# tatsuju/opdstar-nhi-mcp [Health: Active]

**Category:** Biology, Medicine and Bioinformatics  
**Repository:** https://github.com/tatsuju/opdstar-nhi-mcp  
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**Directory Page:** https://allmcps.com/mcp/tatsuju-opdstar-nhi-mcp

## Description
Taiwan's first public MCP server for National Health Insurance (NHI) data — 234 rejection codes, 1,497 ICD-10→procedure mappings across 20 specialties, audit indicators (008/014/027/P043), and semantic wiki search over 8,232 chunks of official NHI documentation. Powered by OPDSTAR. Install: npx @opdstar/nhi-mcp.

## Tools
Capabilities this server exposes over MCP:

- **lookup_rejection_code** — Look up a single Taiwan NHI rejection code (5-character format `NNNNL` — 4 digits + 1 uppercase letter A/B/C/..., e.g. '0317A', '0338A', '0114A'). Returns severity (low / medium / high), category (00 診療品質 · 01 病歷紀錄 · 02 基本診療 · 03 藥品特材 · 04 手術處置 · 05 檢查檢驗 · 06 論病例計酬 · 07 復健精神 · 08 其他 · 09 法令 — first two digits encode the category), and the official Chinese description from 健保署 專業審查不予支付理由代碼. Returns a not-found message (not an error) if the code does not exist. **Use when** an agent encounters a known rejection code in a notice or claim response and needs the human-readable explanation, or when triaging which category a code belongs to. **Typical follow-up**: call `get_drug_rules({rejection_code})` if the code is in category 03 (藥品特材) to surface the drug rule behind the rejection; call `search_audit_guidelines({query: <code>})` for codes in 04 / 05 to read the underlying audit-clause text; call `count_appeal_precedents_for_rejection_code({rejection_code})` to gauge whether disputes for this code are commonly successful. **Don't use** to enumerate codes by category — call `get_rejection_code_category({category})` instead. **Reference only** — the official 健保署 code list is authoritative. Curated by OPDSTAR (https://opdstar.com).
- **get_procedures_for_icd** — Given a Taiwan ICD-10 code and a medical specialty, return the NHI procedure codes plausibly applicable to that diagnosis within that specialty. Each result includes the procedure code, Chinese name, English name, nhi_points (payment points), and audit_notes (specialty-specific review caveats and risk hints). Results are ordered by curated relevance (most commonly applied codes first), capped at `limit` (default 10, max 20). Returns an empty list (not an error) when no curated mapping exists for the given (icd10, specialty) pair — this is common because the mapping is intentionally conservative. **Use when** an agent is drafting SOAP and needs a starting set of procedure codes for the diagnosis within the clinician's specialty context — e.g. dermatologist with `L30.9` (chronic eczema) needs candidate procedure codes. **Typical follow-up**: for each candidate code, call `lookup_fee_code({q: <code>})` to confirm current points and effective dates, and `lookup_audit_clauses_for_procedure({procedure_code})` to surface any audit-clause caveats. **Don't use** as a billing source of truth — the original NHI fee schedule has no ICD field, this is a curated, intentionally conservative mapping that prefers false negatives over false positives; for the canonical fee-schedule entry of a known code, call `lookup_fee_code`. **Reference only** — final code selection remains the clinician's responsibility. Curated by OPDSTAR (https://opdstar.com).
- **get_indicator** — Look up a single Taiwan NHI prescribing-pattern indicator. These are short codes (numeric, or 'P'-prefixed) that encode common over-prescribing patterns such as antibiotic-on-URI, multi-drug co-prescribing, or duration limits. Returns the indicator name, the threshold (e.g. '7-day URI episode'), applicable drugs / diagnoses, and the compliance meaning. Returns a not-found message (not an error) if the code does not exist. **Use when** an agent needs the human-readable explanation for a specific indicator code referenced during a SOAP review or audit response — e.g. an audit notice cites an indicator and the agent needs to surface what it monitors and why a prescription tripped it. **Typical follow-up**: call `get_drug_rules({rejection_code})` with the indicator's downstream rejection code to read the formal payment rule, or `search_audit_guidelines({query})` to read related audit-clause text. **Don't use** for the official 分析審查不予支付指標 (percentage-cap audit) list — that's a different system — call `lookup_audit_indicator` instead. **Reference only** — thresholds and applicable lists reflect published guidance and may change with each NHI release; agents should re-read the indicator each session rather than caching values across sessions. Curated by OPDSTAR (https://opdstar.com).
- **search_nhi_wiki** — Search across Taiwan's official NHI knowledge base (健保署全球資訊網) for natural-language background questions. Covers 9 categories: audit (審查 — review rules / rejection grounds), drugs (藥品特材 — formulary, payment limits), fees (費用 — copay, premiums, contribution), plans (醫療計畫 — disease-management programs), services (醫療服務 — covered benefits), insurance (投保 — enrollment), forms (表單 — applications), records (紀錄 — documentation rules), admin (行政 — contracting, accreditation). Returns up to 10 ranked excerpts (most relevant first); each result includes title, content snippet, source URL, and category tag. Returns an empty list (not an error) when the query has no matches. **Use when** an agent needs broad NHI policy background not tied to a specific code — e.g. '慢性病連續處方箋天數上限' / 'how does balance billing work for orthodontics' / 'what are the rules for telemedicine reimbursement'. **Typical follow-up**: when an excerpt mentions a specific code (e.g. '0317A', '00101B'), call the appropriate code-specific tool (`lookup_rejection_code`, `lookup_fee_code`) for the canonical entry. **Don't use** when you already know a specific rejection code, procedure code, drug name, or audit-clause topic — those have dedicated tools that return structured fields rather than excerpts. **Reference only** — official 健保署 publications are authoritative; ranked excerpts may lag the latest revision and the snippet is not the full document. Curated by OPDSTAR (https://opdstar.com).
