{"txn_id":"HL-CLM-1026","assessment_id":"ra_6d7dc0f93dd441b9","occurred_at":"2026-07-17T00:31:21+00:00","state":"TX","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_e0ad06ede2"},"output":{"decision":"deny","score":0.78,"reason_codes":["E-114"],"premium_delta_pct":null},"human_involvement":{"reviewed":true,"reviewer_role":"adjuster","overridden":false},"adverse_action":{"is_adverse":true,"notice_sent_at":null,"reasons_provided":true,"specific_reasons":false,"ecdis_disclosed":false,"appeal_channel":null},"carrier_note":null,"assessment":{"disposition":"PASS","summary":"PASS: 0 finding(s) under rules 2026.10+dbe5ddf6, corpus 2026-10-30-5f07c521. No regulatory finding; the case file is recorded.","narrative":"On 2026-07-17, claims-adjud v5.1 (an internally developed system) produced 'deny' in a TX health claims transaction. Inputs included medical records, claims history. A human reviewed the output by a adjuster. The outcome was adverse to the consumer; no notice to the consumer is recorded. RegBench applied 7 rule(s) in force on 2026-07-17 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-07-17","rules_version":"2026.10+dbe5ddf6","corpus_snapshot":"2026-10-30-5f07c521","engine_version":"regbench-engine/0.4.0","model_version":"deterministic-1"},"evaluated_at":"2026-10-30T11:23:25.149088+00:00","fingerprint":"14cb8f68cafa131e68331cb5"},"review":null,"ledger":{"seq":1026,"hash":"80b0423e6916884b6f4a5d77a56b5d217fa93457deeeea90996e2de80ab9e9ba","prev_hash":"44475c40e1b88ebdd4b945a255c93dacd78d21a17d8dcb8d8a5444606c031278","recorded_at":"2026-07-17T00:33:18+00:00"}}