Menu

Individual skill

northstar-payer-ops

0upvotes

Turn Northstar payer-operations records into exact JSON answers for UM nurse determinations, pharmacy appeals and assistance intake, claim repricing, peer-to-peer summaries, and finance queue reviews. Use when a task references the Northstar environment, case/appeal/claim/P2P/queue records, policies, rate schedules, documents, criteria, or an answer template.

experiments/codex_gpt5_5_xhigh/reports/skills/task_group_014/reflect-3/reflect-3_attempt_03/SKILL.md

Read pinned source

Source commit 5082a777379156a048881e94940d640702e5e09a

What was checked

Matches the observed repository HEAD
Yes
Scanner rules are current
No
Repository scan complete
No
Skill scan complete
No
Observed behavior
Not checked yet
Last checked
Nov 6, 2026

These are observations at the recorded commit, not a guarantee of safety. Review the source before running it.

Install this skill

Choose an agent in your Stack or copy a command below. Commands fetch the pinned commit and copy only this skill directory. Existing destinations are refused. Copying a command does not install anything.

An install command is unavailable: current rules, complete repository and skill scans, an eligible behavior level and a permitted license are required.

Repository context

Repository stars (not skill ratings)
121
Repository last updated
Oct 29, 2026
License
Apache-2.0

Observed agent integration: No specific integration evidence. Standard SKILL.md installation does not imply verified compatibility.

Files and excerpt

File metadata and permitted, redacted excerpts come from the recorded scan. Source links are pinned to that commit.

Browse files
Read excerpt

# Northstar Payer Ops

## Workflow

1. Read the prompt, task context, and answer template first.
2. Identify the workflow from the required fields.
3. Query the live Northstar records for the target case or queue and its linked member, plan, policy, criteria, documents, line items, auth, trial, benchmark, appeal, or P2P records.
4. Resolve conflicts by precedence:
   - current clinical records over stale exports
   - payer appeal before manufacturer assistance
   - effective benchmark by payer, plan, CPT, modifier, and date over stale rates
   - new patient-specific P2P evidence over older summaries
   - margin threshold before charge sensitivity
5. Build the JSON exactly to the template. Keep key order, enum values, date format, and numeric precision unchanged.
Back to top