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RI-03

Smoke · smoke-v0.1

Case inputs

As of
2026-09-15
Patient
50 years, IL
Request
Immunara for rheumatoid arthritis
Insurance
Northstar, Northstar Choice
Policy
immunara-v0.1
Inputs
sha256:0d8f82aa0122…

Documents 2

Fax cover

fax_cover
SYNTHETIC RECORD - FAX COVER - Prior Authorization Request
To: Northstar Choice Pharmacy Benefits
Re: Immunara request
Member ID: not provided - insurance card not on file

Physician note

physician_note
SYNTHETIC RECORD - Rheumatology Note - 2026-09-03
50-year-old male with rheumatoid arthritis diagnosed in 2024 (RF positive, anti-CCP positive,
symmetric synovitis of the wrists and MCP joints).

Methotrexate 20 mg weekly from 2026-01-20 to 2026-06-10, stopped for inadequate response with
persistent swelling and CDAI 24. Requesting Immunara.

Decisions by provider

REQUEST_INFOcorrect

Decided by: documentation gate · auto_process 0.95

Judgments

p_yes for yes/no questions; ticks are the thresholds a gate compares each one with.

Diagnosis supported
0.980
Step therapy met
0.980
Documentation complete
0.050
Material contradiction
0.060
Missing evidence
INSURANCE_INFORMATION 1.000
Gate path· 7 gates, in engine order
  1. providerpassed

    all five decisions present and well-formed

  2. agepassed

    patient.age=50, policy min_age=18

  3. contradictionpassed

    p_yes(material_contradiction)=0.060, review at >= 0.8

  4. documentationFIRED → REQUEST_INFO

    p_yes(documentation_complete)=0.050, 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=0.050)
  • most likely missing: insurance information (p=1.000)
Run details· q-v0.1

run_20260925T042324Z_eee114 · q-v0.1 · immunara-v0.1 (v0.1)

auto_process 0.95, recorded threshold. The reference smoke run, made with q-v0.1 before q-v0.2 was adopted.

questions: q-v0.1 →

Show expected answer (evaluation only)