Utilization Management
pa_t031_t031_o001_p01_p2p_payer
Peer-to-Peer Session — Arthroscopy, shoulder, surgical; with rotator cuff repair
Case at peer-to-peer stage this morning. Peer-to-peer coordinator seat for a 47-year-old male with Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic; Pain in right shoulder; Raymond Chen, MD is the requesting clinician for Arthroscopy, shoulder, surgical; with rotator cuff repair. (The medical director recorded their decision; the nurse reviewer completed their recommendation; intake was recorded; triage routed the case.) Run the peer-to-peer session, record the outcome, and finalize the determination yourself.
🧰 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