- **search_nhi_interpretations** — Search Taiwan's official NHI administrative interpretations (健保署行政函釋 / 函令) — the binding 公告 and 解釋函 issued by the National Health Insurance Administration that clarify how payment rules, drug-formulary provisions, special-material coverage, and review policy apply in practice. Each result returns the official document number (字號), issue date, 主旨 (subject), a content excerpt, and the source URL on the government law portal. Returns up to 10 ranked excerpts (most relevant first); returns an empty list (not an error) when nothing matches. **Use when** a question turns on an official ruling rather than a code definition — e.g. '函釋怎麼說人工水晶體的給付規定' / 'is there an interpretation on continuous-prescription day limits' — or when the user cites a 函釋 文號 directly (e.g. 健保審字第 1090017813 號). **Don't use** when you already have a specific rejection code, fee code, or drug name — those have dedicated lookup tools (`lookup_rejection_code`, `lookup_fee_code`, `lookup_drug`). **Reference only** — the official 健保署 / 衛福部 publication is authoritative; an excerpt may lag the latest revision and is not the full document, so open the source URL for the binding text. Curated by OPDSTAR (https://opdstar.com).
- **get_drug_rules** — Look up Taiwan NHI drug payment rules (藥品給付規定) — when a drug class is / isn't reimbursable, with severity and source citation. Filter by `specialty`, `rejection_code`, or `drug_category_query` (at least one required). **Use when** an agent is checking whether a drug choice will trigger a rejection before submission, or wants to read the rule behind a known rejection code. **Don't use** to identify a specific drug (brand / generic / strength) — call `lookup_drug` instead; for the underlying audit clauses, use `lookup_audit_clauses_for_procedure` or `lookup_audit_clauses_for_specialty`. **Reference only** — official 健保藥品給付規定 is authoritative; curated subset, not exhaustive. Curated by OPDSTAR (https://opdstar.com).
- **get_safe_phrases** — Preview which documentation scenarios have OPDSTAR-curated NHI-safe phrasing patterns for a given specialty (e.g. dermatology + 抗生素) — returns scenario name, high-risk wording to avoid, the key difference, and the first sentence of the safe-phrasing example. Up to 5 scenarios per call. **Use when** an agent is helping draft SOAP wording and needs to flag risky phrasing before submission. **Don't use** to retrieve full ready-to-copy templates (full library is part of the paid OPDSTAR product — link the user to opdstar.com); for the underlying audit rule that motivates a safe phrase, call `search_audit_guidelines`. **Reference only** — phrasing patterns reflect curated review experience, not formal NHI directives. Curated by OPDSTAR (https://opdstar.com).
- **search_audit_guidelines** — Free-text search over Taiwan NHI 審查注意事項 rules — returns reason + suggestion summaries (first sentence only) for up to 10 rules matching a keyword (Traditional Chinese or English). **Use when** an agent is exploring whether any audit rule covers a topic (e.g. '抗生素', '檢查頻率', '慢性病處方') without knowing a specific code. **Don't use** for clauses tied to a known procedure code — call `lookup_audit_clauses_for_procedure` instead. Full SOAP example templates and detailed reasoning are part of the paid OPDSTAR product. **Reference only** — official 健保署 審查注意事項 is authoritative; results are previews. Curated by OPDSTAR (https://opdstar.com).
- **get_rejection_code_category** — Browse Taiwan NHI rejection codes by category (00-09) for discovery — returns code, severity, and short description, up to 50 per call. Categories: 00 診療品質 · 01 病歷紀錄 · 02 基本診療 · 03 藥品特材 · 04 手術處置 · 05 檢查檢驗 · 06 論病例計酬 · 07 復健精神 · 08 其他 · 09 法令. **Use when** an agent needs to enumerate all rejection codes within a workflow domain (e.g. all surgery-handling codes). **Don't use** to look up a known specific code — call `lookup_rejection_code` instead. **Reference only** — official 健保署 不予支付理由代碼 is authoritative. Curated by OPDSTAR (https://opdstar.com).
- **lookup_drug** — Look up the active Taiwan NHI drug catalog by generic name, brand name, NHI drug code, or alias — returns up to 10 matches with strength, dosage form, route, ATC code, therapeutic class, and brand list. **Use when** an agent needs to identify or disambiguate a drug before recommending dosage / formulation in a SOAP draft. **Don't use** to look up payment / reimbursement rules for the drug — call `get_drug_rules` instead; for an audit clause referencing the drug, call `search_audit_guidelines`. **Reference only** — official 健保署 藥品給付項目及支付標準 is authoritative; the catalog is a working snapshot. Curated by OPDSTAR (https://opdstar.com).
