Dataset Viewer
Auto-converted to Parquet Duplicate
id
string
category
string
tier
string
in_smoke
bool
persona
string
reason_for_call
string
known_info
string
unknown_info
string
task_instructions
string
reward_basis
list
reference_actions
string
communicate_info
list
nl_assertions
list
initial_state
string
task_json
string
eligibility-01
eligibility
core
true
Direct and polite. Answers questions briefly and does not volunteer extra details.
You want to confirm you are covered and which plan you are on.
You are Melissa Mercado, born 1975-11-12, home ZIP code 64649.
Your member ID is on your insurance card; read it from the card when asked.
Ask whether your coverage is active and which plan you have. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document...
[ "DB", "COMMUNICATE" ]
[{"action_id": "eligibility-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000002", "date_of_birth": "1975-11-12"}}]
[ "silver ppo" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"insurance_card": {"member_name": "Melissa Mercado", "member_id": "M-SYNTH-000002", "plan": "Silver PPO", "group_number": "GRP-48213", "pcp": "Dr. Velazquez", "member_services_phone": "1-800-555-0142"}}}}}
{"id": "eligibility-01", "description": {"purpose": "eligibility", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You want to confirm you are covered and which plan you are...
eligibility-02
eligibility
core
false
Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.
You want to confirm you are covered and which plan you are on.
You are Daniel Ramos, born 1939-12-05, home ZIP code 41759.
Your member ID is on your insurance card; read it from the card when asked.
Ask whether your coverage is active and which plan you have. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document...
[ "DB", "COMMUNICATE" ]
[{"action_id": "eligibility-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000003", "date_of_birth": "1939-12-05"}}]
[ "bronze hmo" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"insurance_card": {"member_name": "Daniel Ramos", "member_id": "M-SYNTH-000003", "plan": "Bronze HMO", "group_number": "GRP-48213", "pcp": "Dr. Collins", "member_services_phone": "1-800-555-0142"}}}}}
{"id": "eligibility-02", "description": {"purpose": "eligibility", "notes": "confused"}, "user_scenario": {"persona": "Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.", "instructions": {"domain": "payerbench", "reas...
eligibility-03
eligibility
core
false
An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.
You want to confirm you are covered and which plan you are on.
You are Cathy Soto, born February 17, 1940, home ZIP code 07958.
Your member ID is on your insurance card; read it from the card when asked.
Ask whether your coverage is active and which plan you have. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document...
[ "DB", "COMMUNICATE" ]
[{"action_id": "eligibility-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000004", "date_of_birth": "1940-02-17"}}]
[ "medicare advantage choice" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"insurance_card": {"member_name": "Cathy Soto", "member_id": "M-SYNTH-000004", "plan": "Medicare Advantage Choice", "group_number": "GRP-48213", "pcp": "Dr. Alvarado", "member_services_phone": "1-800-555-0142"}}}}}
{"id": "eligibility-03", "description": {"purpose": "eligibility", "notes": "elderly"}, "user_scenario": {"persona": "An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.", "instructions": {"domain": "payerbench", ...
eligibility-04
eligibility
core
false
Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.
You want to confirm you are covered and which plan you are on.
You are Paul Young, born 1956-03-20, home ZIP code 02819.
Your member ID is on your insurance card; read it from the card when asked.
Ask whether your coverage is active and which plan you have. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document...
[ "DB", "COMMUNICATE" ]
[{"action_id": "eligibility-04_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000005", "date_of_birth": "1956-03-20"}}]
[ "medicare advantage choice" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"insurance_card": {"member_name": "Paul Young", "member_id": "M-SYNTH-000005", "plan": "Medicare Advantage Choice", "group_number": "GRP-48213", "pcp": "Dr. Morgan", "member_services_phone": "1-800-555-0142"}}}}}
{"id": "eligibility-04", "description": {"purpose": "eligibility", "notes": "spanish"}, "user_scenario": {"persona": "Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.", "instructions": {"domain": "payerbench", "reason_for_call": "You want to confirm you are cover...
eligibility_termed-01
eligibility_termed
core
true
Direct and polite. Answers questions briefly and does not volunteer extra details.
A clinic told you your coverage did not go through. You want to know if it is still active.
You are Jennifer Whitehead, born 1950-11-29, home ZIP code 28034. Your member ID is M-SYNTH-000010.
null
Ask whether your coverage is active. If it ended, ask when. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document ...
[ "DB", "COMMUNICATE", "NL_ASSERTION" ]
[{"action_id": "eligibility_termed-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000010", "date_of_birth": "1950-11-29"}}]
[]
[ "The agent tells the caller that their coverage is not active (it has ended)." ]
null
{"id": "eligibility_termed-01", "description": {"purpose": "eligibility termed", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "A clinic told you your coverage did not go t...
eligibility_termed-02
eligibility_termed
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
A clinic told you your coverage did not go through. You want to know if it is still active.
You are Margaret Velasquez, born 1949-01-06, home ZIP code 64543. Your member ID is M-SYNTH-000011.
null
Ask whether your coverage is active. If it ended, ask when. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document ...
[ "DB", "COMMUNICATE", "NL_ASSERTION" ]
[{"action_id": "eligibility_termed-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000011", "date_of_birth": "1949-01-06"}}]
[]
[ "The agent tells the caller that their coverage is not active (it has ended)." ]
null
{"id": "eligibility_termed-02", "description": {"purpose": "eligibility termed", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "A clinic told you your coverage did not go t...
deductible-01
deductible
core
true
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
You want to know how much more you have to pay before your deductible is met.
You are Maria Campbell, born 1943-03-17, home ZIP code 87960. Your member ID is M-SYNTH-000006.
null
Ask how much of your deductible you have met so far and how much is left. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "deductible-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000006", "date_of_birth": "1943-03-17"}}]
[ "177", "1323" ]
[]
null
{"id": "deductible-01", "description": {"purpose": "deductible", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_for_call":...
deductible-02
deductible
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You want to know how much more you have to pay before your deductible is met.
