Individual skill
northstar-payer-ops
Produce template-exact JSON determinations for Northstar Health Plan payer-operations tasks against the shared read-only environment at <TASK_ENV_BASE_URL> (POST /sql/query with bearer pa-review-token-014; open GET /api/... business endpoints). Covers UM nurse authorization summaries, pharmacy appeal + manufacturer-assistance dispositions, payment-integrity claim repricing, peer-to-peer final summaries, and therapy margin-queue analysis. Use whenever a prompt names Northstar Health Plan, the task-env base URL, the pa-review-token-014 SQL endpoint, an answer_template.json contract, or a basis_audit object with source_precedence. Read BEFORE writing the JSON answer.
experiments/claude_code_glm_5_2_max/reports/skills/task_group_014/self/self_attempt_01/SKILL.md
Source commit 5082a777379156a048881e94940d640702e5e09a
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- Last checked
- Nov 6, 2026
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- Oct 29, 2026
- License
- Apache-2.0
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- agent Repository topic
- ai Repository topic
- benchmark Repository topic
- llm Repository topic
- self-evolving Repository topic
- self-learning Repository topic
- skills Repository topic
- legal Derived category
- operations Derived category
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- data-databases Derived category
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SKILL.mdcore · 10,727 bytesSKILL.mdcore · 10,727 bytesSKILL.mdcore · 10,727 bytesreferences/basis_audit.mddoc · 4,909 bytesreferences/data_model.mddoc · 6,322 bytesreferences/endpoints.mddoc · 3,486 bytesreferences/output_discipline.mddoc · 4,316 bytesscripts/query_env.pyruns · 2,603 bytes
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# Northstar Payer Operations Determinations
Produce a single JSON object that exactly matches the task's `answer_template.json`, using only the shared read-only Northstar payer-operations environment. Never invent values, never inspect environment source/database/setup files, and never call any judge endpoint.
## 0. Recognize the task
Every Northstar task follows the same shape: a requester role, a target business ID, a reporting date/period, the shared environment, and an `answer_template.json` contract. Map the task to one of five families (an unseen task will be a variant of one of them):
| Family | Target ID shape | Core question | source_precedence rule |
|---|---|---|---|
| UM nurse authorization | `CASE-*` | Approve / pend / escalate / deny / partial for a requested therapy line | `current_clinical_records_over_stale_export` |
| Pharmacy appeal + assistance | `APPEAL-*` / `APL-*` | Appeal path, deadline, step-therapy failures, packet gaps, assistance screen | `payer_appeal_before_manufacturer_assistance` |
| Payment-integrity claim repricing | `CLAIM-*` | Reprice paid claim lines vs the effective benchmark; reject stale source | `effective_benchmark_by_plan_modifier_and_date` |
| Peer-to-peer final summary | `P2P-*` | Did the P2P supply new patient-specific info that changes the review? | `new_patient_specific_p2p_information` |