Prior Auth Letter Drafter

Source: https://github.com/aipoch/medical-research-skills

Prior Authorization Letter Drafter

Generate professional prior authorization request letters for insurance companies with proper clinical justification and formatting.

When to Use

• Use this skill when the task is to Generate professional prior authorization request letters for insurance companies with proper clinical justification and formatting.
• Use this skill for academic writing tasks that require explicit assumptions, bounded scope, and a reproducible output format.
• Use this skill when you need a documented fallback path for missing inputs, execution errors, or partial evidence.

Key Features

See ## Features above for related details.

• Scope-focused workflow aligned to: Generate professional prior authorization request letters for insurance companies with proper clinical justification and formatting.
• Packaged executable path(s): scripts/main.py.
• Reference material available in references/ for task-specific guidance.
• Structured execution path designed to keep outputs consistent and reviewable.

Dependencies

See ## Prerequisites above for related details.

• Python: 3.10+. Repository baseline for current packaged skills.
• dataclasses: unspecified. Declared in requirements.txt.
• main: unspecified. Declared in requirements.txt.

Example Usage

See ## Usage above for related details.

cd "20260318/scientific-skills/Academic Writing/prior-auth-letter-drafter"
python -m py_compile scripts/main.py
python scripts/main.py --help

Example run plan:

1. Confirm the user input, output path, and any required config values.
2. Edit the in-file CONFIG block or documented parameters if the script uses fixed settings.
3. Run python scripts/main.py with the validated inputs.
4. Review the generated output and return the final artifact with any assumptions called out.

Implementation Details

See ## Workflow above for related details.

• Execution model: validate the request, choose the packaged workflow, and produce a bounded deliverable.
• Input controls: confirm the source files, scope limits, output format, and acceptance criteria before running any script.
• Primary implementation surface: scripts/main.py.
• Reference guidance: references/ contains supporting rules, prompts, or checklists.
• Parameters to clarify first: input path, output path, scope filters, thresholds, and any domain-specific constraints.
• Output discipline: keep results reproducible, identify assumptions explicitly, and avoid undocumented side effects.

Quick Check

Use this command to verify that the packaged script entry point can be parsed before deeper execution.

python -m py_compile scripts/main.py

Audit-Ready Commands

Use these concrete commands for validation. They are intentionally self-contained and avoid placeholder paths.

python -m py_compile scripts/main.py
python scripts/main.py --help
python scripts/main.py --input "Audit validation sample with explicit symptoms, history, assessment, and next-step plan."

Workflow

1. Confirm the user objective, required inputs, and non-negotiable constraints before doing detailed work.
2. Validate that the request matches the documented scope and stop early if the task would require unsupported assumptions.
3. Use the packaged script path or the documented reasoning path with only the inputs that are actually available.
4. Return a structured result that separates assumptions, deliverables, risks, and unresolved items.
5. If execution fails or inputs are incomplete, switch to the fallback path and state exactly what blocked full completion.

Features

• Insurance company-standard letter formatting
• Clinical justification with evidence-based reasoning
• ICD-10/CPT code integration
• Multiple authorization types (procedures, medications, DME)
• Customizable templates for different insurance carriers

Usage

python scripts/main.py --input patient_data.json --output letter.docx

Input Parameters

Service Types

• procedure - Surgical or diagnostic procedures
• medication - Specialty/brand-name drugs
• dme - Durable medical equipment
• imaging - Advanced imaging (MRI, CT, PET)

Output

Generates a formatted prior authorization letter including:

• Header with provider and insurance information
• Patient demographics
• Requested service details with codes
• Clinical justification section
• Provider attestation and signature block

Technical Notes

• Difficulty: Medium
• Dependencies: python-docx, jinja2
• Output format: DOCX (editable) or PDF

References

• references/letter_template.docx - Base template
• references/clinical_phrases.md - Common clinical justification phrases
• references/carrier_requirements.json - Insurance-specific formatting rules