Utilization Management
pa_t032_t032_o002_p01_nurse_review_payer
Nurse Clinical Review — Total disc arthroplasty (artificial disc), anterior approach
Case escalated from triage for clinical review. Nurse clinical review queue for a 52-year-old male with Cervical disc degeneration, mid-cervical region (C5-C6); Radiculopathy, cervical region; Rajesh Patel, MD requested Total disc arthroplasty (artificial disc), anterior approach. (Intake was recorded; triage routed the case.) Work the documentation review, record the recommendation, then carry the case through MD decision, any P2P, 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