You are Michelle Williams, born 1952-04-22, home ZIP code 78001. Your member ID is M-SYNTH-000007.
null
Ask how much of your deductible you have met so far and how much is left. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "deductible-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000007", "date_of_birth": "1952-04-22"}}]
[ "664", "836" ]
[]
null
{"id": "deductible-02", "description": {"purpose": "deductible", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You want to know how much more you have to pay before your d...
deductible-03
deductible
core
false
Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.
You want to know how much more you have to pay before your deductible is met.
You are Eric Barnett, born 1971-09-03, home ZIP code 66884. Your member ID is M-SYNTH-000008.
null
Ask how much of your deductible you have met so far and how much is left. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "deductible-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000008", "date_of_birth": "1971-09-03"}}]
[ "1224", "276" ]
[]
null
{"id": "deductible-03", "description": {"purpose": "deductible", "notes": "confused"}, "user_scenario": {"persona": "Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.", "instructions": {"domain": "payerbench", "reason...
deductible-04
deductible
core
false
An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.
You want to know how much more you have to pay before your deductible is met.
You are Daniel Wheeler, born January 18, 2004, home ZIP code 49059. Your member ID is M-SYNTH-000013.
null
Ask how much of your deductible you have met so far and how much is left. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "deductible-04_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000013", "date_of_birth": "2004-01-18"}}]
[ "4843", "2157" ]
[]
null
{"id": "deductible-04", "description": {"purpose": "deductible", "notes": "elderly"}, "user_scenario": {"persona": "An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.", "instructions": {"domain": "payerbench", "r...
deductible-05
deductible
core
false
Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.
You want to know how much more you have to pay before your deductible is met.
You are Todd Smith, born 2003-09-01, home ZIP code 98063. Your member ID is M-SYNTH-000015.
null
Ask how much of your deductible you have met so far and how much is left. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "deductible-05_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000015", "date_of_birth": "2003-09-01"}}]
[ "3095", "3905" ]
[]
null
{"id": "deductible-05", "description": {"purpose": "deductible", "notes": "spanish"}, "user_scenario": {"persona": "Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.", "instructions": {"domain": "payerbench", "reason_for_call": "You want to know how much more you ...
claim_owed-01
claim_owed
core
true
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
You received an Explanation of Benefits and want to know what you owe for it.
You are Daniel Ramos, born 1939-12-05, home ZIP code 41759. Your member ID is M-SYNTH-000003.
The claim number is in your letter; read it when you need it.
Ask what you owe for the claim on your Explanation of Benefits letter. The claim number is in the letter. Once you know the amount you owe, end the call. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "claim_owed-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000003", "date_of_birth": "1939-12-05"}}]
[ "1756.04" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits", "body": "Claim C-12809450 for echocardiogram on 2026-04-15 with Dr. Edwin Brown. Billed $4,105.88. This is not a bill."}]}}}}
{"id": "claim_owed-01", "description": {"purpose": "claim owed", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_for_call":...
claim_owed-02
claim_owed
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You received an Explanation of Benefits and want to know what you owe for it.
You are the parent of Emily Walters, age 4, who is on your health plan. Your child was born 2022-09-11; home ZIP code 71972. Everything you ask about is your child's coverage. Your child's member ID is M-SYNTH-000016.
The claim number is in your letter; read it when you need it.
Ask what you owe for the claim on your Explanation of Benefits letter. The claim number is in the letter. Once you know the amount you owe, end the call. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "claim_owed-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000016", "date_of_birth": "2022-09-11"}}]
[ "1053.00" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits", "body": "Claim C-16648503 for manual therapy on 2026-09-09 with Dr. Edward Jackson. Billed $3,001.11. This is not a bill."}]}}}}
{"id": "claim_owed-02", "description": {"purpose": "claim owed", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You received an Explanation of Benefits and want to know wha...
claim_owed-03
claim_owed
core
false
Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.
You received an Explanation of Benefits and want to know what you owe for it.
You are Brian Green, born 1947-10-07, home ZIP code 60178. Your member ID is M-SYNTH-000035.
The claim number is in your letter; read it when you need it.
Ask what you owe for the claim on your Explanation of Benefits letter. The claim number is in the letter. Once you know the amount you owe, end the call. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "claim_owed-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000035", "date_of_birth": "1947-10-07"}}]
[ "1585.03" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits", "body": "Claim C-25227616 for echocardiogram on 2026-04-18 with Dr. Rachel Smith. Billed $4,208.39. This is not a bill."}]}}}}
{"id": "claim_owed-03", "description": {"purpose": "claim owed", "notes": "confused"}, "user_scenario": {"persona": "Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.", "instructions": {"domain": "payerbench", "reason...
claim_owed-04
claim_owed
core
false
An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.
You received an Explanation of Benefits and want to know what you owe for it.
You are the parent of Alexis Ayers, age 8, who is on your health plan. Your child was born March 8, 2018; home ZIP code 35331. Everything you ask about is your child's coverage. Your child's member ID is M-SYNTH-000001.
The claim number is in your letter; read it when you need it.
Ask what you owe for the claim on your Explanation of Benefits letter. The claim number is in the letter. Once you know the amount you owe, end the call. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "claim_owed-04_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000001", "date_of_birth": "2018-03-08"}}]
[ "1215.74" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits", "body": "Claim C-25515684 for therapeutic exercise on 2026-09-19 with Dr. Catherine Ball. Billed $1,930.70. This is not a bill."}]}}}}
{"id": "claim_owed-04", "description": {"purpose": "claim owed", "notes": "elderly"}, "user_scenario": {"persona": "An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.", "instructions": {"domain": "payerbench", "r...
claim_owed-05
claim_owed
core
false
Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.
You received an Explanation of Benefits and want to know what you owe for it.
You are the parent of Justin Owens, age 15, who is on your health plan. Your child was born 2010-12-09; home ZIP code 77627. Everything you ask about is your child's coverage. Your child's member ID is M-SYNTH-000023.
The claim number is in your letter; read it when you need it.
Ask what you owe for the claim on your Explanation of Benefits letter. The claim number is in the letter. Once you know the amount you owe, end the call. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "claim_owed-05_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000023", "date_of_birth": "2010-12-09"}}]
[ "485.00" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits", "body": "Claim C-26057190 for knee arthroscopy on 2026-09-03 with Dr. Joshua Russo. Billed $3,980.18. This is not a bill."}]}}}}
{"id": "claim_owed-05", "description": {"purpose": "claim owed", "notes": "spanish"}, "user_scenario": {"persona": "Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.", "instructions": {"domain": "payerbench", "reason_for_call": "You received an Explanation of Bene...
appeal-01
appeal
core
true
Direct and polite. Answers questions briefly and does not volunteer extra details.
One of your claims was denied and you want to appeal it.
You are Dean Warren, born 1940-05-31, home ZIP code 47355. Your member ID is M-SYNTH-000024. Your doctor said the service was medically necessary and you disagree with the denial.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter, explain why you disagree when asked, and ask for a confirmation number. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "appeal-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000024", "date_of_birth": "1940-05-31"}}, {"action_id": "appeal-01_1", "requestor": "assistant", "name": "file_appeal", "arguments": {"claim_id": "C-11086116", "reason": "disagree_medical_necessity"}}]
[ "APL-11086116" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-11086116 for lesion destruction on 2026-07-08 with Dr. Jimmy Harding was denied on 2026-08-03. Reason: Not deemed medically necessary by payer. You may appeal within 180 ...
{"id": "appeal-01", "description": {"purpose": "appeal", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "One of your claims was denied and you want to appeal it.", "known_in...
appeal-02
appeal
core
false
Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.
One of your claims was denied and you want to appeal it.
You are Keith Rodriguez, born 1952-12-26, home ZIP code 40894. Your member ID is M-SYNTH-000028. Your doctor's office told you they got a prior authorization before the service.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter, explain why you disagree when asked, and ask for a confirmation number. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "appeal-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000028", "date_of_birth": "1952-12-26"}}, {"action_id": "appeal-02_1", "requestor": "assistant", "name": "file_appeal", "arguments": {"claim_id": "C-22885368", "reason": "prior_auth_was_obtained"}}]
[ "APL-22885368" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-22885368 for therapeutic exercise on 2026-09-17 with Dr. George Dalton was denied on 2026-10-17. Reason: Deductible amount. You may appeal within 180 days of the date of ...
{"id": "appeal-02", "description": {"purpose": "appeal", "notes": "confused"}, "user_scenario": {"persona": "Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.", "instructions": {"domain": "payerbench", "reason_for_cal...
appeal-03
appeal
core
false
Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.
One of your claims was denied and you want to appeal it.
You are Jason Norris, born 1943-04-11, home ZIP code 01950. Your member ID is M-SYNTH-000029. You think the provider's office billed it with the wrong code.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter, explain why you disagree when asked, and ask for a confirmation number. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "appeal-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000029", "date_of_birth": "1943-04-11"}}, {"action_id": "appeal-03_1", "requestor": "assistant", "name": "file_appeal", "arguments": {"claim_id": "C-44780025", "reason": "billing_or_coding_error"}}]
[ "APL-44780025" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-44780025 for electrocardiogram on 2026-05-16 with Dr. James Gomez was denied on 2026-06-14. Reason: Not deemed medically necessary by payer. You may appeal within 180 day...
{"id": "appeal-03", "description": {"purpose": "appeal", "notes": "spanish"}, "user_scenario": {"persona": "Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.", "instructions": {"domain": "payerbench", "reason_for_call": "One of your claims was denied and you want ...
appeal-04
appeal
core
false
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
One of your claims was denied and you want to appeal it.
You are Margaret Velasquez, born 1949-01-06, home ZIP code 64543. Your member ID is M-SYNTH-000011. You checked the directory before the visit and the provider was listed as in network.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter, explain why you disagree when asked, and ask for a confirmation number. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "appeal-04_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000011", "date_of_birth": "1949-01-06"}}, {"action_id": "appeal-04_1", "requestor": "assistant", "name": "file_appeal", "arguments": {"claim_id": "C-55192567", "reason": "provider_should_be_in_network"...
[ "APL-55192567" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-55192567 for therapeutic exercise on 2026-05-30 with Dr. Travis Allen was denied on 2026-06-14. Reason: Not deemed medically necessary by payer. You may appeal within 180...
{"id": "appeal-04", "description": {"purpose": "appeal", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_for_call": "One of...
appeal-05
appeal
core
false
An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.
One of your claims was denied and you want to appeal it.
You are Brian Green, born October 7, 1947, home ZIP code 60178. Your member ID is M-SYNTH-000035. Your doctor said the service was medically necessary and you disagree with the denial.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter, explain why you disagree when asked, and ask for a confirmation number. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "appeal-05_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000035", "date_of_birth": "1947-10-07"}}, {"action_id": "appeal-05_1", "requestor": "assistant", "name": "file_appeal", "arguments": {"claim_id": "C-55846090", "reason": "disagree_medical_necessity"}}]
[ "APL-55846090" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-55846090 for echocardiogram on 2026-05-15 with Dr. Melanie Baker was denied on 2026-06-08. Reason: Bundled into another service already adjudicated. You may appeal within...
{"id": "appeal-05", "description": {"purpose": "appeal", "notes": "elderly"}, "user_scenario": {"persona": "An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.", "instructions": {"domain": "payerbench", "reason_fo...
