{"txn_id":"HL-UR-0889","assessment_id":"ra_c792a21f0b3c4afc","occurred_at":"2026-10-20T20:05:45+00:00","state":"NY","line_of_business":"health","stage":"utilization_review","program_area":"Utilization Management/Utilization Review/Prior Authorization/Level of Care Determination","ai_system":{"system_id":"ur-auto","model_version":"2.0","vendor":"third_party","vendor_name":"ClinPath AI (fictional)","high_risk_class":"utilization_review"},"inputs":{"feature_classes":["clinical_criteria","medical_records"],"protected_factors_used":[],"ecdis_present":false,"consumer_report_used":false,"credit_used":false,"data_source_refs":["ehr://harborline/clinical-record"],"consumer_token":"tok_367ea5e661"},"output":{"decision":"approve","score":0.374,"reason_codes":[],"premium_delta_pct":null},"human_involvement":{"reviewed":true,"reviewer_role":"nurse","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":"4b97995f05378cc442660c43db5a984b1d40d548a4e7726e8a6dad83119b90d8","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 utilization review 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","inputs.data_source_refs"],"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, inputs.data_source_refs."},"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 utilization review transaction. Nothing binding was checked, so no disposition here says anything about compliance.","narrative":"On 2026-10-20, ur-auto v2.0 (a third-party system from ClinPath AI (fictional)) produced 'approve' in a NY health utilization review transaction. Inputs included clinical criteria, medical records. A human reviewed the output by a nurse. The outcome was not adverse to the consumer. RegBench applied 1 rule(s) in force on 2026-10-20 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-10-20","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":"2026-10-31T05:42:55.429789+00:00","fingerprint":"e5762e954990fd02a4dcde70"},"review":null,"ledger":{"seq":6392,"hash":"941d715d2e3af29be316efe92017c09b784ed8a34d86ae3955703d24516a7756","prev_hash":"02d1055645e34cc8b98defd0d2dc78e6aacf47adee0ce50398a5449617c1d2c8","recorded_at":"2026-10-20T20:08:44+00:00"}}