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GOLD-MIS-17

Missing information · gold-v0.1

Case inputs

As of
2026-09-12
Patient
50 years, TX
Request
Immunara for rheumatoid arthritis
Insurance
CivicCare, CivicCare Plus
Policy
immunara-v0.1
Inputs
sha256:88e60d945387…

Documents 3

Physician note

physician_note
SYNTHETIC RECORD - Example Sundance Rheumatology - Follow-up Visit - 2026-09-08
Patient reference SYN-6690. At this practice, her seropositive rheumatoid arthritis has been followed since it was recognized in 2018; today's visit, for a 50-year-old woman, addresses ongoing hand and wrist symptoms.

She was treated with oral methotrexate 20 mg weekly from 2025-12-01 through 2026-04-25, when it was discontinued because her synovitis persisted despite dose escalation, an inadequate response. Her hand and wrist swelling remains active on exam today. She works as a paralegal and reports prolonged keyboard use has become difficult. Her sustained disease activity supports a switch to Immunara.

Fax cover

fax_cover
SYNTHETIC RECORD - Example Sundance Rheumatology - Fax Cover Sheet - 2026-09-08
To: CivicCare Plus Pharmacy Benefits
Re: Prior authorization request for Immunara
Patient reference SYN-6690. Member ID: see the enclosed insurance card. Pages: 2 of 2.

Insurance card

insurance_card
SYNTHETIC RECORD - CivicCare Plus - Member Insurance Card (copy) - 2026-09-08
Payer: CivicCare
Plan: CivicCare Plus
Member ID: CCP-778821
Group Number: CCP-GRP-2290
Customer Service: 555-0177

Decisions by provider

HUMAN_REVIEWwrong, safe

Decided by: default_review 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
0.810
Material contradiction
0.070
Missing evidence
NONE 0.720
others: INSURANCE_INFORMATION 0.28
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=50, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.070, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.810, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.720), request info at >= 0.7

  6. auto_processpassed

    min(required p_yes)=0.810, auto at >= 0.89; p_yes(material_contradiction)=0.070, blocks at >= 0.2

  7. default_reviewFIRED → HUMAN_REVIEW

    case does not meet the autonomous-action bar

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

  • documentation_complete p_yes=0.810 is below the 0.89 autonomous-action bar
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)