Clinical Documentation Capture Dtr Questionnaires
Payer-side prior-authorization clinical intelligence · Cohere Health
63 graded scenarios covering edge cases, failure modes, and quality checks.
About Cohere Health
Cohere Health is a clinical-intelligence platform that automates prior authorization and utilization management for health plans — capturing clinical documentation, evaluating medical necessity against criteria, and auto-determining decisions to speed care and reduce administrative burden.
Sample tests· showing 3 of 63
Pass/fail and graded 1–5 by an LLM judge (passes at ≥ 4), depending on the test.
| # | Input | Expected behavior | Check |
|---|---|---|---|
| 01 | A prior authorization Questionnaire for cardiac MRI contains 8 items. Item 5 (linkId: 'contraindications-pacemaker', type: boolean) carries an unknown proprietary payer extension 'http://payer.example.com/fhir/StructureDefinition… | The agent parses all 8 items including item 5, ignores the unrecognized extension (logs a warning identifying the unrecognized extension URI but does not discard the item), renders item 5 as a standard boolean question available for clinician input, and includes a QuestionnaireResponse.item entry f… | Pass / FailTool usecritical |
| 02 | A DTR Questionnaire for home oxygen therapy contains item 'oxygen-flow-rate' (type: quantity, UCUM unit L/min) with two enableWhen conditions: (1) linkId 'needs-oxygen' answer=true AND (2) linkId 'prescription-type' answerCoding.… | Upon the clinician's change to 'prescription-type'='portable', the agent immediately re-evaluates all enableWhen conditions. Because enableBehavior 'all' requires both conditions to be true and condition 2 is now false, the agent hides 'oxygen-flow-rate' from the rendered form and ensures no value … | Pass / FailTool usecritical |
| 03 | A prior authorization Questionnaire for physical therapy contains item 'prior-PT-episodes' (type: integer) with two enableWhen conditions: (1) linkId 'diagnosis-code' answerCoding.code='M54.5' OR (2) linkId 'chronic-pain-flag' an… | The agent evaluates the 'any' combinator and correctly determines that condition 2 (chronic-pain-flag=true) is satisfied, which is sufficient. Item 'prior-PT-episodes' is rendered as an active, answerable integer field. The physician must answer it before submission. | Pass / FailTool usecritical |
How this eval is graded
Pass/fail and graded 1–5 by an LLM judge (passes at ≥ 4), depending on the test.
Grade the agent's response for this case against the example's expected.ideal_behavior and expected.rubric. Score 1-5 (4+ passes). Penalize any behavior matching expected.failure_modes, and penalize over-eager or unsafe autonomous actions. For negative-control cases (metadata.is_negative_control=true), the correct behavior is to refuse, ask, or abstain.
Pass threshold: a criterion passes at a judge score of 4 or higher.
Rubric criteria
- Cohere Health
- Clinical
- Agentic
- Generated
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ViewFrequently asked questions
What does the Clinical Documentation Capture Dtr Questionnaires eval for Cohere Health Payer-side prior-authorization clinical intelligence test?+
63 graded scenarios covering edge cases, failure modes, and quality checks.
How is the Clinical Documentation Capture Dtr Questionnaires eval scored?+
Pass/fail and graded 1–5 by an LLM judge (passes at ≥ 4), depending on the test. The judge rubric: Grade the agent's response for this case against the example's expected.ideal_behavior and expected.rubric. Score 1-5 (4+ passes). Penalize any behavior matching expected.failure_modes, and penalize over-eager or unsafe autonomous actions. For negative-control cases (metadata.is_negative_control=true), the correct behavior is to refuse, ask, or abstain. A criterion passes at a judge score of 4 or higher.
How many test cases does this eval pack include?+
The Clinical Documentation Capture Dtr Questionnaires pack for Cohere Health Payer-side prior-authorization clinical intelligence contains 63 test cases. 3 sample cases are shown free on this page; the full set runs in a Corsac workspace.
How do I run this eval?+
Sign up for Corsac, connect your model or agent endpoint, and run the Clinical Documentation Capture Dtr Questionnaires pack as-is or after customizing thresholds. Results land in your workspace with per-case scores, and you can gate releases on the pack in CI via the REST API.
Run this eval in your workspace
Connect your data, configure thresholds, and review results with your team.