Prior auth coworker
Skill FridrichMethod/awesome-skills/skills/prior-auth-coworker
Prior Auth ReviewFrom its SKILL.md
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SKILL.md
2.0 KB, 462 tokens by cl100k_base, as published. Nobody here has run it
Prior Authorization Coworker
This skill acts as an automated utilization management reviewer. It takes unstructured clinical notes and a procedure code, compares them against internal policy criteria (e.g., conservative therapy failure), and renders a decision.
When to Use This Skill
- When a user asks to "review a prior auth request".
- When checking if a patient qualifies for a specific procedure (e.g., MRI).
- When you need to generate a structured approval/denial letter justification.
Core Capabilities
- Policy Matching: Checks against specific criteria (e.g., "Pain > 6 weeks").
- Trace Generation: Produces an "Anthropic-style"
<thinking>trace for auditability. - Structured Output: Returns a JSON object with decision, reasoning, and timestamps.
Workflow
- Extract Data: Parse the clinical note and procedure code from the user's input.
- Execute Review: Run the coworker script.
- Present Decision: Output the JSON decision and the reasoning trace.
Example Usage
User: "Check if this patient qualifies for an MRI of the Lumbar Spine: Patient has had back pain for 2 months, tried PT but it didn't work."
Agent Action:
python3 Skills/Clinical/Prior_Authorization/anthropic_coworker.py --code "MRI-L-SPINE" --note "Patient has back pain > 2 months. Failed PT."
Supported Policies
MRI-L-SPINE(Lumbar Spine MRI)
What ships with it: 5 files
16.2 KB alongside SKILL.md, 3 of them executable
- agent.pyruns3.9 KB
- anthropic_coworker.pyruns7.3 KB
- appeals_agent.pyruns3.8 KB
- policies.json456 B
- skill.yaml784 B