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ClaudSkills / General / business-ops

Prior Authorization

Category: General  ·  Sub-category: business-ops  ·  Last updated:
When the user wants to design, build, integrate, or automate prior authorization workflows. Use when the user mentions "prior auth," "prior authorization," "PA," "pre-auth," "preauthorization," "pre-cert," "precertification," "utilization management," "UM," "278," "X12 278," "Da Vinci CRD," "Da Vinci DTR," "Da Vinci PAS," "CDS Hooks," "CRD," "DTR," "PAS," "CoverMyMeds," "Surescripts," "Newcrop," "ePA," "electronic prior authorization," "NCPDP SCRIPT," "CMS-0057," "CMS Interoperability and Prior Authorization Final Rule," "gold carding," "concurrent review," or "step therapy." For claim submission after PA is obtained, see billing-claims. For coding the service being authorized, see medical-coding. For VBC delegation of UM, see value-based-care.
Security AStatic scan found no risk patternsHow grading works ›

From the source SKILL.md

You are an expert in prior authorization (PA) — the utilization-management workflow where a payer reviews a planned service before it is delivered and decides whether to cover it. Your goal is to help engineers build PA capture, submission, status, and decision-handling software using both legacy paths (fax, portal, phone) and modern electronic standards (X12 278, NCPDP SCRIPT ePA, and the HL7 Da Vinci FHIR Implementation Guides CRD/DTR/PAS). When unsure about a payer-specific rule, a turnaround time, or a regulation's current effective date, say "verify current rule from CMS/payer source"…

What this skill does

Prior Authorization is a community-contributed Claude Code skill in the business-ops sub-category. It ships as a SKILL.md file that Claude Code auto-discovers under ~/.claude/skills/prior-authorization/ and loads when your prompt matches the skill's trigger.

When to invoke it: Use when the user mentions "prior auth," "prior authorization," "PA," "pre-auth," "preauthorization," "pre-cert," "precertification," "utilization management," "UM," "278," "X12 278," "Da Vinci CRD," "Da Vinci DTR," "Da Vinci PAS," "CDS Hooks," "CRD," "DTR," "PAS," "CoverMyMeds," "Surescripts," "Newcrop," "ePA," "electronic prior authorization," "NCPDP SCRIPT," "CMS-0057," "CMS Interoperability and Prior Authorization Final Rule," "gold carding," "concurrent review," or "step therapy." For claim submission after PA is obtained, see billing-claims.

Who uses this skill

The Prior Authorization Claude Code skill is built for Claude Code users and developers across all disciplines looking for general-purpose AI assistance. It's part of ClaudSkills (also referred to as Claude Skills or Claude Code Skills) — the open community-curated registry of 146,000+ SKILL.md files for Anthropic's Claude Code agent and the wider Claude ecosystem (Claude API, Claude Agent SDK).

How to install

Free

Manual install (2 steps)

mkdir -p ~/.claude/skills/prior-authorization
curl -L https://claudskills.com/skills/prior-authorization/SKILL.md \
  -o ~/.claude/skills/prior-authorization/SKILL.md

Or just download SKILL.md directly and drop it into ~/.claude/skills/prior-authorization/. Claude Code auto-discovers it on next session.

Skills live at ~/.claude/skills/prior-authorization/SKILL.md on macOS/Linux, or %USERPROFILE%\.claude\skills\prior-authorization\SKILL.md on Windows. See the full install guide for step-by-step instructions.

Telegram

📱 Install from your phone or desktop Telegram

Open @claudskills_bot on Telegram, tap Open Desktop App, and the desktop app installs this skill for you. Or share the bot link with a colleague — they get the same one-tap install. Learn more →

Pro

One-click install via the desktop app

The ClaudSkills desktop app installs any skill directly into ~/.claude/skills/ with one click — no terminal required. Pro starts at $9/mo or $149 lifetime.

Pro

For the full experience including quality scoring and one-click install features for each skill — upgrade to Pro.

See pricing → Download desktop app

Frequently asked questions

How do I install the Prior Authorization Claude Code skill?
Install via the ClaudSkills desktop app (one click) or copy SKILL.md from the source repository to ~/.claude/skills/prior-authorization/SKILL.md and restart Claude Code. Both flows are detailed at claudskills.com/install/.
What does the Prior Authorization skill do?
When the user wants to design, build, integrate, or automate prior authorization workflows. Use when the user mentions "prior auth," "prior authorization," "PA," "pre-auth," "preauthorization," "pre-cert," "precertification," "utilization management," "UM," "278," "X12 278," "Da Vinci CRD," "Da Vinci DTR," "Da Vinci PAS," "CDS Hooks," "CRD," "DTR," "PAS," "CoverMyMeds," "Surescripts," "Newcrop," "ePA," "electronic prior authorization," "NCPDP SCRIPT," "CMS-0057," "CMS Interoperability and Prior Authorization Final Rule," "gold carding," "concurrent review," or "step therapy." For claim submission after PA is obtained, see billing-claims. For coding the service being authorized, see medical-coding. For VBC delegation of UM, see value-based-care.
Is this skill free to install?
Yes. ClaudSkills is an open registry — every skill keeps its source repository's license, and manual install via copy is free. ClaudSkills Pro ($9/mo, $79/yr, or $149 one-time) adds one-click install via the desktop app and a multi-signal Quality Score.
When should I use the Prior Authorization skill?
Use Prior Authorization when your Claude Code task falls under the General category — specifically in the business ops area. Claude Code auto-discovers installed skills and invokes the right one based on the task description, so you can also ask Claude directly (e.g. "use Prior Authorization" or describe the task and let Claude pick). Browse related skills at /category/general/.
What is a Claude Code skill and how does the Prior Authorization skill fit in?
A Claude Code skill is a SKILL.md file that lives under ~/.claude/skills/<name>/ and tells the Claude Code CLI agent how to perform a specific task (instructions, prompts, allowed tools). Skills are auto-discovered at session start. Prior Authorization is one of 67,000+ skills indexed in the open ClaudSkills catalog, classified under the General category. Learn more at /learn/what-is-a-claude-skill/.

Attribution & license

Cite this skill

If you reference this skill in a blog post, paper, or documentation, you can cite it as:

APA
aks-builds. (2026). Prior Authorization [Claude Code skill]. ClaudSkills. https://claudskills.com/skills/prior-authorization/
BibTeX
@misc{prior-authorization-2026,
  author    = {aks-builds},
  title     = {Prior Authorization [Claude Code skill]},
  year      = {2026},
  publisher = {ClaudSkills},
  url       = {https://claudskills.com/skills/prior-authorization/}
}

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Security scan

Grade A · scanned 2026-07-06 — free static scan against the OWASP Agentic Skills Top 10.

No risk patterns were found in any of the ten OWASP-aligned categories. How grading works ›

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