version: "1.0.2" name: prior-auth-packet-builder description: Build a concise prior authorization packet from local case files and payer policy docs.

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.

1. Read only the most relevant policy files.
2. 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.

1. Create output/human_review_checklist.md with:

• what a human reviewer should verify
• what to tell the patient
• what queue should own the case

1. 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.