prior-auth-review-skill — Claude Code skill: prior authorization
Automates payer review of prior authorization requests: reads clinical documents, checks medical necessity against coverage policy and issues a decision.
npx skills add anthropics/healthcare --skill prior-auth-review-skill -a claude-code
npx skills add anthropics/healthcare --skill prior-auth -a claude-codeWhat prior-auth-review-skill does
The skill runs a request through two stages. First it collects the data and assesses medical necessity, then it produces a decision with rationale and a provider notification. Intermediate output lands in waypoints/assessment.json and waypoints/decision.json, so an interrupted request can be resumed where it stopped.
Three MCP connectors are required: CMS Coverage for coverage policies, ICD-10 for diagnosis code validation and NPI for provider verification through NPPES. If any one is missing, the skill halts and names what is not configured. Check that before you start.
Input is PDFs: the request form, clinical notes, imaging reports, lab results. A sample case ships with the skill, and it uses a demo NPI and member ID — that combination skips the NPI lookup for that one provider while the other calls run normally. Decision logic lives in references/rubric.md: strict rules deny, lenient ones pend the request.
What it helps with
- review a prior authorization request from clinical documents
- check medical necessity against a coverage policy
- validate diagnosis and procedure codes before a decision
- verify a provider through NPI and NPPES
- produce a decision with rationale and provider notification
Example prompts for the agent
- Use the prior-auth-review-skill to review this PA request
- Run prior-auth-review-skill and assess medical necessity from the attached clinical notes
- Process prior authorization with prior-auth-review-skill using the sample case in
assets/sample/
How to install prior-auth-review-skill
1Skills CLI (Vercel)
npx skills add anthropics/healthcare --skill prior-auth-review-skill -a claude-codenpx skills add anthropics/healthcare --skill prior-auth -a claude-code2Manually: put the files in place
~/.claude/skills/prior-auth/SKILL.mdCopy the whole skill folder; for one project use .claude/skills/prior-auth/
1Skills CLI (Vercel)
npx skills add anthropics/healthcare --skill prior-auth -a codex2Manually: put the files in place
.agents/skills/prior-auth/SKILL.mdFor all projects use ~/.agents/skills/
1Skills CLI (Vercel)
npx skills add anthropics/healthcare --skill prior-auth -a cursor2Manually: put the files in place
.cursor/skills/prior-auth/SKILL.mdCursor also reads .agents/skills/ and .claude/skills/
1GitHub CLI
gh skill install anthropics/healthcare prior-auth2Manually: put the files in place
.github/skills/prior-auth/SKILL.md1Skills CLI (Vercel)
npx skills add anthropics/healthcare --skill prior-auth -a gemini-cli2Platform CLI
gemini skills install https://github.com/anthropics/healthcare --path plugins/healthcare/skills/prior-authManually: put the files in place
.devin/skills/prior-auth/SKILL.mdThe legacy .windsurf/skills/ path still works
Skills CLI (Vercel)
npx skills add anthropics/healthcare --skill prior-auth -a opencodeClaude.ai
Zip the folder and upload it in Settings → Capabilities → Skills
Step by step, with commands for each platform: How to install skills in Claude Code: five ways
Questions about prior-auth-review-skill
How do I install prior-auth-review-skill in Claude?
Run npx skills add anthropics/healthcare --skill prior-auth-review-skill -a claude-code. The skill file ends up at ~/.claude/skills/prior-auth/SKILL.md.
What does prior-auth-review-skill do?
It walks a request through intake and assessment, then a decision with rationale and provider notification. Output is stored in waypoint files.
What has to be configured before running it?
Three MCP connectors: CMS Coverage, ICD-10 and NPI. Without any of them the skill exits and lists the missing connectors.
