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Out-of-scope procedure
Score
90.0Pass · 1m 17s
Criteria
Extracted CPT / ICD / NPI correctly1.0
Correctly routed as return1.0
Return reason matches "out_of_scope_procedure"0.5
Emitted reason "not_a_referral" instead of "out_of_scope_procedure"; both are return-path reasons but vocabulary token is wrong.
No spurious ORM^O01 emitted1.0
Patient
Patient
Hector Reyes, 62M
MRN
MRN-MC-00106
Referrer
Dr. Alan Reeves (NPI 1558201496)
Payer
Health Net Medi-Cal
Procedure
CPT 99213 — Office visit (not imaging/outpatient order)
Decision
Return · out_of_scope_procedure
Changes made by agent
SFTP Outbox—→referral-05-out-of-scope.pdf + .return.json written
Agent Activity
0:00
Fetched + OCR PDF
Extracted CPT 99213 with ICD I10; all identity fields matched cleanly.
0:18
Applied scope policy
CPT 99213 (E/M office visit) is not in the accepted outpatient-imaging/ancillary scope.
0:38
Wrote return sidecar
Reason "out_of_scope_procedure" emitted with policy reference.