- **lookup_fee_code** — Look up the Taiwan NHI fee schedule (全民健康保險醫療服務給付項目及支付標準, current effective edition). Search by exact code (e.g. '00101B', 'P15001') or by Chinese / English name (e.g. '門診診察', 'ICU') — returns code, points, effective dates, and audit notes (truncated to 600 chars). Use `category` prefix to scope ('00' 基本診療, '06' 手術, 'P1' 病例計酬, 'N2' 護理). **Use when** an agent needs the canonical fee entry for a known procedure code, or wants to discover codes by name. **Don't use** for drugs (call `lookup_drug`) or for ICD-10 → procedure suggestions (call `get_procedures_for_icd`). The optional `icd` filter applies an OPDSTAR-curated mapping that is intentionally sparse (the original NHI data has no ICD field) — most codes will return no result with `icd` active. **Reference only** — official 健保署 支付標準 is authoritative. Curated by OPDSTAR (https://opdstar.com).
- **lookup_audit_clauses_for_procedure** — Find Taiwan NHI 審查注意事項 clauses that reference a specific procedure code (e.g. '00101B', '51017C') — each result indicates whether the clause carries an amount limit, frequency rule, or indication restriction (critical signals for rejection-risk assessment). Returns clause summary, specialty, and risk flags. **Use when** an agent has a candidate procedure code and needs to surface the audit context attached to it. **Don't use** for the procedure's fee-schedule entry (points / effective dates) — call `lookup_fee_code`; for browsing all clauses within a specialty, call `lookup_audit_clauses_for_specialty`. **Reference only** — clause summaries are first-sentence previews; official 健保署 審查注意事項 is the source of truth. Curated by OPDSTAR (https://opdstar.com).
- **lookup_audit_clauses_for_specialty** — Browse Taiwan NHI 審查注意事項 clauses for a specific medical specialty (dermatology, ophthalmology, ENT, TCM, dentistry, family medicine, etc.) — returns clause headlines with risk flags (amount_limit / frequency_rule / indication) and a short preview of the procedures each clause governs. **Use when** an agent needs section-wide audit context before assisting with claim coding for a specialty. **Don't use** for clauses tied to a known specific procedure code — call `lookup_audit_clauses_for_procedure` instead. **Reference only** — official 健保署 審查注意事項 (current edition) is authoritative; clause summaries are previews. Curated by OPDSTAR (https://opdstar.com).
- **lookup_major_illness** — Browse Taiwan NHI 重大傷病 (major illness) categories — official categories that grant copayment exemption and a more lenient claim-review process. Returns category name, ICD-10 code coverage, application requirement, and validity period. **Use when** an agent needs to enumerate or filter major-illness categories (e.g. 'all cancer categories', 'categories that don't require an application'). **Don't use** if you already have an ICD-10 code and want to know which categories it qualifies for — call `check_icd_for_major_illness_eligibility` instead. **Reference only** — final eligibility requires a formal application with supporting documentation per the official 重大傷病範圍及項目. Curated by OPDSTAR (https://opdstar.com).
- **check_icd_for_major_illness_eligibility** — Reverse-lookup: given a single ICD-10 code, return the Taiwan NHI 重大傷病 (major illness) categories the diagnosis may qualify for, including category name, the ICD pattern that matched, and copayment-exemption flag. **Use when** an agent has a diagnosis and needs to flag major-illness applicability before claim submission. **Don't use** to browse all categories — call `lookup_major_illness` instead (also use it for the category → applicable ICDs direction). **Reference only** — confirmed eligibility still requires a formal application with supporting documentation per the official 重大傷病範圍及項目. Curated by OPDSTAR (https://opdstar.com).
- **lookup_audit_indicator** — Look up Taiwan NHI 分析審查不予支付指標 (official threshold-based audit rules where claims exceeding a percentage are denied) — returns indicator code, category, threshold, applicable specialty, monitored procedure codes, and official action description. **Use when** an agent needs to know whether a procedure code is under a percentage-cap audit (e.g. '23401C' is monitored by indicator 001 眼科局部處置申報率, 30% threshold). Omit `indicator_code` to browse by category / specialty / procedure. **Don't use** for prescribing-pattern indicators — those live in `get_indicator`. **Reference only** — thresholds change with each official release. Curated by OPDSTAR (https://opdstar.com).
- **lookup_appeal_statistics_by_category** — Aggregate dispute-resolution statistics for Taiwan NHI claim disputes, broken down by category and (optionally) review stage — returns category counts and rough win-rate signals only, never individual case details, case numbers, or arguments. **Use when** an agent is helping a clinician understand the general dispute landscape (e.g. 'how often do fee-calculation disputes resolve in the claimant's favor at the first court tier?'). **Don't use** for code-specific signals — call `count_appeal_precedents_for_rejection_code` instead. **Reference only** — historical signal does not predict future outcomes; final decisions rest with the responsible review body. Curated by OPDSTAR (https://opdstar.com).
- **count_appeal_precedents_for_rejection_code** — Aggregate signal-only summary of how disputes involving a given Taiwan NHI rejection code (e.g. '0312A', '0114A') or procedure code (e.g. '86008C') historically resolve — returns rough volume bucket (none / few / several / many), claimant win-rate signal (rare / occasional / moderate / common), and which review stages have on-record outcomes. **Use when** an agent is helping triage whether contesting a specific code is worth pursuing. **Don't use** to fetch individual case details (none are exposed) — for the broader landscape across categories, call `lookup_appeal_statistics_by_category` instead. **Reference only** — historical signal does not predict future outcomes; final review decisions rest with the responsible authority. Curated by OPDSTAR (https://opdstar.com).
