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GOLD-TRK-16

Tricky or ambiguous · gold-v0.1

Case inputs

As of
2026-06-05
Patient
66 years, CO
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice · NSC-687240
Policy
immunara-v0.1
Inputs
sha256:c1aba21c8491…

Documents 2

Physician note

referral_letter
SYNTHETIC RECORD - Example Ashgrove Rheumatology - June 5, 2026

Dear Medical Reviewer,

Patient reference SYN-4409. This 66-year-old man presented in 2024 with symmetric small-joint swelling. His presentation is consistent with rheumatoid arthritis; he meets the 2010 ACR/EULAR classification criteria and has been treated as RA since that visit.

He took oral methotrexate 20 mg weekly from September 1, 2025 to February 15, 2026, discontinued because his hand and wrist synovitis had not improved despite the full trial, an inadequate response.

I am requesting Immunara given his sustained disease activity.

Sincerely,
The diagnosing rheumatologist

Lab report

lab_report
SYNTHETIC RECORD - Example Ashgrove Rheumatology - Laboratory Report - 2026-01-20
Patient reference SYN-4409.
Rheumatoid factor: positive, 68 IU/mL (reference <14).
Anti-CCP antibody: positive, 145 U/mL (reference <20).
ESR: 42 mm/hr (elevated).
CRP: 2.1 mg/dL (elevated).

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
0.890
Step therapy met
0.970
Documentation complete
0.960
Material contradiction
0.070
Missing evidence
NONE 0.870
others: DIAGNOSIS 0.09 · DOSAGE 0.02 · TREATMENT_HISTORY 0.02
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=66, policy min_age=18

  3. contradictionpassed

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

  4. documentationpassed

    p_yes(documentation_complete)=0.960, request info below 0.6

  5. missing_evidencepassed

    missing_evidence=NONE (p=0.870), request info at >= 0.7

  6. auto_processFIRED → AUTO_PROCESS

    min(required p_yes)=0.890, auto at >= 0.89; p_yes(material_contradiction)=0.070, 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)