prior-auth-review-skill
Automate payer review of prior authorization (PA) requests. This skill should be used when users say "Review this PA request", "Process prior authorization for [procedure]", "Assess medical necessity", "Generate PA decision", or when processing clinical documentation for coverage policy validation and authorization decisions.
npx skills add FreedomIntelligence/OpenClaw-Medical-Skills --skill prior-auth-review-skill --agent claude-code
Same command for any agent — swap --agent for codex, cursor, copilot.
Weekly change comes from our own snapshots, not the repository page — it measures attention, not adoption.
# 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
- Overview
- Architecture
- Waypoint Files
- Prerequisites
- Required MCP Servers
- MCP Invocation Notifications
- File Structure
- Decision Policy
- How to Use
- Process PA Request
- Execution Flow
- Startup: Check MCP Configuration
- Startup: Request Input Files
- Startup: Check for Existing Request
What does the prior-auth-review-skill skill do?
Automate payer review of prior authorization (PA) requests. This skill should be used when users say "Review this PA request", "Process prior authorization for [procedure]", "Assess medical necessity", "Generate PA decision", or when processing clinical documentation for coverage policy validation and authorization decisions.
How do I install it?
Run `npx skills add FreedomIntelligence/OpenClaw-Medical-Skills --skill prior-auth-review-skill --agent claude-code` — it drops the skill into your project so the agent can pick it up. Swap the --agent value for codex, cursor or copilot if you use one of those.
Where does this skill come from?
From FreedomIntelligence/OpenClaw-Medical-Skills, a repository with 2,909 stars. We read it straight from the repository tree rather than a submitted listing, so what you see here is what is actually published.
Is a popular skill a good skill?
Not necessarily. Stars measure attention, not adoption — a repository can trend for a week and be abandoned. That is why we show the weekly change from our own snapshots next to the total, instead of a single flattering number.