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GOLD-TMP-18

Temporal reasoning · gold-v0.1

Case inputs

As of
2026-06-15
Patient
34 years, TX
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice · NSC-264490
Policy
immunara-v0.1
Inputs
sha256:f60fe0c13f72…

Documents 3

Lab report

lab_report
SYNTHETIC RECORD - Example Lonestar Rheumatology - Laboratory Report - 2026-04-28
Patient reference SYN-6018.
Rheumatoid factor: positive, 58 IU/mL (reference <14).
Anti-CCP antibody: positive, 76 U/mL (reference <20).
CRP: 1.8 mg/dL (elevated).

Medication history

medication_history
SYNTHETIC RECORD - Example Lonestar Rheumatology - Medication History - 2026-06-05
Patient reference SYN-6018.
METHOTREXATE 15 MG PO WEEKLY - status: inactive - start 2025-10-06 - end 2025-11-03 - reason: travel
METHOTREXATE 15 MG PO WEEKLY - status: inactive - start 2026-01-12 - end 2026-05-04 - reason: inadequate response
FOLIC ACID 1 MG ORAL DAILY - status: inactive - start 2026-01-12

Physician note

physician_note
SYNTHETIC RECORD - Example Lonestar Rheumatology - Office Visit - 2026-06-08
Patient reference SYN-6018. This 34-year-old woman returns today after completing a second course of methotrexate for her seropositive rheumatoid arthritis, first diagnosed in 2021.

She first took oral methotrexate 15 mg weekly from 2025-10-06 to 2025-11-03, stopping after only four weeks because of an extended overseas work trip that made weekly lab monitoring impractical. She restarted methotrexate on 2026-01-12 and continued it through 2026-05-04, when it was stopped because her synovitis had not improved despite the longer trial. She reports mild fatigue but otherwise feels well and has no other significant medical history.

Given the inadequate response to this second, longer course of methotrexate, Immunara is being requested.

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
0.960
Step therapy met
0.932
Documentation complete
0.970
Material contradiction
0.130
Missing evidence
NONE 0.910
others: DOSAGE 0.05 · DIAGNOSIS 0.03 · TREATMENT_HISTORY 0.01
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=34, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.130, review at >= 0.8

  4. documentationpassed

    p_yes(documentation_complete)=0.970, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.910), request info at >= 0.7

  6. auto_processFIRED → AUTO_PROCESS

    min(required p_yes)=0.932, auto at >= 0.89; p_yes(material_contradiction)=0.130, 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)

What changed

q-v0.2 to q-v0.3:

ACTION UNCHANGED

The question sets differ: compare q-v0.2 → q-v0.3 →

Full comparison· before and after, every judgment

The later segment alone clears 12 weeks; q-v0.3 sees the restart and still approves.

Before

Jev q-v0.2 @0.89

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

After

Jev q-v0.3 @0.81

AUTO_PROCESScorrect
  • all required judgments are at or above 0.81 and contradiction risk is below 0.2
JudgmentBeforeAfterΔThresholds crossed
Diagnosis supportedp_yes=0.960p_yes=0.970+0.010none
Step therapy metp_yes=0.932p_yes=0.960+0.028none
Documentation completep_yes=0.970p_yes=0.970+0.000none
Material contradictionp_yes=0.130p_yes=0.110−0.020(auto_process)
Missing evidenceNONE (0.91)NONE (0.91)+0.000none

(name) = a comparison no engine gate acts on.

Threshold
auto_process 0.89 → 0.81