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Create a prior-authorization review packet

Parse a submission, retrieve the matching version of CMS policy, assess each criterion, and return a cited human-review queue without a coverage decision.

Goal

Parse a submission, retrieve the matching version of CMS policy, assess each criterion, and return a cited human-review queue without a coverage decision.

Steps

  1. Parse the sample PDF and validate required fields. [src-openai-create-prior-authorization-review-packet]
  2. Resolve the application-owned policy ID/version and retrieve CMS text for each criterion. [src-openai-create-prior-authorization-review-packet]
  3. Validate evidence citations and review queue, then return review_ready. [src-openai-create-prior-authorization-review-packet]

How to verify

Each criterion must cite the selected policy version, clinical evidence must cite the submission, and the final state must be `review_ready`.

Troubleshooting

Reject unknown policy IDs/versions; if a citation is absent from retrieved chunks, inspect KB identity/results and fail validation.

Permissions

Prerequisites

Permissions

Limitations

Sample CMS policies do not define a real plan’s rules; a payer reviewer must handle every result.

Pinned upstream source

https://github.com/openai/openai-cookbook/blob/5bd6cb40b6b84b69b2032d810610aa85064102df/examples/partners/AWS/policy_to_review_prior_authorization_agents_sdk_agentcore.ipynb

Repository
openai/openai-cookbook
File path
examples/partners/AWS/policy_to_review_prior_authorization_agents_sdk_agentcore.ipynb
Pinned commit
5bd6cb40b6b84b69b2032d810610aa85064102df
Source checked
2026-10-14 · Reviewed against the pinned upstream source

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License: MIT

Main topic

Turn ecommerce campaign materials into a reviewable weekly brief

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