Skip to content

GOLD-CON-12

Conflicting evidence · gold-v0.1

Case inputs

As of
2026-07-01
Patient
63 years, VA
Request
Immunara for rheumatoid arthritis
Insurance
CivicCare, CivicCare Plus
Policy
immunara-v0.1
Inputs
sha256:a9d283d65649…

Documents 3

Medication history

medication_history
SYNTHETIC RECORD - Example Union Square Medical Partners - Medication History - 2026-06-20
Patient reference SYN-3345.
METHOTREXATE 15 MG PO WEEKLY - status: inactive - start 2026-01-10 - end 2026-05-20 - reason: inadequate response
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-01-10
ATORVASTATIN 20 MG PO DAILY - status: active

Physician note

problem_list
SYNTHETIC RECORD - Example Union Square Medical Partners - Problem List Update - 2026-06-25
Patient reference SYN-3345. 63-year-old man.

- Seropositive rheumatoid arthritis, diagnosed 2017, followed at this practice since.
- Methotrexate has never been tried for this patient's joint symptoms; he has relied on acetaminophen alone.
- Hyperlipidemia, managed with a statin.
- Plan: discuss Immunara given the extent of untreated joint involvement.

Fax cover

fax_cover
SYNTHETIC RECORD - Example Union Square Medical Partners - Fax Cover Sheet - 2026-06-28
To: CivicCare Plus Pharmacy Benefits
Re: Prior authorization request for Immunara
Patient reference SYN-3345. Member ID: not provided; the patient's insurance card was not available at the time of this visit. Pages: 1 of 1.

Decisions by provider

HUMAN_REVIEWcorrect

Decided by: contradiction gate · auto_process 0.89

Judgments

p_yes for yes/no questions; ticks are the thresholds a gate compares each one with.

Diagnosis supported
0.940
Step therapy met
0.258
Documentation complete
0.070
Material contradiction
0.970
Missing evidence
INSURANCE_INFORMATION 0.970
others: NONE 0.02 · TREATMENT_HISTORY 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=63, policy min_age=18

  3. contradictionFIRED → HUMAN_REVIEW

    p_yes(material_contradiction)=0.970, review at >= 0.8

  4. documentationnot reached
  5. missing_evidencenot reached
  6. auto_processnot reached
  7. default_reviewnot reached

passed = the gate checked and did not fire; not reached = an earlier gate decided.

  • a material contradiction is likely (p=0.970)
Run details· q-v0.2

run_20260925T170857Z_b95be9 · q-v0.2 · immunara-v0.1 (v0.1)

auto_process 0.89, chosen on gen-v0.2-dev.

questions: q-v0.2 →

Show expected answer (evaluation only)