Individual skill
prior-authorization-letter
Write a persuasive prior-authorization / medical-necessity letter to an insurer. Use when asked to write a prior authorization letter, a letter of medical necessity, or to appeal a denied treatment/medication/procedure. Produces a structured letter — patient and request, clinical justification tied to guidelines, treatments tried, and the specific approval asked for — ready for clinician review and signature.
plugins/pm-health/skills/prior-authorization-letter/SKILL.md
Source commit f7c90bc09ee05dc25cf257bdb1826f2c2552c2cb
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- Observed behavior
- Network or broad shell
- Last checked
- Nov 9, 2026
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- Repository last updated
- Nov 10, 2026
- License
- MIT
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SKILL.mdcore · 4,659 bytes
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# Prior Authorization Letter Skill
A prior-auth or medical-necessity letter succeeds when it connects *this patient's* clinical facts to the
insurer's coverage criteria — clearly, with evidence, and with the exact request spelled out. This skill
structures that argument so the reviewer can approve it quickly, and so an appeal addresses the stated denial
reason head-on.
> **Clinical-safety note:** this is a documentation aid, **not medical advice**. The clinical justification must
> reflect the treating clinician's judgement and the patient's actual record; the clinician must review, verify,
> and sign before submission. Do not invent diagnoses, codes, history, or evidence.
## Working from a brief
Given the treatment and a diagnosis, **produce the full letter anyway** — structure the argument and insert the