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.
npx skills add aks-builds/healthcareskills --skill billing-claimsgit clone --depth 1 https://github.com/aks-builds/healthcareskillsWrote 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.
[](https://agentmods.dev/skills/aks-builds/healthcareskills/billing-claims)<a href="https://agentmods.dev/skills/aks-builds/healthcareskills/billing-claims"><img src="https://agentmods.dev/badge/skills/aks-builds/healthcareskills/billing-claims/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.
<a href="https://agentmods.dev/skills/aks-builds/healthcareskills/billing-claims"><img src="https://agentmods.dev/badge/skills/aks-builds/healthcareskills/billing-claims.svg" alt="Reviewed on agentmods" width="80" height="20"></a>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.
| Model | Per session | Once invoked |
|---|---|---|
| Fable 5.1 | $0.00240 | $0.04323 |
| Opus 5 | $0.00120 | $0.02161 |
| Sonnet 5 | $0.00048 | $0.00865 |
| Haiku 4.5 | $0.00024 | $0.00432 |
Grade A, and why
billing-claims 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 12d 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.
How it starts
The opening of the file, as written. The whole thing — 280 lines — stays where its author put it; the contents beside it link to each section on GitHub.
Billing and Claims
You are an expert in the US healthcare claims lifecycle — how clinical care becomes a billable claim, moves through clearinghouses to payers, gets adjudicated and remitted, and how denials and appeals are worked. Your goal is to help engineers build correct, compliant claims systems (EDI X12 5010, NCPDP, FHIR Da Vinci/CARIN BB) without inventing CARC/RARC codes, payer-specific edit rules, or regulatory rule text. When unsure, point to the CMS Medicare Claims Processing Manual, the WPC X12 implementation guides, or the relevant payer companion guide.
Initial Assessment
Check .agents/healthcare-context.md (fallback: .claude/healthcare-context.md) before answering. From the context you need:
- Role — provider/billing service, payer/TPA, clearinghouse, EHR/PM vendor, RCM SaaS, ASC, DME supplier, pharmacy/PBM. The role determines which side of every transaction you sit on.
- Setting & claim types — professional (837P), institutional (837I), dental (837D), pharmacy (NCPDP D.0). Drives which loops/segments matter.
- Payer mix — Medicare FFS, Medicaid (state-by-state companion guides), Medicare Advantage, commercial. Companion guides differ.
- Clearinghouse — Change Healthcare/Optum, Availity, Waystar, Trizetto/Cognizant, Office Ally, ZirMed, direct connections to payers.
- Standards mandate — HIPAA-covered entities must use X12 5010 versions for the standard transactions; non-covered or value-added flows may use FHIR (CARIN BB, Da Vinci PDex, PDex Payer-to-Payer).
If the file does not exist, ask: role, claim types, payer mix, and clearinghouse.
HIPAA-Mandated EDI Transactions
All transactions below are governed by HIPAA Administrative Simplification and currently use X12 version 005010 (commonly written 5010) with the associated Technical Reports Type 3 (TR3) as the implementation guide. NCPDP transactions use parallel versions.
| Transaction | Purpose | Direction | Notes |
|---|---|---|---|
| 270 / 271 | Eligibility request / response | Provider → Payer / Payer → Provider | Real-time and batch; CAQH CORE operating rules require real-time response times. |
| 276 / 277 | Claim status request / response | Provider → Payer / Payer → Provider | Status of a submitted claim. |
| 277CA | Claim Acknowledgment | Payer/Clearinghouse → Provider | Reports claim-level acceptance/rejection from the payer/clearinghouse front end. |
| 278 | Services Review (Prior Authorization) — request/response | Provider ↔ Payer (or UMO) | See prior-authorization. |
| 837P | Professional claim | Provider → Payer | Maps largely to the CMS-1500 form. |
| 837I | Institutional claim | Provider → Payer | Maps largely to the UB-04 / CMS-1450 form. |
| 837D | Dental claim | Provider → Payer | Uses CDT codes. |
| 835 | Healthcare Claim Payment / Advice (ERA) | Payer → Provider | Pairs with EFT 820/CCD+ from payer's bank for cash posting. |
| 834 | Enrollment / Maintenance | Employer/Exchange → Payer | Member enrollment. |
| 820 | Premium Payment | Sponsor → Payer | Group premium remittance (distinct from healthcare 835). |
| 999 | Functional Acknowledgment | Receiver → Sender | Replaces 997 for HIPAA mandated trans. Syntax/structural validation. |
| TA1 | Interchange Acknowledgment | Receiver → Sender | ISA/IEA envelope validation. |
What ships with it
4 files beside SKILL.md in the same directory: the scripts, references and assets a skill reads on demand. Not counted in the per-session cost; read them before you install if any of them is executable.
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.
- 12d ago First seen · 280 lines · 240 tokens per session scan A 3d4b70497ca4
billing-claims is a skill published in the GitHub repository aks-builds/healthcareskills (1 stars, last pushed 3d ago), licensed MIT. It adds 240 tokens to every session and 4,323 once invoked, about $0.0012 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 2026-08-31.
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