Regulatory Assessment

HL-CLM-1085 PASS

TX · health · claims · decided 2026-08-22 18:38 UTC · Harborline Health Plan, Inc. (fictional)

On 2026-08-22, 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 2026-08-22 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 2026-08-22 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: 2026-08-22
Rules version: 2026.10+c4982313
Corpus snapshot: 2026-10-30-9c5dad5a
Engine: regbench-engine/0.5.0 · deterministic-1
Fingerprint: 5fb968695461bb269135588c (pattern grouping, not an integrity check)
Input digest: 4246a7bc1a484ba6b30c3c4b876bc40d5b888cecdebf2849ad175a13ef077849
Evaluated: 2026-10-31 05:42:55 UTC
Exhibit C case file: yes

Ledger

Entry: #6588 · assessment · recorded 2026-08-22T18:40:04+00:00
Hash: 33fa99ec77fa3297895504dbfc9b60ba6053c07fb113c1e07aa4b0308244dcce
Previous: 44f28a0eb4d8cd83be983124f6ffb733ca58460adba1c919f7a6c6cd8ad8c95d
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: deny · score 0.607 · 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_37a4866a21