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chore: import upstream snapshot with attribution

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2026-07-13 12:39:17 +08:00
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examples/sandbox/healthcare_support/data/fixtures/insurance_eligibility.json
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{
"records": [
{
"payer": "Blue Cross",
"member_id": "BCX-4439201",
"dob": "1985-02-14",
"plan_name": "Blue Cross PPO Silver 4500",
"eligibility_status": "active",
"copay_primary_care": "$35",
"copay_specialist": "$60",
"deductible_remaining": "$1,200",
"prior_auth_required_services": [
"mri",
"ct angiogram",
"elective surgery"
],
"notes": "Coverage active. MRI requires prior authorization except emergency use."
},
{
"payer": "UnitedHealthcare",
"member_id": "UHC-771032",
"dob": "1990-09-03",
"plan_name": "UHC Choice Plus Bronze",
"eligibility_status": "active",
"copay_primary_care": "$30",
"copay_specialist": "$75",
"deductible_remaining": "$2,050",
"prior_auth_required_services": [
"ct angiogram",
"inpatient admission",
"outpatient surgery"
],
"notes": "Prior auth required for CT angiogram unless ordered in emergency setting."
},
{
"payer": "Aetna",
"member_id": "AET-562100",
"dob": "1978-11-20",
"plan_name": "Aetna Open Access Basic",
"eligibility_status": "active",
"copay_primary_care": "$25",
"copay_specialist": "$50",
"deductible_remaining": "$850",
"prior_auth_required_services": [
"specialist consult"
],
"notes": "Referral on file for specialist consult."
},
{
"payer": "Cigna",
"member_id": "CG-291001",
"dob": "1982-06-30",
"plan_name": "Cigna Connect Gold",
"eligibility_status": "active",
"copay_primary_care": "$20",
"copay_specialist": "$45",
"deductible_remaining": "$300",
"prior_auth_required_services": [
"advanced imaging",
"elective procedures"
],
"notes": "Claims for advanced imaging can deny if authorization is missing."
},
{
"payer": "Blue Cross",
"member_id": "BCX-8822009",
"dob": "1974-05-12",
"plan_name": "Blue Cross PPO Platinum",
"eligibility_status": "active",
"copay_primary_care": "$20",
"copay_specialist": "$40",
"deductible_remaining": "$0",
"prior_auth_required_services": [
"physical therapy after 12 visits"
],
"notes": "Physical therapy benefit allows 12 visits without prior authorization per calendar year."
},
{
"payer": "Blue Cross",
"member_id": "BCX-9017710",
"dob": "1992-04-17",
"plan_name": "Blue Cross PPO Silver 3000",
"eligibility_status": "active",
"copay_primary_care": "$30",
"copay_specialist": "$55",
"deductible_remaining": "$1,600",
"prior_auth_required_services": [
"mri",
"knee surgery consult",
"outpatient surgery"
],
"notes": "Prior auth normally required for knee surgery consult and advanced imaging."
}
],
"default_response": {
"eligibility_status": "unknown",
"notes": "No eligibility match. Confirm payer, member ID, and DOB."
}
}
examples/sandbox/healthcare_support/data/fixtures/patient_profiles.json
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{
"records": [
{
"patient_id": "PAT-1001",
"name": "Maya Thompson",
"dob": "1985-02-14",
"phone": "555-0111",
"payer": "Blue Cross",
"member_id": "BCX-4439201",
"referral_id": "REF-44120"
},
{
"patient_id": "PAT-1002",
"name": "Victor Chen",
"dob": "1990-09-03",
"phone": "555-0122",
"payer": "UnitedHealthcare",
"member_id": "UHC-771032",
"referral_id": "REF-77100"
},
{
"patient_id": "PAT-1003",
"name": "Nora Patel",
"dob": "1978-11-20",
"phone": "555-0133",
"payer": "Aetna",
"member_id": "AET-562100",
"referral_id": "REF-88421"
},
{
"patient_id": "PAT-1004",
"name": "Luis Romero",
"dob": "1982-06-30",
"phone": "555-0144",
"payer": "Cigna",
"member_id": "CG-291001",
"referral_id": "REF-12880"
},
{
"patient_id": "PAT-1005",
"name": "Ella Brooks",
"dob": "1974-05-12",
"phone": "555-0155",
"payer": "Blue Cross",
"member_id": "BCX-8822009",
"referral_id": "REF-33002"
},
{
"patient_id": "PAT-1006",
"name": "Jordan Lee",
"dob": "1992-04-17",
"phone": "555-0134",
"payer": "Blue Cross",
"member_id": "BCX-9017710",
"referral_id": "REF-90171"
}
]
}
examples/sandbox/healthcare_support/data/fixtures/referral_status.json
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{
"records": [
{
"referral_id": "REF-88421",
"patient_id": "PAT-1003",
"status": "approved",
"specialty": "Cardiology",
"requested_provider": "Dr. Ramos",
"authorized_visits": 6,
"remaining_visits": 4,
"notes": "Authorization valid through 2026-07-31."
