Utilization Management
pa_t012_t012_o001_p01_triage_payer
Triage Routing — Extracapsular cataract removal with IOL insertion and insert
Case routed from intake, ready for routing decisions. Ready to route this case for a 68-year-old female with Primary open-angle glaucoma, mild stage, right eye; Age-related nuclear cataract, right eye; Robert J. Chen, MD requested Extracapsular cataract removal with IOL insertion and insert. (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