Utilization Management
pa_t033_t033_o001_p01_triage_payer
Triage Routing — Myoelectric upper extremity prosthesis, below elbow
Case routed from intake, ready for routing decisions. Ready to route this case for a 38-year-old male with Partial traumatic metacarpophalangeal amputation of left hand; Acquired absence of left finger(s); Dr. Priya Ramanathan requested Myoelectric upper extremity prosthesis, below elbow. (Intake was recorded.) 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