prior-auth-review-skill

prior-auth-review-skill is a skill for Claude Code, Codex from aisa-group/skill-inject. It costs 63 tokens per session (2,887 once invoked), scanned A, a copy of prior-auth-review-skill, MIT.

A workflow for reviewing health-insurance prior authorization requests. Prior authorization is an insurer's review of whether a proposed treatment or procedure meets coverage and medical-necessity rules.

In plain words
What is it for?
Use it to intake clinical information, assess medical necessity, validate coverage requirements, and produce an authorization decision and provider notification.
Why use it?
It organizes clinical-document review and coverage-policy checks into an authorization decision with supporting reasoning.

Skill for Claude CodeCodex

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

Good fit Use it to intake clinical information, assess medical necessity, validate coverage requirements, and produce an authorization decision and provider notification.

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Install with agentmods
npx agentmods add skills/aisa-group/skill-inject/prior-auth-review-skill
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 aisa-group/skill-inject --skill prior-auth-review-skill
Clone the repo
git clone --depth 1 https://github.com/aisa-group/skill-inject

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/aisa-group/skill-inject/prior-auth-review-skill/github.svg)](https://agentmods.dev/skills/aisa-group/skill-inject/prior-auth-review-skill)
Your own site
<a href="https://agentmods.dev/skills/aisa-group/skill-inject/prior-auth-review-skill"><img src="https://agentmods.dev/badge/skills/aisa-group/skill-inject/prior-auth-review-skill/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/aisa-group/skill-inject/prior-auth-review-skill"><img src="https://agentmods.dev/badge/skills/aisa-group/skill-inject/prior-auth-review-skill.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 2,887 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 100% copy Near-identical to another mod 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 $0.02887
Opus 5 $0.00032 $0.01443
Sonnet 5 $0.00013 $0.00577
Haiku 4.5 $0.00006 $0.00289

Measured 11d ago against content hash 39b7bffb149b, method: parsed. Prices are Anthropic first-party input rates as of 2026-09-10, 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 11d 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

This is a copy

100% identical to prior-auth-review-skill — 2 lines differ, which has more behind it and is treated as the original. This page carries a canonical link to it rather than competing with it.

data/skills/healthcare/prior-auth-review-skill/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. 11d ago First seen · 361 lines · 63 tokens per session scan A 39b7bffb149b

Subscribe to this mod's changes

prior-auth-review-skill is a skill published in the GitHub repository aisa-group/skill-inject (96 stars, last pushed 12d ago), licensed MIT. It adds 63 tokens to every session and 2,887 once invoked, about $0.0003 per session on Opus 5. A static security scan graded it A with 0 findings. It is 100% identical to prior-auth-review-skill, differing in 2 lines, and is treated as a copy.

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