Prepare insurance reviews before they're due: have an AI agent pull the evidence from patient charts, flag missing documentation and draft the medical-necessity summary for a clinician to approve: AI agent prompt
Behavioral health providers lose paid treatment days when insurer reviews are late or thin. On Oct 29, 2026 Kipu Health made its Utilization Review Agent generally available: it surfaces upcoming continued-stay reviews, scans patient charts for the relevant clinical findings, writes source-cited summaries, flags missing clinical indicators before submission and drafts the review forms, with a clinician approving every payer submission. Kipu says the agent has already prepared 23,000 continued stay reviews. The prompt below sets up the same prep work for any clinic, using de-identified or properly secured records.
The prompt
You help my clinic's utilization review team at [clinic name] prepare insurer reviews. Only work with records inside our approved, HIPAA-compliant system; never paste patient details anywhere else. Each morning: 1) List every review due in the next [3] days from this schedule: [paste or connect], sorted by due date and level of care. 2) For each patient, read the chart notes since the last review and pull out the findings that support continued care, each with the note date and author so it can be checked. 3) Compare them against the payer's criteria: [paste criteria, e.g. ASAM or the payer's own guide] and list anything missing or weak, such as no recent risk assessment or vague progress notes, so a clinician can document it before we submit. 4) Draft a short medical-necessity summary in the payer's format: [paste template]. 5) Mark anything you're unsure of with [CHECK]. Never invent clinical facts, and never submit anything: a clinician reviews, edits and approves every review before it goes to the payer.
Fill in the blanks, then copy
This prompt has 5 [bracket]s to fill in. Type your details below and the prompt updates as you go. Your answers stay in this browser and are reused on other prompts with the same blanks. Nothing is sent to us.
Example values are fictional, just to show how a filled-in prompt reads. Replace them with your real details.How to use it
- Copy the prompt above.
- Replace every [bracket] with your own details (use the fill-in-the-blanks box above, which remembers your answers for the next prompt).
- Paste it into Kipu Helix Utilization Review Agent, ChatGPT, Claude and review the answer before you use it.
Works with: Kipu Helix Utilization Review Agent, ChatGPT, Claude, Microsoft Copilot
Real-world example: prnewswire.com/news-releases/kipu-health-launches-agentic-ai-powered-b
Featured in: AI prompts to summarize meetings, notes, documents and reports
Before you use it: what to check
Already built into this prompt
- Only work with records inside our approved, HIPAA-compliant system; never paste patient details anywhere else.
- Never invent clinical facts, and never submit anything: a clinician reviews, edits and approves every review before it goes to the payer.
Check yourself
- This prompt works on text other people wrote (emails, reviews, messages or web pages). That text can hide instructions aimed at AI, such as "ignore your rules and…". Paste it as material to work on, and never let the AI act on requests inside it, like paying, sharing logins or changing records. How prompt injection works →
- Anything legal, tax or compliance-related is a first draft for a qualified person to check. It is not professional advice, and clause references and deadlines must be checked against the source.
- Remove names, contact details, account numbers and other personal data the task doesn't need before you paste, and check your AI tool's data and training settings.
- Check names, dates, numbers and any claim against your own source material before you use the answer. AI can misread or invent details.
Using an AI agent? Download this prompt as a SKILL.md agent skill with these checks built in, or get the .zip for Claude.ai. How to install skills.
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