Individual skill

northstar-payer-review

Process Northstar Health Plan payer operations reviews that require data gathering from a shared API environment and structured JSON output. Use this skill whenever the task involves Northstar, payer operations, prior authorization, UM review, pharmacy appeals, claim repricing, payment integrity, peer-to-peer, therapy margin analysis, or any review that references a task environment with SQL and REST endpoints. This applies when the task includes a task_context.json and answer_template.json specifying the output contract, and mentions endpoints like POST /sql/query with a bearer token.

experiments/codex_skill_creator_comparison_deepseek_v4_pro_max/reports/skills/task_group_014/fewshot/opencode/fewshot_attempt_01/SKILL.md

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Oct 29, 2026
License
Apache-2.0

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# Northstar Payer Operations Review

## Overview

This skill covers the Northstar Health Plan payer review methodology: query a
shared API environment, evaluate cases against policy criteria and rate
schedules, and return structured JSON matching a provided output template.
The methodology applies across all Northstar review types:

- Prior authorization (UM nurse)
- Pharmacy coverage appeals and manufacturer assistance intake
- Claim repricing and payment integrity correction
- Peer-to-peer final summaries
- Therapy margin queue analysis