appeal-06
appeal
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
One of your claims was denied and you want to appeal it.
You are Todd Smith, born 2003-09-01, home ZIP code 98063. Your member ID is M-SYNTH-000015. Your doctor's office told you they got a prior authorization before the service.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter, explain why you disagree when asked, and ask for a confirmation number. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "appeal-06_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000015", "date_of_birth": "2003-09-01"}}, {"action_id": "appeal-06_1", "requestor": "assistant", "name": "file_appeal", "arguments": {"claim_id": "C-61051337", "reason": "prior_auth_was_obtained"}}]
[ "APL-61051337" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-61051337 for hemoglobin a1c on 2026-08-31 with Dr. Austin Henson was denied on 2026-09-14. Reason: Deductible amount. You may appeal within 180 days of the date of this n...
{"id": "appeal-06", "description": {"purpose": "appeal", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "One of your claims was denied and you want to appeal it.", "known_in...
appeal-07
appeal
core
false
Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.
One of your claims was denied and you want to appeal it.
You are Deborah Gonzales, born 1956-08-18, home ZIP code 22066. Your member ID is M-SYNTH-000012. You think the provider's office billed it with the wrong code.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter, explain why you disagree when asked, and ask for a confirmation number. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "appeal-07_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000012", "date_of_birth": "1956-08-18"}}, {"action_id": "appeal-07_1", "requestor": "assistant", "name": "file_appeal", "arguments": {"claim_id": "C-64279950", "reason": "billing_or_coding_error"}}]
[ "APL-64279950" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-64279950 for manual therapy on 2026-08-24 with Dr. Catherine Ball was denied on 2026-09-08. Reason: Bundled into another service already adjudicated. You may appeal withi...
{"id": "appeal-07", "description": {"purpose": "appeal", "notes": "confused"}, "user_scenario": {"persona": "Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.", "instructions": {"domain": "payerbench", "reason_for_cal...
appeal-08
appeal
core
false
Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.
One of your claims was denied and you want to appeal it.
You are David Richards, born 1953-09-19, home ZIP code 03843. Your member ID is M-SYNTH-000030. You checked the directory before the visit and the provider was listed as in network.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter, explain why you disagree when asked, and ask for a confirmation number. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "appeal-08_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000030", "date_of_birth": "1953-09-19"}}, {"action_id": "appeal-08_1", "requestor": "assistant", "name": "file_appeal", "arguments": {"claim_id": "C-72958231", "reason": "provider_should_be_in_network"...
[ "APL-72958231" ]
[]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-72958231 for electrocardiogram on 2026-05-24 with Dr. Erin Rodriguez was denied on 2026-06-22. Reason: Precertification/authorization absent. You may appeal within 180 da...
{"id": "appeal-08", "description": {"purpose": "appeal", "notes": "spanish"}, "user_scenario": {"persona": "Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.", "instructions": {"domain": "payerbench", "reason_for_call": "One of your claims was denied and you want ...
appeal_expired-01
appeal_expired
core
true
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
One of your claims was denied a while ago and you want to appeal it now.
You are the parent of Carolyn Sutton, age 17, who is on your health plan. Your child was born 2009-06-30; home ZIP code 40441. Everything you ask about is your child's coverage. Your child's member ID is M-SYNTH-000026. You only just found the letter.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter. Insist at least once if the agent says no. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the...
[ "DB", "COMMUNICATE", "NL_ASSERTION" ]
[{"action_id": "appeal_expired-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000026", "date_of_birth": "2009-06-30"}}]
[]
[ "The agent does not tell the caller that an appeal was filed.", "The agent explains that the 180-day appeal window for this claim has passed." ]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-21305488 for electrocardiogram on 2026-03-06 with Dr. Juan Bell was denied on 2026-03-22. Reason: Not deemed medically necessary by payer. You may appeal within 180 days ...
{"id": "appeal_expired-01", "description": {"purpose": "appeal expired", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_fo...
appeal_expired-02
appeal_expired
core
false
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
One of your claims was denied a while ago and you want to appeal it now.
You are Daniel Ramos, born 1939-12-05, home ZIP code 41759. Your member ID is M-SYNTH-000003. You only just found the letter.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter. Insist at least once if the agent says no. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the...
[ "DB", "COMMUNICATE", "NL_ASSERTION" ]
[{"action_id": "appeal_expired-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000003", "date_of_birth": "1939-12-05"}}]
[]
[ "The agent does not tell the caller that an appeal was filed.", "The agent explains that the 180-day appeal window for this claim has passed." ]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-49447089 for manual therapy on 2026-01-31 with Dr. John Hill was denied on 2026-02-28. Reason: Not deemed medically necessary by payer. You may appeal within 180 days of ...
{"id": "appeal_expired-02", "description": {"purpose": "appeal expired", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_fo...
appeal_expired-03
appeal_expired
core
false
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
One of your claims was denied a while ago and you want to appeal it now.
You are Todd Smith, born 2003-09-01, home ZIP code 98063. Your member ID is M-SYNTH-000015. You only just found the letter.
The claim number is in your denial letter.
Ask the agent to file an appeal on the denied claim in your letter. Insist at least once if the agent says no. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the...
[ "DB", "COMMUNICATE", "NL_ASSERTION" ]
[{"action_id": "appeal_expired-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000015", "date_of_birth": "2003-09-01"}}]
[]
[ "The agent does not tell the caller that an appeal was filed.", "The agent explains that the 180-day appeal window for this claim has passed." ]
{"initialization_data": {"agent_data": null, "user_data": {"caller": {"letters": [{"title": "Explanation of Benefits: claim denied", "body": "Claim C-51870318 for echocardiogram on 2026-02-15 with Dr. Rachel Smith was denied on 2026-03-02. Reason: Bundled into another service already adjudicated. You may appeal within ...
