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GOLD-MIS-12

Missing information · gold-v0.1

Case inputs

As of
2026-09-05
Patient
63 years, VA
Request
Immunara for rheumatoid arthritis
Insurance
ExampleHealth, ExampleHealth Gold
Policy
immunara-v0.1
Inputs
sha256:5b197e34cf4b…

Documents 1

Physician note

referral_letter
SYNTHETIC RECORD - Example Summit Rheumatology and Orthopedics - Referral Letter - 2026-09-01

Dear Colleague,

This 63-year-old man has an established diagnosis of seropositive rheumatoid arthritis, followed at our practice for the past two years. He was treated with oral methotrexate from March 2026 through July 2026, but the medication caused progressively elevated liver enzymes on routine monitoring and was discontinued for this intolerance.

His coverage is currently pending verification with his new employer's plan, and his member number was not available at the time of this visit. I am hopeful this can be resolved quickly so that we can move forward with Immunara, given his ongoing disease activity.

With regards,
The treating rheumatologist

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
0.980
Step therapy met
0.970
Documentation complete
0.060
Material contradiction
0.080
Missing evidence
INSURANCE_INFORMATION 1.000
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. contradictionpassed

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

  4. documentationFIRED → REQUEST_INFO

    p_yes(documentation_complete)=0.060, 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=0.060)
  • most likely missing: insurance information (p=1.000)
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)