{"txn_id":"HL-UR-0934","assessment_id":"ra_61767158f9684dd9","occurred_at":"2026-08-23T07:49:55+00:00","state":"TX","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_26254b4600"},"output":{"decision":"adverse_determination","score":0.922,"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":"025e8e2892a97616c3c9b6b16dd7312e61bc3620af87b2ba44a5d1ecbf00b211","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":4,"general_rules_applied":0,"advisory_rules_applied":1,"rules_considered":30,"rules_applied":["doctrine.unreviewed-adverse-high-risk","tx.4201.adverse-determination-by-automated-system","tx.4201.adverse-determination-notice","tx.tdi.consequential-decision-without-human-review","tx.traiga.ai-discrimination-context"],"statement":"4 state-specific and 0 general black-letter rule(s) applied to this TX health utilization review 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","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.","narrative":"On 2026-08-23, ur-auto v2.0 (a third-party system from ClinPath AI (fictional)) produced 'adverse determination' in a TX 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 5 rule(s) in force on 2026-08-23 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-08-23","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":"2026-10-31T05:42:55.548883+00:00","fingerprint":"4ef47d96bc6ef8140ebc70cc"},"review":null,"ledger":{"seq":6437,"hash":"176506c3ec0a441edb52f41785c5a71e5854ff56b2d0e6dc848dcebb6ac5ad51","prev_hash":"c12ba1647d99431445113f9c303fb0a99f57da5f78478263ee75cdd9ff0173bf","recorded_at":"2026-08-23T07:53:08+00:00"}}