Prior Auth Packet Builder

Prior Auth Packet Builder

Use this skill when a case requires prior authorization review, referral validation, imaging review, or payer-specific policy checks.

Workflow

1. Inspect case/scenario.json and case/transcript.txt.
2. Search policies/ for payer, prior auth, referral, imaging, and PPO guidance:
   • Run the preferred search and fallback as one shell command: rg -n -i 'prior authorization|prior-auth|imaging|referral|billing|PPO|Blue Cross' policies || grep -RniE 'prior authorization|prior-auth|imaging|referral|billing|PPO|Blue Cross' policies.
   • An rg launcher or bootstrap failure is not evidence that there are no policy matches.
3. Read only the most relevant policy files.
4. Create output/policy_findings.md with these exact headings:
   • ## Case summary
   • ## Matched policy files
   • ## Prior authorization
   • ## Referral
   • ## Missing information Cite each matched policy by its filename.
5. Create output/human_review_checklist.md with:
   • what a human reviewer should verify
   • what to tell the patient
   • what queue should own the case
6. Call finalize_policy_packet only after both artifacts exist.

Rules

• Use targeted searches over broad file reads.
• Use the targeted grep -RniE fallback only when rg cannot complete the search.
• Only cite policy files you actually inspected.
• Keep outputs concise and operational.
• The workflow is complete only when finalize_policy_packet succeeds.
• If referral status is pending and prior auth is unclear, recommend human review.