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GOLD-TRK-02

Tricky or ambiguous · gold-v0.1

Case inputs

As of
2026-08-03
Patient
29 years, TX
Request
Immunara for rheumatoid arthritis
Insurance
ExampleHealth, ExampleHealth Gold · EXH-118273
Policy
immunara-v0.1
Inputs
sha256:8b0461b1b0a5…

Documents 1

Physician note

referral_letter
SYNTHETIC RECORD - Example Thornfield Rheumatology - August 3, 2026

Dear Utilization Reviewer,

Patient reference SYN-3392. This 29-year-old woman carries an established diagnosis of seropositive rheumatoid arthritis, confirmed in 2024 after elevated rheumatoid factor and anti-CCP titers, and continues to have active synovitis of the hands despite her current regimen.

Notably, her older sister was also followed at this practice for rheumatoid arthritis and took oral methotrexate 15 mg weekly from 2019-04-01 to 2019-10-15, stopping after six and a half months because of persistent nausea; the sister has since done well on a different regimen and remains under separate care.

I am requesting Immunara for this patient given her ongoing disease activity.

Best regards,
The evaluating 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
0.970
Step therapy met
0.000
Documentation complete
0.120
Material contradiction
0.170
Missing evidence
TREATMENT_HISTORY 1.000
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=29, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.170, review at >= 0.8

  4. documentationFIRED → REQUEST_INFO

    p_yes(documentation_complete)=0.120, 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=0.120)
  • most likely missing: treatment history (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)