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prior-auth-review-skill
维护者 FreedomIntelligence · 最近更新 2026年4月1日
This skill automates the payer review process for prior authori.
原始来源
FreedomIntelligence/OpenClaw-Medical-Skills
https://github.com/FreedomIntelligence/OpenClaw-Medical-Skills/tree/main/skills/prior-auth-review-skill
- 维护者
- FreedomIntelligence
- 许可
- MIT
- 最近更新
- 2026年4月1日
技能摘要
来自 SKILL.md 的关键信息
核心说明
- This skill automates payer review process ，用于 prior authorization (PA) requests. It processes clinical documentation，validates medical necessity against coverage policies，、 generates authorization decisions ，支持 supporting rationale。
- Target Users：Health insurance payer organizations (Medicare Advantage，Commercial，Medicaid MCOs)。
- Value Proposition：Reduce PA review time ，面向 30-60 minutes to under 5 minutes. Enable auto-approval ，用于 40-60% of clear-cut cases。
- This skill uses simplified 2-subskill workflow：。
原始文档
SKILL.md 摘录
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.
适用场景
- Use prior-auth-review-skill ，用于 clinical，translational，或 medical research tasks。
- Apply prior-auth-review-skill when healthcare-specific guidance is required。
不适用场景
- Do not rely on this catalog entry alone ，用于 installation 或 maintenance details。
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