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prior-auth-review-skill
Maintainer FreedomIntelligence · Last updated April 1, 2026
This skill automates the payer review process for prior authori.
Original source
FreedomIntelligence/OpenClaw-Medical-Skills
https://github.com/FreedomIntelligence/OpenClaw-Medical-Skills/tree/main/skills/prior-auth-review-skill
- Maintainer
- FreedomIntelligence
- License
- MIT
- Last updated
- April 1, 2026
Skill Snapshot
Key Details From SKILL.md
Key Notes
- 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.
- This skill uses a simplified 2-subskill workflow:.
Source Doc
Excerpt From SKILL.md
Required MCP Servers
This skill requires 3 healthcare MCP connectors:
- CMS Coverage MCP Connector - Medicare coverage policies (NCDs, LCDs)
- ICD-10 MCP Connector - Diagnosis code validation and lookup
- NPI MCP Connector - Healthcare provider verification via NPPES
For detailed tool usage, parameters, and CMS web resources, see references/01-intake-assessment.md.
MCP Invocation Notifications
During execution, the skill displays notifications before and after each MCP connector call:
- Before: "Verifying provider credentials via NPI MCP Connector..."
- After: "NPI MCP Connector completed successfully - Provider verified: Dr. [Name]"
- Before: "Validating diagnosis codes via ICD-10 MCP Connector..."
- After: "ICD-10 MCP Connector completed successfully - [N] codes validated"
- Before: "Searching coverage policies via CMS Coverage MCP Connector..."
- After: "CMS Coverage MCP Connector completed successfully - Found policy: [Policy ID]"
- Before: "Validating procedure codes via CMS Fee Schedule..."
- After: "CPT/HCPCS codes validated via CMS Fee Schedule - [N] codes checked"
File Structure
See README.md File Organization section for complete directory structure and file descriptions.
Use cases
- Use prior-auth-review-skill for clinical, translational, or medical research tasks.
- Apply prior-auth-review-skill when healthcare-specific guidance is required.
Not for
- Do not rely on this catalog entry alone for installation or maintenance details.
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