Utilization Management
pa_t017_t017_o001_p01_mdreview_payer
MD Review — Uvulopalatopharyngoplasty (UPPP)
Escalated to you for MD decision. This is the physician review handoff for a 54-year-old male with Obstructive sleep apnea; Excessive daytime sleepiness; Chibueze Okafor, MD requested Uvulopalatopharyngoplasty (UPPP). (The nurse reviewer completed their recommendation; intake was recorded; triage routed the case.) Work the case, record the MD decision, run the peer-to-peer first if the case requires one, 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