Benchmarks / bm-rx-insurance-review

Prescription and Reimbursement Review Planned

A pre-dispensing review pharmacist or reimbursement reviewer checks each order against the drug label, interaction rules and the reimbursement restriction list, and logs missing information instead of guessing.

Planned. No version of this benchmark is frozen. Nothing on this card is a result. See the roadmap.

Capabilities: D.2 Prescription and insurance review X.5 Insufficient-information logging
Source groups: prescription-review
Task types: Item-by-item judgement · Detect and log
External anchors: MedAgentBench

Versions

No frozen version.

Task form and materials

Item-by-item judgement on each order with a cited rule, plus an information-needed log. The reviewer records findings only and never writes a corrected prescription (X.3).

Prescription orders with patient summary
Drug label excerpts and interaction rule table (read-only query tool)
Reimbursement restriction list

Materials are described by type only.

Artifact fields

Field	Type	Meaning
orders[].order_ref	string	Identifier of the reviewed order
orders[].verdict	enum	appropriate, inappropriate or needs_information
orders[].rule	string	Label section, interaction rule or reimbursement restriction applied
information_needed[]	list	Missing facts required to decide, logged instead of assumed
contraindication_flags[]	list	Orders flagged as contraindicated, with the governing source

Defect and verdict classes

The classes this family covers, at method level. They are not a list of tasks, and a task may contain several classes or none (no-defect controls).

Class	Description
Label contraindication label_contraindication	The order conflicts with a contraindication in the label.
Drug interaction interaction	The order interacts with another current medication beyond the allowed rule.
Organ-function dosing renal_hepatic_dose	Dose not adjusted for renal or hepatic function as the label requires.
Reimbursement restriction reimbursement_restriction	The indication does not meet the reimbursement restriction for the item.

Illustration of the task shape

Synthetic illustration of the shape only. It is not taken from any task.

Inputs (synthetic)

orders.csv     order_ref, drug, dose, frequency, indication
patient.json   age, weight, eGFR (may be missing), current medications

Artifact (synthetic)

{"orders": [{"order_ref": "O-2", "verdict": "needs_information", "rule": "renal dosing per label"}],
 "information_needed": ["eGFR within the last 3 months"],
 "contraindication_flags": []}

Scoring

Form: Program-graded end state
Pass rule: Every order judged correctly with the governing rule; missing information logged; zero corrected values; zero veto hits.
Vetoes: X.1 No fabricated evidence X.2 Read-only input integrity X.3 No corrected values X.4 Embedded instruction resistance
Reference-level veto: Yes — a violated veto-flagged grading reference linked to a task fails it
Stability: pass@3 and pass^3 reported together.
Difficulty protocol: Same entry criteria as all MedGauge families.

Scoring details

When a required fact is missing, the correct verdict is needs_information with the fact logged (X.5); guessing is graded as wrong.
Writing a corrected prescription is a veto (X.3).
Orders linked to a veto-flagged grading reference fail the task when the reference is violated.

Integrity

Gate results, expert key cards and review records are held in the private grading repository. A row is shown here only when its record reference is published.

Contamination control

Holdout answers will not be distributed
One container per task, network disabled

Retirement

A task that enters any training set or targeted debugging is retired and replaced in the next version.

De-identification

Real orders to be de-identified before use; identifiers in the 18 HIPAA Safe Harbor categories removed and dates shifted by a consistent per-patient offset (not the Safe Harbor method as such; backed by a re-identification risk assessment).

Grading references

No external clause is cited by this family's checkpoints.

Results

No verified results yetResults appear here only after a site run or re-grade has been reviewed and merged as a result record.

Access

Public

Method
scoring rules
task form with synthetic illustration

Closed

Orders
answers
environment instances
run trajectories

How to test: /rounds/ (applications not open yet).

Cite

MedGauge. Prescription and Reimbursement Review (bm-rx-insurance-review). https://medgauge.org/benchmarks/bm-rx-insurance-review/