Regulatory Assessment

HL-UR-0949 PASS

TX · health · utilization review · decided 2026-08-30 00:42 UTC · Harborline Health Plan, Inc. (fictional)

On 2026-08-30, ur-auto v2.0 (a third-party system from ClinPath AI (fictional)) produced 'adverse determination' in a TX 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 5 rule(s) in force on 2026-08-30 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. 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. 5 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 2026-08-30 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: 2026-08-30
Rules version: 2026.10+c4982313
Corpus snapshot: 2026-10-30-9c5dad5a
Engine: regbench-engine/0.5.0 · deterministic-1
Fingerprint: acde102e5438013740e1a95a (pattern grouping, not an integrity check)
Input digest: 63e1272fd685c901c66a6a77659c0aa80c6c861bad3a56842aa90a4fd824766a
Evaluated: 2026-10-31 05:42:55 UTC
Exhibit C case file: yes

Ledger

Entry: #6452 · assessment · recorded 2026-08-30T00:45:42+00:00
Hash: 552f42e38f988f48fac8709b47a9290bb839eb5ccf1388fd2d5579cec61122aa
Previous: 3b07423bd019573e3496e70827d2cf4a8866586223ea3fa134e2aece4b9a238c
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 0.661 · 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_ad4a3f5ea9