Utilization Management
pa_t030_t030_o002_p01_triage_payer
Triage Routing — Cheilectomy of first metatarsophalangeal joint without impla
Triage queue has one case sitting past its SLA clock. Ready to route this case for a 68-year-old female with Hallux rigidus, right foot; Ricardo Vasquez, DPM requested Cheilectomy of first metatarsophalangeal joint without impla. Pick the right review lane, then work the case through clinical review, MD decision, and any P2P to final determination yourself — no one else picks it up after you.
🧰 Workspace
| Resource | Location |
|---|---|
| Case data & payer tools | chi-bench MCP server |
| Handbook | /workspace/skills/managed-care-operations-handbook/SKILL.md |
| Incoming request docs | /logs/artifacts/workspaces/<case-id>/payer/incoming_request/ |
| Working files | /logs/artifacts/workspaces/<case-id>/payer/ |
| Shared handoff | /logs/artifacts/workspaces/<case-id>/shared/handoff/ |
| Tool reference | /opt/chi-bench-task-assets/tool_reference.md |
📋 Rules
- Use only payer namespaces:
payer_intake_hub,triage,review,determination,p2p,p2p_session,payer_letter_center - Do not inspect simulator source, tests, solution, or expectations files
- Do not fabricate source evidence — only create agent-authored summaries or correspondence when your workflow requires it
- Include rationale-rich notes when submitting clinical reviews