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northstar-payer-ops-determination

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Produce a structured JSON determination for a Northstar Health Plan payer-operations work item (prior-authorization / UM nurse review, pharmacy coverage appeal + manufacturer assistance intake, payment-integrity claim repricing, peer-to-peer close-out, or UM-finance margin-queue summary). Use when a task ships an input/payloads/task_context.json plus an input/payloads/answer_template.json, points at a shared "Northstar" / "payer operations" environment reachable via POST /sql/query (bearer token) and GET /api/* endpoints, and asks for JSON conforming to the answer template. Triggers: "UM nurse determination", "prior authorization", "coverage appeal", "manufacturer assistance", "claim repricing / payment integrity", "peer-to-peer summary", "margin queue", "basis_audit", "source_precedence", "pa-review-token".

experiments/claude_code_opus_4_8_xhigh/reports/skills/task_group_014/self/self_attempt_03/SKILL.md

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Oct 29, 2026
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Apache-2.0

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# Northstar payer-operations structured determination

You are handed one payer-operations work item and must return a single JSON object that
exactly matches the task's `answer_template.json`. Every task in this family follows the
same shape: read two payload files, pull the relevant records from a shared read-only
environment, apply the decision rules for the item's family, and serialize the result.

The final numeric/enum values are **case-specific** — never carry values between tasks.
This skill gives you the *procedure and decision rules*, not answers.

## Step 1 — Read the contract before touching the network

Read both payload files first:
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