{"txn_id":"HL-CLM-1019","assessment_id":"ra_77ab7a88e936429b","occurred_at":"2026-09-26T17:05:58+00:00","state":"NY","line_of_business":"health","stage":"claims","program_area":"Claims/Adjudication","ai_system":{"system_id":"claims-adjud","model_version":"5.1","vendor":"internal","vendor_name":null,"high_risk_class":"claims"},"inputs":{"feature_classes":["medical_records","claims_history"],"protected_factors_used":[],"ecdis_present":false,"consumer_report_used":false,"credit_used":false,"data_source_refs":[],"consumer_token":"tok_148e70c54d"},"output":{"decision":"pay","score":0.052,"reason_codes":[],"premium_delta_pct":null},"human_involvement":{"reviewed":false,"reviewer_role":null,"overridden":false},"adverse_action":{"is_adverse":false,"notice_sent_at":null,"reasons_provided":false,"specific_reasons":false,"ecdis_disclosed":false,"appeal_channel":null},"carrier_note":null,"input":{"revision":1,"current_revision":1,"input_digest":"d1fc6de160a29f1e0e86b846abb1cd2099e886e348165a3bcbe08c1fd12674f7","digest_ok":true,"note":"input_digest is SHA-256 over the canonical JSON of the transaction revision assessed; it is inside the assessment the ledger hashes."},"assessment":{"disposition":"PASS","coverage":{"status":"unsupported","state_rules_applied":0,"general_rules_applied":0,"advisory_rules_applied":1,"rules_considered":30,"rules_applied":["doctrine.unreviewed-adverse-high-risk"],"statement":"No black-letter rule in the pack covers a NY health claims transaction. Nothing binding was checked, so no disposition here says anything about compliance."},"evidence":{"status":"carrier_asserted","asserted":["ai_system.governance_attested","ai_system.model_doc_ref","ai_system.testing_report_ref"],"missing":[],"statement":"Supplied by the carrier and not verified by RegBench: ai_system.governance_attested, ai_system.model_doc_ref, ai_system.testing_report_ref."},"summary":"PASS: 0 finding(s) under rules 2026.10+c4982313, corpus 2026-10-30-9c5dad5a. No configured check fired; the case file is recorded. This is not a compliance conclusion. Coverage unsupported: No black-letter rule in the pack covers a NY health claims transaction. Nothing binding was checked, so no disposition here says anything about compliance.","narrative":"On 2026-09-26, claims-adjud v5.1 (an internally developed system) produced 'pay' in a NY health claims transaction. Inputs included medical records, claims history. No human reviewed the output before it took effect. The outcome was not adverse to the consumer. RegBench applied 1 rule(s) in force on 2026-09-26 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-09-26","basis":"transaction_date","rules_version":"2026.10+c4982313","corpus_snapshot":"2026-10-30-9c5dad5a","engine_version":"regbench-engine/0.5.0","model_version":"deterministic-1"},"evaluated_at":"2026-10-31T05:42:55.783616+00:00","fingerprint":"386d0fc0b5c787d70b91f07a"},"review":null,"ledger":{"seq":6522,"hash":"b558eb96adb3dbd5b22c70041a5bc92a012868973d90ab716310f1d4c097bb88","prev_hash":"9a5cc669baa2ac997618f129cd626f1fd35db4f3ab0da470b597b1bf636a4377","recorded_at":"2026-09-26T17:08:49+00:00"}}