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GOLD-MIS-10

Missing information · gold-v0.1

Case inputs

As of
2026-09-01
Patient
58 years, GA
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice
Policy
immunara-v0.1
Inputs
sha256:deb1c53dc623…

Documents 2

Physician note

physician_note
SYNTHETIC RECORD - Example Silverlake Rheumatology - Follow-up Visit - 2026-08-28
Patient reference SYN-3391. This 58-year-old man returns for follow-up of chronic hand and wrist swelling. His chart documents seropositive rheumatoid arthritis, confirmed at this office in 2019 after persistent synovitis and an elevated rheumatoid factor.

He was started on oral methotrexate 20 mg weekly on 2025-10-13 and continued it until 2026-03-30, when it was discontinued because his synovitis and morning stiffness had not improved despite dose escalation, an inadequate response. He has since managed with over-the-counter analgesics and reports increasing difficulty with yard work. He has no known drug allergies. Given the extent of his ongoing disease activity, Immunara is being requested.

Fax cover

fax_cover
SYNTHETIC RECORD - Example Silverlake Rheumatology - Fax Cover Sheet - 2026-08-28
To: Northstar Choice Pharmacy Benefits
Re: Prior authorization request for Immunara
Patient reference SYN-3391. A copy of the member's insurance card is attached to this transmission, along with the office visit note. Pages: 1 of 3.

Decisions by provider

REQUEST_INFOcorrect

Decided by: documentation gate · auto_process 0.89

Judgments

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

Diagnosis supported
0.970
Step therapy met
0.980
Documentation complete
0.160
Material contradiction
0.080
Missing evidence
INSURANCE_INFORMATION 0.950
others: NONE 0.05
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=58, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.080, review at >= 0.8

  4. documentationFIRED → REQUEST_INFO

    p_yes(documentation_complete)=0.160, request info below 0.6

  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.

  • documentation is likely incomplete (p_yes=0.160)
  • most likely missing: insurance information (p=0.950)
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)