{"txn_id":"HL-CLM-1058","assessment_id":"ra_b7846eb0e2ea45dd","occurred_at":"2026-09-28T09:56:06+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_a14d5048be"},"output":{"decision":"pay","score":0.058,"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":"932f8b19a82c1c0f3617cb281924d00e9f985f1b7f25832a1a560ab0d90ee41f","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":"supported","state_rules_applied":6,"general_rules_applied":0,"advisory_rules_applied":1,"rules_considered":30,"rules_applied":["doctrine.unreviewed-adverse-high-risk","tx.544.prohibited-basis","tx.542.rejection-without-reasons","tx.542.algorithmic-denial-without-human-review","tx.tdi.consequential-decision-without-human-review","tx.tdi.third-party-data-source-unrecorded","tx.traiga.ai-discrimination-context"],"statement":"6 state-specific and 0 general black-letter rule(s) applied to this TX health claims transaction. Only the configured checks were run; a result is not a legal opinion on 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.","narrative":"On 2026-09-28, claims-adjud v5.1 (an internally developed system) produced 'pay' in a TX 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 7 rule(s) in force on 2026-09-28 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-09-28","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":"2026-10-31T05:42:55.901969+00:00","fingerprint":"c3e45819a42df0831a461b3b"},"review":null,"ledger":{"seq":6561,"hash":"0fb0afa3272351cfb2e774dffd2262dd71e8aeab99913bcae3828ca6a852b1f0","prev_hash":"e6f396cb3acbf623151f7016ad990c5c5331e17ad33b2d89f34ef435c850b58a","recorded_at":"2026-09-28T09:58:31+00:00"}}