{"txn_id":"HL-CLM-1043","assessment_id":"ra_f512b53019d14267","occurred_at":"2026-09-30T19:55:58+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_40f8dd1504"},"output":{"decision":"deny","score":0.632,"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 2026-09-30, 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 2026-09-30 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-09-30","rules_version":"2026.10+dbe5ddf6","corpus_snapshot":"2026-10-30-5f07c521","engine_version":"regbench-engine/0.4.0","model_version":"deterministic-1"},"evaluated_at":"2026-10-30T11:23:25.180198+00:00","fingerprint":"abbb2aeea1d17b782dae3678"},"review":null,"ledger":{"seq":1043,"hash":"ec4f5d36c0dfec519e87a98317afb8fe0d3a9cfa8b9ec94be8a6f306955b6bb6","prev_hash":"587bdc80b30d56faa85c74bcc77b0d4462b2c0de8a8d0145c8bf5e3de89c3f12","recorded_at":"2026-09-30T19:58:11+00:00"}}