Regulatory Assessment

HL-CLM-1109 PASS

NY · health · claims · decided 2026-09-04 14:09 UTC · Harborline Health Plan, Inc. (fictional)

On 2026-09-04, claims-adjud v5.1 (an internally developed system) produced 'pay' in a NY 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 1 rule(s) in force on 2026-09-04 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 unsupported: No black-letter rule in the pack covers a NY health claims transaction. Nothing binding was checked, so no disposition here says anything about compliance.

Coverage: unsupported. No black-letter rule in the pack covers a NY health claims transaction. Nothing binding was checked, so no disposition here says anything about compliance. 1 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 2026-09-04 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: 2026-09-04
Rules version: 2026.10+c4982313
Corpus snapshot: 2026-10-30-9c5dad5a
Engine: regbench-engine/0.5.0 · deterministic-1
Fingerprint: 88901cd0f1fc853071200643 (pattern grouping, not an integrity check)
Input digest: 577452cd03b75118aacdb950a6e37b182b30520eef35ff8539b79dc0877913e7
Evaluated: 2026-10-31 05:42:56 UTC
Exhibit C case file: yes

Ledger

Entry: #6612 · assessment · recorded 2026-09-04T14:12:44+00:00
Hash: 08cbc5da39598e7f398ee48899cddf92c6348d1deee48ce6e06bbac4383f8212
Previous: 8dd22db341015690b805a29426f067197e515caad029e18ee20590c641be9651
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 0.243
Human review: none
Adverse to consumer: False
Notice: not recorded · reasons: False · specific: False · external data disclosed: False
Appeal channel: –
Consumer token: tok_e92b6fcece