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prior-auth-coworker
Maintainer FreedomIntelligence · Last updated April 1, 2026
Prior authorization workflow assistant for insurance approval processes.
Original source
FreedomIntelligence/OpenClaw-Medical-Skills
https://github.com/FreedomIntelligence/OpenClaw-Medical-Skills/tree/main/skills/prior-auth-coworker
- Maintainer
- FreedomIntelligence
- License
- MIT
- Last updated
- April 1, 2026
Skill Snapshot
Key Details From SKILL.md
Key Notes
- 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 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.
- 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.
Source Doc
Excerpt From SKILL.md
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:
Use cases
- 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.
Not for
- Do not rely on this catalog entry alone for installation or maintenance details.
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