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northstar-payer-ops-determination

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Produce a structured JSON determination for a Northstar Health Plan payer-operations task by reading its inputs and querying the shared read-only payer-ops environment (SQLite-backed portal with a POST /sql/query endpoint plus GET /api business endpoints). Use when a task packet gives a prompt.txt + task_context.json + answer_template.json that references the Northstar payer operations environment and asks for JSON matching the template. Covers the five archetypes: UM prior-authorization nurse determination, pharmacy coverage appeal + manufacturer-assistance intake, payment-integrity claim repricing, peer-to-peer (P2P) final summary, and service-margin queue analysis. Triggers: "Northstar", "payer operations", "prior authorization", "UM nurse", "determination", "coverage appeal", "manufacturer assistance", "claim repricing / benchmark", "peer-to-peer", "service margin queue", "pa-review-token", "basis_audit".

experiments/claude_code_opus_4_8_xhigh/reports/skills/task_group_014/fewshot/fewshot_attempt_01/SKILL.md

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Nov 11, 2026

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Repository last updated
Oct 29, 2026
License
Apache-2.0

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# Northstar Payer-Operations Determination

You are given a task packet that asks for a structured JSON answer derived from the
**Northstar Health Plan payer-operations environment** — a shared, read-only portal
backed by a SQLite database. Your job is to read the task, query the environment for
**only the target record(s)**, apply the archetype's business rules, and emit JSON that
matches the task's `answer_template.json` exactly.

Do **not** invent values. Every field is derived from environment records plus the
task's own definitions. The environment contains many unrelated "distractor" rows —
scope strictly to the target business id(s).

## 1. Read the three input files first
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