- **recent_nhi_amendments** — List recent amendments to Taiwan NHI rules and audit guidelines (健保署「醫療費用審查注意事項」近一年修正公告). Returns the publication / effective dates, the amendment title and type ('primary' = main regulation update, 'comparison' = side-by-side diff document), and direct links to the official DOCX / ODT / PDF announcement files plus the 健保署 listing page. **Use when** an agent needs to answer 'what NHI rule changes are coming?', 'when does the new 審查注意事項 take effect?', or wants to check whether a specific rule has been recently amended before quoting it. **Typical follow-up**: call `search_audit_guidelines({query})` to pull the post-amendment clause text, or `lookup_rejection_code({code})` to see how it ties into existing rejection codes. **Reference only** — official 健保署 announcements are authoritative. Curated by OPDSTAR (https://opdstar.com).
- **search_taiwan_drug** — Search Taiwan drugs across NHI and TFDA registries with unified cross-reference. Returns generic name (EN + 中文學名), all brand names + aliases, NHI 9碼 billing code, ATC code, dosage form, strength, route, therapeutic class, applicable specialties, compound-flag, and effective date. The query auto-detects four input shapes: (1) **NHI drug code** 9碼 (e.g. 'AC4537911', 'A04403412' — 1-2 letter prefix + 6-9 digits) → direct match; (2) **ATC code** prefix (e.g. 'J01CR02' or 'J01' for the antibacterials class) → class match; (3) **Generic name** EN or 中文 → ILIKE; (4) **Brand name / alias** → secondary fallback. **Use when** an agent has any drug identifier and needs the canonical record for billing / SOAP / appeal context. **Typical follow-up**: call `get_drug_rules({drug_category_query})` for NHI payment rules / prior-authorization on this drug, `lookup_icd10_cm` for the diagnosis side, or `count_appeal_precedents_for_rejection_code` if a rejection code is involved. **Out of scope**: drug-drug interactions, severity scoring, indication-specific dosing. **Reference only** — TFDA license / 健保 給付規定 are authoritative. Curated by OPDSTAR (https://opdstar.com).
- **lookup_icd10_cm** — Look up ICD-10-CM diagnosis codes with English / Traditional Chinese descriptions, category, and the OPDSTAR specialties each code is keyed against. **Use when** the agent encounters an ICD-10 code in a note, claim, or rejection notice and needs the canonical name, or wants to free-text search by EN / 中文 keyword to find candidate codes. **Typical follow-up**: chain into `get_procedures_for_icd({icd10, specialty})` to find the procedures commonly paired with the code, or `check_icd_for_major_illness_eligibility({icd10})` to check 重大傷病 coverage. **Scope note**: Currently backed by OPDSTAR's specialty-keyed Taiwan-relevant subset (the diagnoses doctors actually code on outpatient claims); the full CMS public-domain ICD-10-CM 2025 set will be merged in a later release. **Out of scope**: SNOMED CT cross-mapping, international procedure codes (ICD-10-PCS), drug interactions. **Reference only** — clinical coding decisions require physician judgment. Curated by OPDSTAR (https://opdstar.com).
- **lookup_preventive_service** — Browse Taiwan NHI preventive-care and screening services — adult health checks, the major cancer screenings (breast, cervical, colorectal, oral, lung LDCT), prenatal care, child preventive health, and child dental fluoride / pit-and-fissure sealant programs. Returns each service's target population, age / sex eligibility, subsidy frequency, and screening tool. **Use when** an agent needs to know who is eligible for a preventive service and how often it is subsidised (e.g. 'who can get a mammogram and how often', 'child fluoride coverage'). **Reference only** — eligibility and subsidy follow the official 衛生福利部 announcements; the screening provider confirms eligibility at the point of service. Curated by OPDSTAR (https://opdstar.com).
- **lookup_chronic_prescription_rule** — Look up Taiwan NHI chronic-disease continuous-prescription (慢性病連續處方箋) rules. Given an ICD-10 code or a disease name, returns whether the condition falls within the official chronic-disease scope and its dispensing limits — maximum days per dispense, maximum total medication days, and prescription validity. **Use when** an agent needs to know if a diagnosis qualifies for a continuous prescription and the applicable day limits. **Reference only** — the issuing physician must confirm the patient's condition is stable and that the same long-term medication applies, per the official 全民健康保險醫療辦法 慢性病範圍. Curated by OPDSTAR (https://opdstar.com).
- **lookup_point_value** — Look up Taiwan NHI floating point values (浮動點值) — the settled per-point payment amount by region and total-budget sector. Taiwan NHI reimburses on a points system under a global budget, so one claimed point is usually worth less than NT$1; this tool returns the actual settled rate. With no year, returns the latest settled value for each region × sector; with a year (and optional quarter), returns the quarterly time series. **Use when** an agent needs to estimate actual reimbursement — claimed points × point value ≈ amount paid. **Reference only** — official figures are published quarterly by 衛生福利部中央健康保險署. Curated by OPDSTAR (https://opdstar.com).

