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Peer-to-peer prep & appeal strategy
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When should Ohtari use this skill?
Always use
A payer denies a prior auth, or requests a peer-to-peer call to review medical necessity.
How should Ohtari handle this situation?
This skill defines how Ohtari handles payer denials and prepares the surgeon for a peer-to-peer call. Used by the appeal step of Spine prior auth orchestration.
Evidence packet contents
- Original PA packet (verbatim, with submission timestamp)
- Denial letter and cited criteria
- Conservative care timeline (PT attendance, NSAID trial, activity modification)
- Recent imaging summary with key findings
- Surgeon attestation of medical necessity
- Patient functional impact statement (if available)
Surgeon brief format
Delivered 24h before peer-to-peer (configurable per surgeon):
- Patient one-pager (history, prior treatments, imaging summary)
- Suggested talking points based on denial reason
- Payer's named medical director (when available)
- Estimated call duration and back-out windows
Type @ to mention a workflow or person inline. v2.3 · Updated 3 days ago