Regulatory Assessment

HL-UR-0961 PASS

NY · health · utilization review · decided 2026-09-29 10:10 UTC · Harborline Health Plan, Inc. (fictional)

On 2026-09-29, ur-auto v2.0 (a third-party system from ClinPath AI (fictional)) produced 'adverse determination' in a NY 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 1 rule(s) in force on 2026-09-29 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 utilization review 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 utilization review 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, inputs.data_source_refs.

Findings (0)

No configured check fired under the rules in force on 2026-09-29 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: 2026-09-29
Rules version: 2026.10+c4982313
Corpus snapshot: 2026-10-30-9c5dad5a
Engine: regbench-engine/0.5.0 · deterministic-1
Fingerprint: aae1a62b6e8c8fcff284311b (pattern grouping, not an integrity check)
Input digest: 810129e148b7ee13430c55408ce75e60408b8576d5003d6bdc57ea8a3fb979f4
Evaluated: 2026-10-31 05:42:55 UTC
Exhibit C case file: yes

Ledger

Entry: #6464 · assessment · recorded 2026-09-29T10:13:53+00:00
Hash: 4170f38598c14652a91e4837127f1179509103b80b0eb7a0e51e85068486ee8c
Previous: 61e3f82f2a2ecfd47c60c212be3c8201c02e37311e4cfdc53f39b30dad52d7ab
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: ur-auto v2.0 · third party (ClinPath AI (fictional)) · high-risk class: utilization review
Governance attested: True
Testing report: test://harborline/ur-auto/2026Q2
Model documentation: doc://harborline/ur-auto/2.0
Feature classes: clinical_criteria, medical_records
Protected factors used: none
External data (ECDIS): False
Consumer report / credit: False / False
Data sources: ehr://harborline/clinical-record

Decision: adverse determination · score 0.672 · codes MN-02
Human review: yes (physician)
Adverse to consumer: True
Notice: not recorded · reasons: True · specific: True · external data disclosed: False
Appeal channel: –
Consumer token: tok_f66ae470bf