Regulatory Assessment

HL-CLM-1040 PASS

TX · health · claims · decided 2026-09-25 04:59 UTC · Harborline Health Plan, Inc. (fictional)

On 2026-09-25, claims-adjud v5.1 (an internally developed system) produced 'pay' in a TX health claims transaction. Inputs included medical records, claims history. No human reviewed the output before it took effect. The outcome was not adverse to the consumer. RegBench applied 7 rule(s) in force on 2026-09-25 and recorded no findings.

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: supported. 6 state-specific and 0 general black-letter rule(s) applied to this TX health claims transaction. Only the configured checks were run; a result is not a legal opinion on compliance. 7 of 30 rules applied.

Evidence (carrier asserted). Supplied by the carrier and not verified by RegBench: ai_system.governance_attested, ai_system.model_doc_ref, ai_system.testing_report_ref.

Findings (0)

No configured check fired under the rules in force on 2026-09-25 for this state, line and stage. That is not a compliance conclusion; the case file is recorded all the same.

Point in time

Law as of: 2026-09-25
Rules version: 2026.10+c4982313
Corpus snapshot: 2026-10-30-9c5dad5a
Engine: regbench-engine/0.5.0 · deterministic-1
Fingerprint: a581448f63abeeb8ba518dc4 (pattern grouping, not an integrity check)
Input digest: 626bcc3c185c44e0ef8cafa1625ed3bdf808f9d9d19de46fc2a1aad3b2b01bfa
Evaluated: 2026-10-31 05:42:55 UTC
Exhibit C case file: yes

Ledger

Entry: #6543 · assessment · recorded 2026-09-25T05:01:45+00:00
Hash: fa9053877af1531cb3bd3f6474fec2a361e2c3fa1b8d7c09196403fd338f5df6
Previous: e79ff0779587dc2ff5f58194b3648c3be72df4db3a708613b92d7ca40ef859bc
Stored copy intact: yes, hashes match
Assessed input intact: yes, revision 1 matches the input digest

Verify the whole chain Case file JSON

Carrier review

No review item: the disposition was PASS.

Recorded facts revision 1

As asserted by the carrier. References are recorded, not verified: RegBench holds no copy of the documents they name.

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: pay · score 0.252
Human review: none
Adverse to consumer: False
Notice: not recorded · reasons: False · specific: False · external data disclosed: False
Appeal channel: –
Consumer token: tok_de4e22342d