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GOLD-TMP-12

Temporal reasoning · gold-v0.1

Case inputs

As of
2026-09-10
Patient
53 years, WA
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice · NSC-826031
Policy
immunara-v0.1
Inputs
sha256:eebc89ff507b…

Documents 1

Physician note

referral_letter
SYNTHETIC RECORD - Example Summit Rheumatology - September 10, 2026

Dear Prior Authorization Reviewer,

Patient reference SYN-6012. Her wrists and hands remain visibly swollen at today's visit despite ongoing treatment, and her methotrexate trial has not produced the improvement we had hoped for. She is 53 years old, with seropositive rheumatoid arthritis established in 2016, and recently took up gardening again after several months of avoiding it because of hand pain.

She started oral methotrexate 20 mg weekly five months before this visit and has continued taking it since, but her wrist and hand swelling has not improved on this regimen, an inadequate response.

Please approve Immunara given her ongoing disease activity despite methotrexate.

Sincerely,
Her rheumatologist

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
0.980
Step therapy met
0.601
Documentation complete
0.920
Material contradiction
0.090
Missing evidence
NONE 0.850
others: TREATMENT_HISTORY 0.13 · DOSAGE 0.02
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=53, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.090, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.920, request info below 0.6

  5. missing_evidencepassed

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

  6. auto_processpassed

    min(required p_yes)=0.601, auto at >= 0.89; p_yes(material_contradiction)=0.090, 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.

  • step_therapy p_yes=0.601 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)