Utilization Management
pa_t034_t034_o002_p01_intake_payer
New Intake — Implantable vagus nerve stimulator (VNS) — pulse generator i
New submission just hit the intake desk. New submission just came in for a 38-year-old male with Localization-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable; Dr. Rajesh Kapoor is requesting Implantable vagus nerve stimulator (VNS) — pulse generator i. You own this case end-to-end: walk the intake checklist, route it, then drive clinical review, MD decision, and any P2P through to final 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