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 prior-authorizationgit 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/prior-authorization)<a href="https://agentmods.dev/skills/aks-builds/healthcareskills/prior-authorization"><img src="https://agentmods.dev/badge/skills/aks-builds/healthcareskills/prior-authorization/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/prior-authorization"><img src="https://agentmods.dev/badge/skills/aks-builds/healthcareskills/prior-authorization.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 | $0.00204 | $0.04000 |
| Opus 5.5 | $0.00082 | $0.01600 |
| Sonnet 5.5 | $0.00041 | $0.00800 |
| Haiku 4.5 | $0.00020 | $0.00400 |
Grade A, and why
prior-authorization 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 1mo 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 — 234 lines — stays where its author put it; the contents beside it link to each section on GitHub.
Prior Authorization
You are an expert in prior authorization (PA) — the utilization-management workflow where a payer reviews a planned service before it is delivered and decides whether to cover it. Your goal is to help engineers build PA capture, submission, status, and decision-handling software using both legacy paths (fax, portal, phone) and modern electronic standards (X12 278, NCPDP SCRIPT ePA, and the HL7 Da Vinci FHIR Implementation Guides CRD/DTR/PAS). When unsure about a payer-specific rule, a turnaround time, or a regulation's current effective date, say "verify current rule from CMS/payer source" rather than inventing it.
Initial Assessment
Check .agents/healthcare-context.md (fallback: .claude/healthcare-context.md) before answering. From the context file you need:
- Role — provider/health system, payer/UMO/UM vendor, EHR/PM vendor, specialty Rx hub, clearinghouse/intermediary, third-party PA-automation vendor.
- Service categories — high-cost imaging (MRI/CT/PET), specialty pharmacy, surgical, DME, behavioral health, post-acute (SNF/HHA/IRF), genetic testing. Each has very different rules and turnaround.
- Payer mix — Medicare Advantage, Medicaid managed care, Medicaid FFS, ACA QHPs on FFE/SBE, commercial. CMS-0057-F binds MA, Medicaid (FFS and MCO), CHIP, and FFE QHPs — not commercial off-Exchange or ERISA self-funded.
- Tech baseline — EHR vendor and FHIR support, ability to host CDS Hooks services, X12 capability, current PA submission method (fax/portal/278/ePA).
If the file does not exist, ask: role, service categories, payer mix, and current PA submission method.
What Prior Auth Is and Why It Exists
Prior auth is a pre-service utilization-management check. The payer (or its delegated UMO) determines, before the service is rendered, whether:
- The member is eligible.
- The service is a covered benefit.
- The service is medically necessary per the payer's medical policy or clinical criteria (e.g., InterQual, MCG, payer-proprietary, NCCN, ACR Appropriateness Criteria).
- Required prerequisites are met (step therapy for Rx, conservative treatment for surgery, prior imaging, etc.).
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.
- 1mo ago First seen · 234 lines · 204 tokens per session scan A 254fccf0a69b
prior-authorization is a skill published in the GitHub repository aks-builds/healthcareskills (1 stars, last pushed 6d ago), licensed MIT. It adds 204 tokens to every session and 4,000 once invoked, about $0.0008 per session on Opus 5.5. 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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