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 to Use This Skill
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.
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:
python3 Skills/Clinical/Prior_Authorization/anthropic_coworker.py --code "MRI-L-SPINE" --note "Patient has back pain > 2 months. Failed PT."
Supported Policies
MRI-L-SPINE (Lumbar Spine MRI)
1---2name: prior-auth-coworker3description: Prior Auth Review4---56<!--7# COPYRIGHT NOTICE8# This file is part of the "Universal Biomedical Skills" project.9# Copyright (c) 2026 MD BABU MIA, PhD <md.babu.mia@mssm.edu>10# All Rights Reserved.11#12# This code is proprietary and confidential.13# Unauthorized copying of this file, via any medium is strictly prohibited.14#15# Provenance: Authenticated by MD BABU MIA1617-->18192021# Prior Authorization Coworker2223This 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.2425## When to Use This Skill2627* When a user asks to "review a prior auth request".28* When checking if a patient qualifies for a specific procedure (e.g., MRI).29* When you need to generate a structured approval/denial letter justification.3031## Core Capabilities32331. **Policy Matching**: Checks against specific criteria (e.g., "Pain > 6 weeks").342. **Trace Generation**: Produces an "Anthropic-style" `<thinking>` trace for auditability.353. **Structured Output**: Returns a JSON object with decision, reasoning, and timestamps.3637## Workflow38391. **Extract Data**: Parse the clinical note and procedure code from the user's input.402. **Execute Review**: Run the coworker script.413. **Present Decision**: Output the JSON decision and the reasoning trace.4243## Example Usage4445**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."4647**Agent Action**:48```bash49python3 Skills/Clinical/Prior_Authorization/anthropic_coworker.py --code "MRI-L-SPINE" --note "Patient has back pain > 2 months. Failed PT."50```5152## Supported Policies5354* `MRI-L-SPINE` (Lumbar Spine MRI)555657<!-- AUTHOR_SIGNATURE: 9a7f3c2e-MD-BABU-MIA-2026-MSSM-SECURE -->
Run npx skillmds@latest add bg-szy/prior-auth-coworker in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.
Prior Auth Review It is listed under Coding & Dev Tools on SkillMD.
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bg-szy (@bg-szy) published this skill. Their other Agent Skills are listed on their SkillMD profile.
bg-szy