Summary
This automates prior authorization reviews for health insurance payers, cutting review time from 30-60 minutes down to under 5 minutes. It validates provider credentials, checks diagnosis and procedure codes, searches CMS coverage policies, extracts clinical info from medical documents, and generates approve/deny/pend decisions with supporting rationale. Needs three MCP connectors: CMS Coverage for policy lookup, ICD-10 for diagnosis validation, and NPI for provider verification. The decision logic follows a rubric you can customize (strict mode auto-denies invalid codes, lenient mode pends when evidence is thin). Comes with sample files for a lung biopsy case if you want to test it out. Built for Medicare Advantage, commercial insurers, and Medicaid MCOs.
Install to Claude Code
npx -y skills add anthropics/healthcare --skill prior-auth-review-skill --agent claude-codeInstalls into .claude/skills of the current project.
Keep your Mac awake while Claude Code and 40+ AI agents run. Sleeps when they're idle.
One time payment $9 →
Integrate web data into your AI product. One API to scrape website & brand data.
Get API Key Now →
Agent, run crypto. Access onchain data & trade routes via 1inch.
Install now →
On Capafy, your Skill runs online 24/7 as an agent product, and you get paid every time someone uses it.
Start earning →
Files
SKILL.md
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Featured
Keep your Mac awake while Claude Code and 40+ AI agents run. Sleeps when they're idle.
One time payment $9 →Integrate web data into your AI product. One API to scrape website & brand data.
Get API Key Now →Agent, run crypto. Access onchain data & trade routes via 1inch.
Install now →On Capafy, your Skill runs online 24/7 as an agent product, and you get paid every time someone uses it.
Start earning →
