differ. Treat this as one consistent yardstick across the catalogue rather than a bill. Prices are per million input tokens.

ModelPer sessionOnce invoked
Fable 5.1 $0.00063 $0.02885
Opus 5 $0.00032 $0.01443
Sonnet 5 $0.00013 $0.00577
Haiku 4.5 $0.00006 $0.00288

Measured 6d ago against content hash c4aa803882cd, method: parsed. Prices are Anthropic first-party input rates as of 2026-09-11, from the pricing page.

Security

Grade A, and why

prior-auth-review-skill scanned grade A with 0 findings against 26 rules in 11 categories — prompt injection, anti-refusal, data exfiltration, privilege escalation, supply chain, agent snooping, system-prompt leakage, SSRF and excessive agency — measured 6d ago.

A static scan of the body, not an audit. Every finding is printed with the line that produced it so you can judge whether it matters here. A mod is markdown that instructs an agent; that is exactly why what it instructs is worth reading.

Nothing flagged

None of the 26 patterns this scan looks for appear in this file: no shell pipes, no recursive deletes, no credential paths, no hidden text, no instruction-override or anti-refusal phrasing, no agent-config snooping. That is not a guarantee, it is the absence of the things that are checkable.

Origin

Copies of this mod

1 near-identical copy found in the catalogue:

data/skills-sh/skills/anthropics/prior-auth-review-skill.md · 361 lines

How it starts

The opening of the file, as written. The whole thing — 361 lines — stays where its author put it; the contents beside it link to each section on GitHub.

Prior Authorization Review Skill

Overview

This skill automates the payer review process for prior authorization (PA) requests. It processes clinical documentation, validates medical necessity against coverage policies, and generates authorization decisions with supporting rationale.

Target Users: Health insurance payer organizations (Medicare Advantage, Commercial, Medicaid MCOs)

Value Proposition: Reduce PA review time from 30-60 minutes to under 5 minutes. Enable auto-approval for 40-60% of clear-cut cases.


Architecture

This skill uses a simplified 2-subskill workflow:

Subskill 1: Intake & Assessment
  ↓ (validates data, extracts clinical info, assesses medical necessity)
Subskill 2: Decision & Notification
  ↓ (generates auth decision with provider notification)

ONLY REVIEW THE SUBSKILL FILES WHEN THEY ARE NEEDED, DONT PRE-READ THE WHOLE SKILL ON BOOTUP

Output: Authorization Decision Package

Waypoint Files

waypoints/
├── assessment.json          # Subskill 1 output (consolidated)
└── decision.json           # Subskill 2 output (final decision)

Prerequisites

Required MCP Servers

This skill requires 3 healthcare MCP connectors:

  1. CMS Coverage MCP Connector - Medicare coverage policies (NCDs, LCDs)
  2. ICD-10 MCP Connector - Diagnosis code validation and lookup
  3. NPI MCP Connector - Healthcare provider verification via NPPES

For detailed tool usage, parameters, and CMS web resources, see references/01-intake-assessment.md.

MCP Invocation Notifications

During execution, the skill displays notifications before and after each MCP connector call:

  • Before: "Verifying provider credentials via NPI MCP Connector..."
  • After: "NPI MCP Connector completed successfully - Provider verified: Dr. [Name]"
  • Before: "Validating diagnosis codes via ICD-10 MCP Connector..."
  • After: "ICD-10 MCP Connector completed successfully - [N] codes validated"
  • Before: "Searching coverage policies via CMS Coverage MCP Connector..."
  • After: "CMS Coverage MCP Connector completed successfully - Found policy: [Policy ID]"
  • Before: "Validating procedure codes via CMS Fee Schedule..."
  • After: "CPT/HCPCS codes validated via CMS Fee Schedule - [N] codes checked"

Read the full file on GitHub · 361 lines

Changes

What this file has done since we first saw it

Hashed on every crawl. A supply-chain change to an agent config is a question of when, not whether, so the history is kept rather than the latest state alone.

  1. 6d ago First seen · 361 lines · 63 tokens per session scan A c4aa803882cd

Subscribe to this mod's changes

prior-auth-review-skill is a skill published in the GitHub repository Agent-Threat-Rule/agent-threat-rules (389 stars, last pushed yesterday), licensed MIT. It adds 63 tokens to every session and 2,885 once invoked, about $0.0003 per session on Opus 5. A static security scan graded it A with 0 findings. No closer match exists in the catalogue, so it is treated as the original; first seen 2026-09-05.

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