},
{
"referral_id": "REF-77100",
"patient_id": "PAT-1002",
"status": "pending_clinical_review",
"specialty": "Radiology",
"requested_provider": "Riverfront Imaging",
"authorized_visits": 1,
"remaining_visits": 0,
"notes": "Pending prior authorization packet completion."
},
{
"referral_id": "REF-90171",
"patient_id": "PAT-1006",
"status": "pending",
"specialty": "Orthopedics",
"requested_provider": "Summit Ortho Group",
"authorized_visits": 8,
"remaining_visits": 8,
"notes": "Awaiting payer determination."
}
]
}
examples/sandbox/healthcare_support/data/scenarios/billing_coverage_clarification.json
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{
"scenario_id": "billing_coverage_clarification",
"description": "Patient received an unexpected imaging bill and wants coverage clarification.",
"transcript": "Hey, this is Luis Romero. I got a bill after an ultrasound on 2026-02-08 and I thought it was covered.\nMy insurance is Cigna and my member ID is CG-291001.\nCan someone explain what happened and what I should do now?",
"patient_metadata": {
"patient_id": "PAT-1004"
},
"followup_qa": {
"date of service": "2026-02-08",
"payer": "Cigna"
},
"expected": {
"intent": "billing_coverage_clarification",
"required_entities": {
"payer": "Cigna",
"member_id": "CG-291001"
},
"required_tool_calls": [
"insurance_eligibility_lookup"
],
"required_resolution_elements": [
"billing coverage review",
"recommended next step"
],
"expected_payer": "Cigna"
},
"gold": {
"expected_next_step": "Route to billing review with EOB and service date context."
}
}
examples/sandbox/healthcare_support/data/scenarios/blue_cross_pt_benefits.json
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{
"scenario_id": "blue_cross_pt_benefits",
"description": "Blue Cross member asks about remaining physical therapy benefit and coverage path.",
"transcript": "This is Ella Brooks. I am a Blue Cross member and my ID is BCX-8822009.\nI am trying to continue physical therapy and need to know if I still have covered visits left.\nI do not have my date of birth in front of me if you need it.",
"patient_metadata": {
"patient_id": "PAT-1005"
},
"followup_qa": {
"date of birth": "05/12/1974",
"physical therapy": "physical therapy"
},
"expected": {
"intent": "eligibility_verification",
"required_entities": {
"payer": "Blue Cross",
"member_id": "BCX-8822009"
},
"required_tool_calls": [
"insurance_eligibility_lookup"
],
"required_resolution_elements": [
"eligibility verified",
"recommended next step"
],
"expected_payer": "Blue Cross"
},
"gold": {
"expected_next_step": "Confirm PT visit limits and advise on when additional review is needed."
