Healthcare & insurance
Where an automated decision needs a named human behind it
Coverage, eligibility and clinical-adjacent workflows are exactly the cases where the answer to 'who decided this' cannot be 'the system'. The band that requires a person has to be enforced, not documented.
The actions that are not recoverable here
Governance is worth its cost where the effect cannot be undone by correcting a record.
Coverage and eligibility determinations
A determination that reduces or denies cover needs a separately authenticated human with the required role, and an approval bound to that specific determination.
Claims adjudication and payment
Payment carries the money-movement risk; adjudication carries the accountability one. Both are answered before the effect, and both are recorded.
Record and status changes
Altering a member or patient record is an action, not a read, and needs the same bounded authority as any other effect.
Prohibited automation classes
Some decisions should never be automated at all. Those belong in the hard-deny class, where no approval can release them.
What a reviewer will ask
Each of these is answered by an artifact rather than by a description of a process.
Was a human required for this decision class, and was that requirement enforced
Answered from the signed decision record: acting identity, principal, policy version, decision, approver where one exists, and the execution result.
Who approved it, under which role, and was the approval single-use
Answered from the signed decision record: acting identity, principal, policy version, decision, approver where one exists, and the execution result.
Which policy version was in force at the moment of the decision
Answered from the signed decision record: acting identity, principal, policy version, decision, approver where one exists, and the execution result.
Can a reviewer verify the record without trusting the operator
Answered from the signed decision record: acting identity, principal, policy version, decision, approver where one exists, and the execution result.
The controls that answer them
Pre-execution authorization
ProvenEvery governed action is authorized before it executes, not observed after. The decision to allow, hold or deny is taken against the active policy inside the same write transaction that reserves the budget and consumes the approval, so a policy change lands entirely before or entirely after an action — never halfway through one.
Human approval, bound and single-use
ProvenAn action held for approval produces no effect until a separately authenticated human with the required role approves that exact request. The approval is bound to the payload and the envelope, is consumed once, and cannot release a different action or the same action twice.
Budget and action limits
ProvenSpend and action limits are reserved atomically inside the authorization transaction. A limit lowered below what is already spent stops further spend without rewriting history, and the change is recorded as a signed configuration record naming the principal who made it.
Revocation of agent authority
ProvenAn authorized operator can revoke an agent. Its next request cannot execute, and an action it had already had approved but not yet dispatched cannot execute either — revocation reaches work already in flight, not only new requests.
Signed, hash-linked evidence
ProvenEach decision, authorization, outcome, refusal and configuration change is written as a signed record in a hash-linked chain. The record carries the request identity, the policy version, the decision, the approver where one exists, timestamps and the execution result.
Offline independent verification
ProvenEvidence is verified by a portable verifier with no database, no signing key, no network and no product installation on the path. Deliberately altered evidence — an edited amount inside a signed body, a stripped signature, a broken chain link, a checkpoint re-signed by the writer's own key — is refused, and a verifier that cannot run reports an instrument failure rather than a refusal.
Limitation · The verifier was written by the same party as the system it checks. Verifying with it confirms signatures, linkage and key separation; it is not a substitute for an independent implementation of the documented record format.
Relevant frameworks
EU AI Act, ISO/IEC 42001, ISO/IEC 42005. Coverage is stated control by control, with gaps named. ApexClaw holds no certification and displays no certification badge.