{"id": "appeal_expired-03", "description": {"purpose": "appeal expired", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_fo...
address_change-01
address_change
core
true
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
You moved and need to update your mailing address.
You are Michelle Williams, born 1943-06-25, home ZIP code 96466. Your member ID is M-SYNTH-000009. Your new address is 77 Birch Ln, Sandy, UT 84070.
null
Ask the agent to update your mailing address. Give the new address exactly as written. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, an...
[ "DB", "COMMUNICATE" ]
[{"action_id": "address_change-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000009", "date_of_birth": "1943-06-25"}}, {"action_id": "address_change-01_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000009", "street": "7...
[]
[]
null
{"id": "address_change-01", "description": {"purpose": "address change", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_fo...
address_change-02
address_change
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You moved and need to update your mailing address.
You are Douglas Williams, born 1963-06-15, home ZIP code 98260. Your member ID is M-SYNTH-000018. Your new address is 1450 E Fort Union Blvd Apt 12, Cottonwood Heights, UT 84121.
null
Ask the agent to update your mailing address. Give the new address exactly as written. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, an...
[ "DB", "COMMUNICATE" ]
[{"action_id": "address_change-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000018", "date_of_birth": "1963-06-15"}}, {"action_id": "address_change-02_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000018", "street": "1...
[]
[]
null
{"id": "address_change-02", "description": {"purpose": "address change", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You moved and need to update your mailing address.",...
address_change-03
address_change
core
false
Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.
You moved and need to update your mailing address.
You are Steven Jackson, born 1948-09-07, home ZIP code 41779. Your member ID is M-SYNTH-000019. Your new address is 9 Canyon Rd, Ogden, UT 84401.
null
Ask the agent to update your mailing address. Give the new address exactly as written. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, an...
[ "DB", "COMMUNICATE" ]
[{"action_id": "address_change-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000019", "date_of_birth": "1948-09-07"}}, {"action_id": "address_change-03_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000019", "street": "9...
[]
[]
null
{"id": "address_change-03", "description": {"purpose": "address change", "notes": "confused"}, "user_scenario": {"persona": "Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.", "instructions": {"domain": "payerbench",...
address_change-04
address_change
core
false
An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.
You moved and need to update your mailing address.
You are Ronald Wheeler, born June 10, 1952, home ZIP code 65482. Your member ID is M-SYNTH-000020. Your new address is 220 S 200 E Unit 5, Salt Lake City, UT 84111.
null
Ask the agent to update your mailing address. Give the new address exactly as written. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, an...
[ "DB", "COMMUNICATE" ]
[{"action_id": "address_change-04_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000020", "date_of_birth": "1952-06-10"}}, {"action_id": "address_change-04_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000020", "street": "2...
[]
[]
null
{"id": "address_change-04", "description": {"purpose": "address change", "notes": "elderly"}, "user_scenario": {"persona": "An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.", "instructions": {"domain": "payerbe...
address_change-05
address_change
core
false
Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.
You moved and need to update your mailing address.
You are Julie Williams, born 1942-02-27, home ZIP code 51483. Your member ID is M-SYNTH-000022. Your new address is 31 Juniper Ct, Provo, UT 84604.
null
Ask the agent to update your mailing address. Give the new address exactly as written. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, an...
[ "DB", "COMMUNICATE" ]
[{"action_id": "address_change-05_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000022", "date_of_birth": "1942-02-27"}}, {"action_id": "address_change-05_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000022", "street": "3...
[]
[]
null
{"id": "address_change-05", "description": {"purpose": "address change", "notes": "spanish"}, "user_scenario": {"persona": "Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.", "instructions": {"domain": "payerbench", "reason_for_call": "You moved and need to updat...
phone_change-01
phone_change
core
true
Direct and polite. Answers questions briefly and does not volunteer extra details.
You changed phone numbers.
You are Jennifer Jordan, born 1972-01-30, home ZIP code 45969. Your member ID is M-SYNTH-000025. Your new phone number is 801-555-0131.
null
Ask the agent to update the phone number on file. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document in the sam...
[ "DB", "COMMUNICATE" ]
[{"action_id": "phone_change-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000025", "date_of_birth": "1972-01-30"}}, {"action_id": "phone_change-01_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000025", "phone": "801-55...
[]
[]
null
{"id": "phone_change-01", "description": {"purpose": "phone change", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You changed phone numbers.", "known_info": "You are Jenn...
phone_change-02
phone_change
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You changed phone numbers.
You are Julia Brown, born 1951-07-22, home ZIP code 65635. Your member ID is M-SYNTH-000027. Your new phone number is (385) 555-0177.
null
Ask the agent to update the phone number on file. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document in the sam...
[ "DB", "COMMUNICATE" ]
[{"action_id": "phone_change-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000027", "date_of_birth": "1951-07-22"}}, {"action_id": "phone_change-02_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000027", "phone": "(385) ...
[]
[]
null
{"id": "phone_change-02", "description": {"purpose": "phone change", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You changed phone numbers.", "known_info": "You are Juli...
phone_change-03
phone_change
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You changed phone numbers.
You are Matthew Santiago, born 1951-12-30, home ZIP code 17757. Your member ID is M-SYNTH-000031. Your new phone number is 801.555.0199.
null
Ask the agent to update the phone number on file. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same document twice, and never look at a document in the sam...
[ "DB", "COMMUNICATE" ]
[{"action_id": "phone_change-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000031", "date_of_birth": "1951-12-30"}}, {"action_id": "phone_change-03_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000031", "phone": "801.55...
[]
[]
null
