Regulatory Assessment
HL-CLM-1012 PASS
TX · health · claims · decided 2026-10-25 17:58 UTC · Harborline Health Plan, Inc. (fictional)
On 2026-10-25, claims-adjud v5.1 (an internally developed system) produced 'deny' in a TX health claims transaction. Inputs included medical records, claims history. A human reviewed the output by a adjuster. The outcome was adverse to the consumer; no notice to the consumer is recorded. RegBench applied 7 rule(s) in force on 2026-10-25 and recorded no findings.
PASS: 0 finding(s) under rules 2026.10+dbe5ddf6, corpus 2026-10-30-5f07c521. No regulatory finding; the case file is recorded.
Findings (0)
No finding under the rules in force on 2026-10-25 for this state, line and stage. The case file is recorded all the same.
Point in time
- Law as of
- 2026-10-25
- Rules version
- 2026.10+dbe5ddf6
- Corpus snapshot
- 2026-10-30-5f07c521
- Engine
- regbench-engine/0.4.0 · deterministic-1
- Fingerprint
- f5d3c5ea3669eaf553ad3bc8
- Evaluated
- 2026-10-30 11:23:25 UTC
- Exhibit C case file
- yes
Ledger
- Entry
- #1012 · assessment · recorded 2026-10-25T18:02:24+00:00
- Hash
- acf1b302da92e24b4e48677cb55041c78e41b2a18218ed2ec9ffc11d7ce23301
- Previous
- b8f98e3fcf57605a8a4c1cdd1025c23089b93e7fd4b9d674de262ed61ba5387d
- Stored copy intact
- yes, hashes match
Carrier review
No review item: the disposition was PASS.
Recorded facts
- AI system
- claims-adjud v5.1 · internal · high-risk class: claims
- Governance attested
- True
- Testing report
- test://harborline/claims-adjud/2026Q1
- Model documentation
- doc://harborline/claims-adjud/5.1
- Feature classes
- medical_records, claims_history
- Protected factors used
- none
- External data (ECDIS)
- False
- Consumer report / credit
- False / False
- Data sources
- none recorded
- Decision
- deny · score 0.663 · codes E-114
- Human review
- yes (adjuster)
- Adverse to consumer
- True
- Notice
- not recorded · reasons: True · specific: False · external data disclosed: False
- Appeal channel
- –
- Consumer token
- tok_832208ebcc