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GOLD-TMP-08

Temporal reasoning · gold-v0.1

Case inputs

As of
2026-09-07
Patient
58 years, OH
Request
Immunara for rheumatoid arthritis
Insurance
ExampleHealth, ExampleHealth Gold · EXH-390115
Policy
immunara-v0.1
Inputs
sha256:50f05221ce39…

Documents 1

Physician note

referral_letter
SYNTHETIC RECORD - Example Lakeshore Rheumatology - September 7, 2026

Dear Pharmacy Benefits Reviewer,

Patient reference SYN-6008. I am requesting authorization for Immunara on behalf of this 58-year-old woman, who continues to have active synovitis at both wrists and several MCP joints at today's visit despite treatment. Her seropositive rheumatoid arthritis was diagnosed in 2017 and has been managed at this practice since.

She has been taking oral methotrexate 20 mg weekly continuously since 2026-06-15 and remains on it today, but her disease activity has not improved despite this ongoing trial. She reports increasing difficulty opening jars and buttoning clothing.

Please approve Immunara at this time given her inadequate response to methotrexate.

Sincerely,
The prescribing rheumatologist

Decisions by provider

AUTO_PROCESScorrect

Decided by: auto_process 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
0.960
Documentation complete
0.910
Material contradiction
0.110
Missing evidence
NONE 0.850
others: TREATMENT_HISTORY 0.11 · DOSAGE 0.03 · LAB_RESULT 0.01
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)=0.110, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.910, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.850), request info at >= 0.7

  6. auto_processFIRED → AUTO_PROCESS

    min(required p_yes)=0.910, auto at >= 0.89; p_yes(material_contradiction)=0.110, blocks at >= 0.2

  7. default_reviewnot reached

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

  • all required judgments are at or above 0.89 and contradiction risk is below 0.2
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)