}
}
examples/sandbox/healthcare_support/data/scenarios/eligibility_verification_basic.json
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{
"scenario_id": "eligibility_verification_basic",
"description": "Basic eligibility verification call with clear Blue Cross identifiers.",
"transcript": "Hi, this is Maya Thompson. I have an MRI next week and I want to confirm if it is covered.\nI have Blue Cross and my member ID is BCX-4439201. My date of birth is 02/14/1985.\nCan you tell me what my benefits look like and what I should do next?",
"patient_metadata": {
"patient_id": "PAT-1001"
},
"followup_qa": {
"member ID": "BCX-4439201",
"date of birth": "02/14/1985"
},
"expected": {
"intent": "eligibility_verification",
"required_entities": {
"payer": "Blue Cross",
"member_id": "BCX-4439201"
},
"required_tool_calls": [
"insurance_eligibility_lookup"
],
"required_resolution_elements": [
"eligibility verified",
"recommended next step"
],
"expected_payer": "Blue Cross"
},
"gold": {
"expected_next_step": "Confirm prior auth requirement for MRI and proceed with scheduling."
}
}
examples/sandbox/healthcare_support/data/scenarios/messy_ambiguous_knee_case.json
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{
"scenario_id": "messy_ambiguous_knee_case",
"description": "Messy real-world call with ambiguous details requiring follow-up, retrieval, and multiple tool invocations.",
"transcript": "Hi, this is Jordan Lee. I had a knee surgery consult and maybe some imaging planned, then I got mixed messages about auth.\nI also saw a bill and I am not sure if this is Blue something PPO or what.\nMy phone is 555-0134 and I think the referral might be REF-90171.\nCan you figure out what I need to do next?",
"patient_metadata": {
"patient_id": "PAT-1006"
},
"followup_qa": {
"insurance payer": "Blue Cross",
"member ID": "BCX-9017710",
"date of birth": "04/17/1992",
"procedure or visit type": "knee surgery consult",
"referral ID": "REF-90171"
},
"expected": {
"intent": "prior_auth_confusion",
"required_entities": {
"payer": "Blue Cross",
"member_id": "BCX-9017710"
},
"required_tool_calls": [
"insurance_eligibility_lookup",
"appointment_referral_status_lookup"
],
"required_resolution_elements": [
"prior authorization",
"recommended next step"
],
"expected_payer": "Blue Cross"
},
"gold": {
"expected_next_step": "Route to auth queue and share referral pending status with patient."
}
}
examples/sandbox/healthcare_support/data/scenarios/prior_auth_confusion_ct.json
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{
"scenario_id": "prior_auth_confusion_ct",
"description": "Caller is confused about whether CT angiogram needs prior auth and what intake should do.",
"transcript": "This is Victor Chen. I was told to schedule a CT angiogram, but another office said prior authorization is missing.\nMy insurance is UnitedHealthcare and I think my ID is UHC-771032.\nI need to know if I can move forward or if you need more information.",
"patient_metadata": {
"patient_id": "PAT-1002"
},
"followup_qa": {
"date of birth": "09/03/1990",
"procedure or visit type": "CT angiogram",
"payer": "UnitedHealthcare",
"member ID": "UHC-771032"
},
"expected": {
"intent": "prior_auth_confusion",
"required_entities": {
"payer": "UnitedHealthcare",
"member_id": "UHC-771032"
},
"required_tool_calls": [
"insurance_eligibility_lookup"
],
"required_resolution_elements": [
"prior authorization",
"recommended next step"
],
"expected_payer": "UnitedHealthcare"
},
"gold": {
"expected_next_step": "Route to utilization review with CT angiogram authorization packet."
}
}
examples/sandbox/healthcare_support/data/scenarios/referral_status_check.json
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{
"scenario_id": "referral_status_check",
"description": "Patient asks for specialist referral status with known referral ID.",
"transcript": "Hi, this is Nora Patel. I am checking on referral number REF-88421 for cardiology with Dr. Ramos.\nCan you tell me if it has been approved and how many visits I still have?",
"patient_metadata": {
"patient_id": "PAT-1003"
},
"followup_qa": {
"referral number": "REF-88421",
"provider": "Dr. Ramos"
},
"expected": {
"intent": "referral_status_question",
"required_entities": {
"referral_id": "REF-88421"
},
"required_tool_calls": [
"appointment_referral_status_lookup"
],
"required_resolution_elements": [
"referral",
"remaining authorized visits"
],
"expected_payer": "Aetna"
},
"gold": {
"expected_next_step": "Notify patient referral is approved and proceed to specialist scheduling."
}
}