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. Use rg against policies/ to find payer, prior auth, referral, imaging, and PPO guidance.
3. Read only the most relevant policy files.
4. Create output/policy_findings.md with:
   • case summary
   • matched policy files
   • prior auth determination
   • referral determination
   • missing information
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

Rules

• Use targeted rg searches over broad file reads.
• Only cite policy files you actually inspected.
• Keep outputs concise and operational.
• If referral status is pending and prior auth is unclear, recommend human review.