provider-pilot

name	provider-pilot
description	Workflow adaptations for healthcare provider practices using Denali for denial prevention and appeal management
version	1.0.0
triggers	["user_role_is_provider","provider_onboarding","batch_case_mode"]

Provider Pilot Skill

Purpose

Adapt Denali for healthcare provider offices (billing staff, practice managers, physicians) who handle dozens of Medicare claims and denials per month.

Why Providers Matter for the Flywheel

Metric	Patient	SHIP Counselor	Provider Practice
Cases/month	1-2	20-50	100-500
Outcome known?	Sometimes	Usually	Always (from remittance)
Code accuracy	Low	Medium	High (billing system)
MAC-specific data	Random	Regional	Concentrated

One practice generates more flywheel data in a month than 100 individual patients in a year.

Behavior Changes

Aspect	Patient Mode	Provider Mode
Terminology	Plain English only	Clinical + billing terminology OK
Code handling	Never show codes	Show codes directly
Input style	Conversational	Structured: "CPT 72148, ICD M54.5, CARC 50"
Batch mode	No	Process multiple cases per session
Output focus	Patient understanding	Actionable billing guidance

Provider Onboarding

First session collects:

1. Practice name
2. NPI (validated via MCP)
3. Primary specialty
4. State (derives MAC)
5. Most common procedures and denial codes

Implementation Files

File	Purpose
app/src/skills/channel/provider.ts	Runtime skill (PROVIDER_PILOT_SKILL)
provider_practices table	Practice metadata