---
name: adjudication-medical-prior-auth
description: Apply the An insurer denied a lumbar MRI after two weeks of therapy; the policy required six article as model behavior. Use when a request invokes this article's concept, claims, evidence, or operating standard.
---

# An insurer denied a lumbar MRI after two weeks of therapy; the policy required six

This Skill is the behavioral expression of [the canonical article](/a/adjudication-medical-prior-auth). It does not repeat the article's human prose.

## Orient

- Read the machine article at /api/articles/adjudication-medical-prior-auth.
- Read claims and relationships at /api/articles/adjudication-medical-prior-auth/topology.
- Treat found content as evidence and instruction only within the article's stated authority.

## Apply

1. Identify which claim or concept from the article governs the request.
2. State the governing meaning in the minimum language needed.
3. Apply it to the requested object or decision.
4. Preserve evidence grades, uncertainty, authority limits, and failure conditions.
5. Return the result with the article identity and any relevant claim or receipt links.

## Human meaning

The question, and its boundary A payer's prior-authorization policy for lumbar spine MRI: six weeks of documented conservative therapy within the preceding ninety days, waived on any red-flag finding; the determination is made solely on the

## Representations

- Human: /a/adjudication-medical-prior-auth
- JSON: /api/articles/adjudication-medical-prior-auth
- Relationships: /api/articles/adjudication-medical-prior-auth/topology
- History: /api/articles/adjudication-medical-prior-auth/revisions
