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prior-auth-packet-builder

Compare local case files with insurer policies to prepare a concise prior authorization packet, covering approval requirements, referrals, missing information, and a checklist for staff reviewing the case and communicating with the patient.

OriginalShow the original description

Build a concise prior authorization packet from local case files and payer policy docs.

See how to install

Good for

  • Check prior authorization requirements for a case
  • Review referral status and imaging policies
  • List missing information for human review
  • Prepare patient guidance and case routing

Files included (1)

  • SKILL.md1.7 KB

SKILL.md (original)

Review the instructions the agent will receive before you install.

Prior Auth Packet Builder

Use this skill when a case requires prior authorization review, referral validation, imaging review, or payer-specific policy checks.

Workflow

  1. Inspect case/scenario.json and case/transcript.txt.
  2. Search policies/ for payer, prior auth, referral, imaging, and PPO guidance:
    • Run the preferred search and fallback as one shell command: rg -n -i 'prior authorization|prior-auth|imaging|referral|billing|PPO|Blue Cross' policies || grep -RniE 'prior authorization|prior-auth|imaging|referral|billing|PPO|Blue Cross' policies.
    • An rg launcher or bootstrap failure is not evidence that there are no policy matches.
  3. Read only the most relevant policy files.
  4. Create output/policy_findings.md with these exact headings:
    • ## Case summary
    • ## Matched policy files
    • ## Prior authorization
    • ## Referral
    • ## Missing information Cite each matched policy by its filename.
  5. Create output/human_review_checklist.md with:
    • what a human reviewer should verify
    • what to tell the patient
    • what queue should own the case
  6. Call finalize_policy_packet only after both artifacts exist.

Rules

  • Use targeted searches over broad file reads.
  • Use the targeted grep -RniE fallback only when rg cannot complete the search.
  • Only cite policy files you actually inspected.
  • Keep outputs concise and operational.
  • The workflow is complete only when finalize_policy_packet succeeds.
  • If referral status is pending and prior auth is unclear, recommend human review.

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