{"id": "phone_change-03", "description": {"purpose": "phone change", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You changed phone numbers.", "known_info": "You are Matt...
id_card-01
id_card
core
true
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
You need a replacement insurance card.
You are Margaret Rivera, born 1957-04-19, home ZIP code 69848. You lost your card.
You do not know your member ID.
Ask for a replacement card sent to the address on file. You do not know your member ID; give your name, date of birth and ZIP code instead. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "id_card-01_0", "requestor": "assistant", "name": "find_member_id", "arguments": {"first_name": "Margaret", "last_name": "Rivera", "date_of_birth": "1957-04-19", "zip_code": "69848"}}, {"action_id": "id_card-01_1", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-0...
[]
[]
null
{"id": "id_card-01", "description": {"purpose": "id card", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_for_call": "You ...
id_card-02
id_card
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You need a replacement insurance card.
You are James James, born 1948-07-10, home ZIP code 61807. Your card went through the wash and is unreadable.
You do not know your member ID.
Ask for a replacement card sent to the address on file. You do not know your member ID; give your name, date of birth and ZIP code instead. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "id_card-02_0", "requestor": "assistant", "name": "find_member_id", "arguments": {"first_name": "James", "last_name": "James", "date_of_birth": "1948-07-10", "zip_code": "61807"}}, {"action_id": "id_card-02_1", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-00003...
[]
[]
null
{"id": "id_card-02", "description": {"purpose": "id card", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You need a replacement insurance card.", "known_info": "You are Ja...
id_card-03
id_card
core
false
Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.
You need a replacement insurance card.
You are Tiffany Sullivan, born 2004-07-23, home ZIP code 20835. You never received a card after enrolling.
You do not know your member ID.
Ask for a replacement card sent to the address on file. You do not know your member ID; give your name, date of birth and ZIP code instead. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "id_card-03_0", "requestor": "assistant", "name": "find_member_id", "arguments": {"first_name": "Tiffany", "last_name": "Sullivan", "date_of_birth": "2004-07-23", "zip_code": "20835"}}, {"action_id": "id_card-03_1", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-...
[]
[]
null
{"id": "id_card-03", "description": {"purpose": "id card", "notes": "confused"}, "user_scenario": {"persona": "Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.", "instructions": {"domain": "payerbench", "reason_for_c...
id_card-04
id_card
core
false
An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.
You need a replacement insurance card.
You are Xavier Christian, born May 20, 1945, home ZIP code 52764. You lost your card.
You do not know your member ID.
Ask for a replacement card sent to the address on file. You do not know your member ID; give your name, date of birth and ZIP code instead. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "id_card-04_0", "requestor": "assistant", "name": "find_member_id", "arguments": {"first_name": "Xavier", "last_name": "Christian", "date_of_birth": "1945-05-20", "zip_code": "52764"}}, {"action_id": "id_card-04_1", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-...
[]
[]
null
{"id": "id_card-04", "description": {"purpose": "id card", "notes": "elderly"}, "user_scenario": {"persona": "An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.", "instructions": {"domain": "payerbench", "reason_...
id_card_new_address-01
id_card_new_address
core
true
Direct and polite. Answers questions briefly and does not volunteer extra details.
You lost your card and you have also moved.
You are Jesse Davis, born 1997-04-04, home ZIP code 91868. Your member ID is M-SYNTH-000040. Your new address is 220 S 200 E Unit 5, Salt Lake City, UT 84111.
null
Ask for a replacement card for a lost card, sent to your new address. Do not mention that the address on file is old unless the agent asks where to send it. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you ne...
[ "DB", "COMMUNICATE" ]
[{"action_id": "id_card_new_address-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000040", "date_of_birth": "1997-04-04"}}, {"action_id": "id_card_new_address-01_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000040", "s...
[]
[]
null
{"id": "id_card_new_address-01", "description": {"purpose": "id card new address", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You lost your card and you have also moved...
id_card_new_address-02
id_card_new_address
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You lost your card and you have also moved.
You are Melissa Mercado, born 1975-11-12, home ZIP code 64649. Your member ID is M-SYNTH-000002. Your new address is 31 Juniper Ct, Provo, UT 84604.
null
Ask for a replacement card for a lost card, sent to your new address. Do not mention that the address on file is old unless the agent asks where to send it. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you ne...
[ "DB", "COMMUNICATE" ]
[{"action_id": "id_card_new_address-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000002", "date_of_birth": "1975-11-12"}}, {"action_id": "id_card_new_address-02_1", "requestor": "assistant", "name": "update_contact_info", "arguments": {"member_id": "M-SYNTH-000002", "s...
[]
[]
null
{"id": "id_card_new_address-02", "description": {"purpose": "id card new address", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You lost your card and you have also moved...
pcp_change-01
pcp_change
core
true
Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.
You want to change your primary care doctor.
You are Cathy Soto, born 1940-02-17, home ZIP code 07958. Your member ID is M-SYNTH-000004. A friend recommended Dr. Christine May, whose office is in ZIP 84121.
null
Ask to change your primary care provider to Dr. Christine May. If the agent lists doctors, choose that one. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the sa...
[ "DB", "COMMUNICATE" ]
[{"action_id": "pcp_change-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000004", "date_of_birth": "1940-02-17"}}, {"action_id": "pcp_change-01_1", "requestor": "assistant", "name": "change_pcp", "arguments": {"member_id": "M-SYNTH-000004", "npi": "1912136755"}}]
[]
[]
null
{"id": "pcp_change-01", "description": {"purpose": "pcp change", "notes": "spanish"}, "user_scenario": {"persona": "Native Spanish speaker with limited English. Writes only in Spanish, even if the agent writes in English.", "instructions": {"domain": "payerbench", "reason_for_call": "You want to change your primary car...
pcp_change-02
pcp_change
core
false
Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.
You want to change your primary care doctor.
You are Paul Young, born 1956-03-20, home ZIP code 02819. Your member ID is M-SYNTH-000005. A friend recommended Dr. Rachel Fry, whose office is in ZIP 84115.
null
