Individual skill
northstar-payer-determinations
Produces a correct structured-JSON determination for Northstar Health Plan payer-operations tasks — UM nurse authorization, pharmacy coverage appeal + manufacturer assistance, payment-integrity claim repricing, peer-to-peer (P2P) summary, and UM-finance margin-queue analysis — backed by records in the shared payer-operations environment. Use whenever a task gives a target business ID, a payer-operations role, a reporting date, and an answer_template.json, and asks you to return one JSON object conforming to that template.
experiments/claude_code_glm_5_2_max/reports/skills/task_group_014/reflect-3/reflect-3_attempt_02/SKILL.md
Source commit 5082a777379156a048881e94940d640702e5e09a
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- Last checked
- Nov 11, 2026
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- Repository last updated
- Oct 29, 2026
- License
- Apache-2.0
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- agent Repository topic
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- self-evolving Repository topic
- self-learning Repository topic
- skills Repository topic
- finance Derived category
- operations Derived category
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SKILL.mdcore · 7,856 bytesSKILL.mdcore · 7,856 bytesSKILL.mdcore · 7,856 bytesreferences/data_model.mddoc · 5,410 bytesreferences/determination_patterns.mddoc · 9,371 bytes
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# Northstar Payer Operations Determinations
## What these tasks are
Each task gives you:
- `prompt.txt` — the request (your role, the target business ID, the reporting date, what to return).
- `payloads/task_context.json` — target IDs, role, dates, and any domain definitions (finance thresholds, packet items, appeal windows, etc.).
- `payloads/answer_template.json` — the **exact** JSON contract: required fields, types, enum choices, list-ordering rules, numeric precision, and null-handling rules.
The shared payer-operations environment holds the source records (cases, members, plans, providers, clinical documents, policies, criteria, authorizations, appeals, drug trials, assistance screens, claims, claim lines, rate schedules, P2P events, margin rows). Your job is to read the right records, apply the determination logic, and return **one JSON object** matching the template. Output JSON only — no prose, no markdown fence, no comments.
Produce the correct answer in a single pass: read the inputs carefully, derive each field exactly from environment records, and validate every field against the template before emitting JSON.
## Entry workflow (every task)
1. **Read all three inputs fully.** The template is the contract — note every required field, enum choice, list-ordering rule, numeric precision, and null rule before touching the environment.