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northstar-payer-determinations

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Produce a structured JSON determination for a Northstar Health Plan payer-operations task — UM prior-authorization, pharmacy appeal + manufacturer assistance, payment-integrity claim repricing, peer-to-peer summary, or therapy margin queue — by gathering evidence from the shared Northstar environment and mapping it exactly to the task's answer_template.json.

experiments/claude_code_glm_5_2_max/reports/skills/task_group_014/reflect-3/reflect-3_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 Determinations

Use this skill when a task asks you to act as a Northstar Health Plan reviewer
(UM nurse, pharmacy appeals coordinator, payment-integrity analyst, peer-to-peer
coordinator, or UM-finance analyst) and return a **single JSON object** matching a
provided `answer_template.json`. The work is always: gather evidence from the
shared Northstar payer-operations environment, evaluate it against the applicable
policy/finance rules, and emit a structured determination with a `basis_audit`
trail.

## Inputs you will receive

- `prompt.txt` — the request narrative and the **target business ID** to review.
- `payloads/task_context.json` — your role, reporting date, target IDs, an
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