{"txn_id":"HL-UR-0909","assessment_id":"ra_c7a6c058f5224d65","occurred_at":"2026-09-21T16:30:15+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_4d4bacb936"},"output":{"decision":"adverse_determination","score":0.617,"reason_codes":["MN-02"],"premium_delta_pct":null},"human_involvement":{"reviewed":true,"reviewer_role":"physician","overridden":false},"adverse_action":{"is_adverse":true,"notice_sent_at":null,"reasons_provided":true,"specific_reasons":true,"ecdis_disclosed":false,"appeal_channel":null},"carrier_note":null,"input":{"revision":1,"current_revision":1,"input_digest":"422053c537805fbf9570060cbcd6a4e694ae90e407139c7191057ec47ba2a47a","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 2026-09-21, ur-auto v2.0 (a third-party system from ClinPath AI (fictional)) produced 'adverse determination' in a NY health utilization review transaction. Inputs included clinical criteria, medical records. A human reviewed the output by a physician. The outcome was adverse to the consumer; no notice to the consumer is recorded. RegBench applied 1 rule(s) in force on 2026-09-21 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-09-21","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":"2026-10-31T05:42:55.485289+00:00","fingerprint":"b9e9f9b52c34a2e3f7654294"},"review":null,"ledger":{"seq":6412,"hash":"65d1eb4fbf56df1fa23db437c2d7e7170e6c0b377dec3c21c874329a8421dd45","prev_hash":"06f9eabde89105ab7b77bf0aa6768b836b83379332fe6f3d3efc6240905c41df","recorded_at":"2026-09-21T16:32:40+00:00"}}