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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 (UM prior-auth nurse review, pharmacy coverage appeal + manufacturer assistance intake, payment-integrity claim repricing, peer-to-peer closure, or UM-finance margin-queue review) by reading the task's own answer_template, querying the shared read-only payer-operations environment, and mapping the environment records into the exact output contract. Use whenever a task hands you a prompt.txt + payloads/task_context.json + payloads/answer_template.json referencing a Northstar / payer-operations environment reachable at <TASK_ENV_BASE_URL> with a POST /sql/query endpoint.

experiments/claude_code_opus_4_8_xhigh/reports/skills/task_group_014/fewshot/fewshot_attempt_02/SKILL.md

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Oct 29, 2026
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Apache-2.0

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# Northstar Payer-Operations Determination

You are answering a single Northstar Health Plan payer-operations work item. The
task gives you a target **business id** (a case / appeal / claim / P2P / queue id)
and a strict JSON **answer_template**. Every answer is *derived from records already
present in the environment* — the environment pre-stages criteria results,
recommended authorizations, appeal packets, benchmarks, and margin rows. Your job is
to **find the right records for the exact target, apply light operational logic, and
render them into the template's exact shape** — including the shared `basis_audit`
audit trail that every template requires.

Do not invent facts. If a value is not derivable from the environment, re-query
before guessing.
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