Ask to change your primary care provider to Dr. Rachel Fry. If the agent lists doctors, choose that one. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "pcp_change-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000005", "date_of_birth": "1956-03-20"}}, {"action_id": "pcp_change-02_1", "requestor": "assistant", "name": "change_pcp", "arguments": {"member_id": "M-SYNTH-000005", "npi": "1920153809"}}]
[]
[]
null
{"id": "pcp_change-02", "description": {"purpose": "pcp change", "notes": "adversarial"}, "user_scenario": {"persona": "Impatient and pushy. Demands results, threatens to complain or cancel, and tries to get the agent to bend the rules before accepting a no.", "instructions": {"domain": "payerbench", "reason_for_call":...
pcp_change-03
pcp_change
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You want to change your primary care doctor.
You are Maria Campbell, born 1943-03-17, home ZIP code 87960. Your member ID is M-SYNTH-000006. A friend recommended Dr. Alan West, whose office is in ZIP 84101.
null
Ask to change your primary care provider to Dr. Alan West. If the agent lists doctors, choose that one. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the same d...
[ "DB", "COMMUNICATE" ]
[{"action_id": "pcp_change-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000006", "date_of_birth": "1943-03-17"}}, {"action_id": "pcp_change-03_1", "requestor": "assistant", "name": "change_pcp", "arguments": {"member_id": "M-SYNTH-000006", "npi": "1943199778"}}]
[]
[]
null
{"id": "pcp_change-03", "description": {"purpose": "pcp change", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You want to change your primary care doctor.", "known_info":...
pcp_change-04
pcp_change
core
false
Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.
You want to change your primary care doctor.
You are Michelle Williams, born 1952-04-22, home ZIP code 78001. Your member ID is M-SYNTH-000007. A friend recommended Dr. Duane Schneider, whose office is in ZIP 84111.
null
Ask to change your primary care provider to Dr. Duane Schneider. If the agent lists doctors, choose that one. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at the ...
[ "DB", "COMMUNICATE" ]
[{"action_id": "pcp_change-04_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000007", "date_of_birth": "1952-04-22"}}, {"action_id": "pcp_change-04_1", "requestor": "assistant", "name": "change_pcp", "arguments": {"member_id": "M-SYNTH-000007", "npi": "1958011926"}}]
[]
[]
null
{"id": "pcp_change-04", "description": {"purpose": "pcp change", "notes": "confused"}, "user_scenario": {"persona": "Easily confused. Mixes up claims and dates, asks the agent to repeat or explain things, and sometimes gives details out of order or corrects themselves.", "instructions": {"domain": "payerbench", "reason...
pa_expedite-01
pa_expedite
core
true
Direct and polite. Answers questions briefly and does not volunteer extra details.
You are waiting on a prior authorization for CT abdomen.
You are Melissa Mercado, born 1975-11-12, home ZIP code 64649. Your member ID is M-SYNTH-000002. Your doctor told you that waiting much longer for this could seriously harm your health.
null
Ask about the status of the request and whether it can be sped up. Mention what your doctor said if the agent asks why. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never lo...
[ "DB", "COMMUNICATE" ]
[{"action_id": "pa_expedite-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000002", "date_of_birth": "1975-11-12"}}, {"action_id": "pa_expedite-01_1", "requestor": "assistant", "name": "request_expedited_review", "arguments": {"auth_id": "PA-171970"}}]
[ "72" ]
[]
null
{"id": "pa_expedite-01", "description": {"purpose": "pa expedite", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You are waiting on a prior authorization for CT abdomen.",...
pa_expedite-02
pa_expedite
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You are waiting on a prior authorization for sleep study.
You are Xavier Christian, born 1945-05-20, home ZIP code 52764. Your member ID is M-SYNTH-000038. Your doctor told you that waiting much longer for this could seriously harm your health.
null
Ask about the status of the request and whether it can be sped up. Mention what your doctor said if the agent asks why. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never lo...
[ "DB", "COMMUNICATE" ]
[{"action_id": "pa_expedite-02_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000038", "date_of_birth": "1945-05-20"}}, {"action_id": "pa_expedite-02_1", "requestor": "assistant", "name": "request_expedited_review", "arguments": {"auth_id": "PA-231819"}}]
[ "72" ]
[]
null
{"id": "pa_expedite-02", "description": {"purpose": "pa expedite", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You are waiting on a prior authorization for sleep study."...
pa_expedite-03
pa_expedite
core
false
Direct and polite. Answers questions briefly and does not volunteer extra details.
You are waiting on a prior authorization for CT abdomen.
You are Michelle Williams, born 1943-06-25, home ZIP code 96466. Your member ID is M-SYNTH-000009. Your doctor told you that waiting much longer for this could seriously harm your health.
null
Ask about the status of the request and whether it can be sped up. Mention what your doctor said if the agent asks why. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never lo...
[ "DB", "COMMUNICATE" ]
[{"action_id": "pa_expedite-03_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000009", "date_of_birth": "1943-06-25"}}, {"action_id": "pa_expedite-03_1", "requestor": "assistant", "name": "request_expedited_review", "arguments": {"auth_id": "PA-405113"}}]
[ "72" ]
[]
null
{"id": "pa_expedite-03", "description": {"purpose": "pa expedite", "notes": "plain"}, "user_scenario": {"persona": "Direct and polite. Answers questions briefly and does not volunteer extra details.", "instructions": {"domain": "payerbench", "reason_for_call": "You are waiting on a prior authorization for CT abdomen.",...
pa_status-01
pa_status
core
true
An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.
You want to know whether your sleep study has been authorized.
You are Ronald Wheeler, born 1952-06-10, home ZIP code 65482. Your member ID is M-SYNTH-000020.
null
Ask for the status of your prior authorization. You are not in any urgent situation; do not ask to speed it up. Only share a piece of information when the agent asks for it or when it is needed for your request. Look at your card, letters or practice details only when you need a detail you do not know, never look at th...
[ "DB", "COMMUNICATE", "NL_ASSERTION" ]
[{"action_id": "pa_status-01_0", "requestor": "assistant", "name": "verify_identity", "arguments": {"member_id": "M-SYNTH-000020", "date_of_birth": "1952-06-10"}}]
[]
[ "The agent tells the caller that the prior authorization is still pending (not yet decided)." ]
null
{"id": "pa_status-01", "description": {"purpose": "pa status", "notes": "elderly"}, "user_scenario": {"persona": "An older caller, polite and unhurried. Hard of hearing, asks for things to be repeated, and reads numbers off documents slowly, sometimes in groups of digits.", "instructions": {"domain": "payerbench", "rea...
End of preview. Expand in Data Studio

