Individual skill
northstar-payer-review
Process Northstar Health Plan payer-operations review tasks (prior auth, appeals, payment integrity, P2P, margin queues) against the shared Northstar environment API, producing structured JSON determinations with full basis audit trails.
experiments/claude_code_deepseek_v4_pro_max/reports/skills/task_group_014/self/self_attempt_03/SKILL.md
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- Last checked
- Nov 6, 2026
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- Oct 29, 2026
- License
- Apache-2.0
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- operations Derived category
- security Derived category
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# Northstar Payer Operations Review
## Purpose
This skill handles structured review tasks across the Northstar Health Plan payer-operations domain. It covers five review types: utilization management (UM) determinations, pharmacy coverage appeals, payment integrity claim repricing, peer-to-peer (P2P) summaries, and therapy margin queue analysis. The skill produces a single JSON object conforming to the supplied answer template, including a full business basis audit trail.
## When to Use
Invoke this skill when a task requires:
- Reviewing a Northstar case, appeal, claim, P2P event, or margin queue against the shared payer-operations environment
- Producing a structured determination, intake disposition, correction packet, P2P summary, or margin queue report
- The task supplies `task_context.json` (target IDs, requester role, dates, domain) and `answer_template.json` (required output shape)
## Operating Rules