{"txn_id":"HL-UR-0957","assessment_id":"ra_0cd39f69fde148ad","occurred_at":"2026-09-17T19:43:54+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_09c5842488"},"output":{"decision":"approve","score":0.056,"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":"f4acd6e1bda40787d05b1782bd0acffcf103b58d3e41c9d19a1a03c44c0924ed","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 2026-09-17, ur-auto v2.0 (a third-party system from ClinPath AI (fictional)) produced 'approve' in a TX 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 5 rule(s) in force on 2026-09-17 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-09-17","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":"2026-10-31T05:42:55.609689+00:00","fingerprint":"7253e5e7de7cb4546f6a773a"},"review":null,"ledger":{"seq":6460,"hash":"b7bf4492ed9898b86a853eb9d11ef2b0bbfbc1e2abac4821fe426be4fb8d3b8f","prev_hash":"4a618a3c649432ede7a68b2d8d22dd19422abcf59b26c8d8fbf43e51bde84ece","recorded_at":"2026-09-17T19:45:13+00:00"}}