PayerBench

A τ²-bench domain for health-plan member services: a written policy, a synthetic plan database, 15 agent tools, 3 caller tools and 104 simulated calls. An LLM plays the member (or a provider office) with a hidden goal; the agent under test follows the policy and calls tools; the call is scored on the final state of the database, on facts the agent must state, and, for 32 tasks, on written assertions checked by an LLM judge.

Code to run it: github.com/knotkeep/payerbench.

Subsets

subset rows one row is
tasks 104 a simulated call: persona, what the caller knows, instructions, reference actions, required facts, judge assertions
results 1,080 one simulation from the leaderboard runs, with its reward, failure reasons and full transcript
leaderboard 8 pass^1 to pass^4 for one agent on one tier

Plain files: db.json (the starting database), policy.md (the agent's policy), split_tasks.json (smoke 33, core 73, hard 31, full 104).

Nested fields (reference_actions, initial_state, task_json, messages) are JSON strings. task_json is the task exactly as τ²-bench loads it.

Leaderboard (October 2026, 4 trials per task)

pass^k is the share of tasks solved in all k of k attempts.

agent tier tasks pass^1 pass^4 agent cost
Claude Haiku 5.5 hard 31 0.992 0.968 $0.62
Claude Sonnet 5.5 hard 31 0.984 0.935 $12.10
Gemma 4 31B 8-bit (local) full 104 0.925 0.875 $0
Gemma 4 31B 8-bit (local) hard 31 0.798 0.774 $0
Qwen3.8-Flash-Next 4-bit (local) full 104 0.858 0.673 $0
Qwen3.8-Flash-Next 4-bit (local) hard 31 0.887 0.710 $0

Agents ran as τ²'s standard llm_agent. Every agent faced the same simulated caller (Gemma 4 31B 8-bit, temperature 0.7) and the same judge (Gemma 4 31B 8-bit, temperature 0). Local models were served by oMLX on a Mac Studio; Claude models ran over the Anthropic API with default settings.

Scoring

  • Database: τ² replays the task's reference actions on a fresh copy of the database and compares hashes with the agent's final database. Identity verification is a recorded write, so verifying the wrong person fails the task. Free text is stored as codes and addresses and phones are normalized, so the hash measures what was done, not how it was worded.
  • Required facts: each string in communicate_info must appear in an agent message (case and commas ignored). Only language-neutral tokens are used: amounts as digits, plan names, IDs.
  • Written assertions: an LLM judge checks nl_assertions where neither of the above can see the failure (a refusal, a disclosure, a false approval).

Caveats

  • Saturated for frontier models: v1 does not separate Claude Haiku 5.5 from Sonnet 5.5.
  • One simulated caller and one judge, both Gemma 4 31B. Results with a different caller or judge are a new baseline.
  • The policy and tasks were written by the benchmark's author; the hard tier was designed after seeing where Gemma succeeded.
  • Four trials per task; a single flip moves a hard-tier row by 3 to 12 points.

Data and license

All member, claim, prior-authorization and provider records are synthetic, generated with fixed seeds; no real person's data is included. MIT license. τ²-bench is MIT-licensed by Sierra Research.

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