## Claude Desktop Quick Installation
Install path detected from listing signals. Uses `npx` (confidence: high):

```json
"mcpServers": {
  "opdstar-nhi-mcp": {
    "command": "npx",
    "args": ["-y","@opdstar/nhi-mcp"]
  }
}
```

## Documentation

## What the tatsuju/opdstar-nhi-mcp MCP server does

tatsuju/opdstar-nhi-mcp MCP server provides MCP-accessible reference data for Taiwan National Health Insurance workflows. Its tools cover rejection-code explanations, category browsing, fee-schedule searches, ICD-10-CM lookups, curated diagnosis-to-procedure mappings, drug identification, drug payment rules, audit clauses, prescribing indicators, and percentage-based audit indicators.

The server also supports broader policy and administrative research. Agents can search the official NHI knowledge base and administrative interpretations, inspect recent amendments, browse preventive-care eligibility, check chronic-prescription limits, review major-illness categories, and query floating point values. Appeal tools return aggregate signals rather than individual case records.

## How it works

Clients send tool calls over MCP using inputs such as a rejection code, fee code, ICD-10 code plus specialty, drug identifier, audit topic, or natural-language policy question. Structured tools return fields such as descriptions, severity, categories, payment points, effective dates, risk flags, eligibility conditions, or source links. Search tools return ranked excerpts with titles, snippets, categories, document numbers, dates, and URLs where applicable.

Several datasets are curated by OPDSTAR and intentionally conservative. For example, ICD-10-to-procedure results may be empty when no curated specialty mapping exists, and audit or drug-rule results may be previews rather than complete source documents. The official Taiwan NHI publications remain the authoritative references.

## Setup and configuration

The package is published as `@opdstar/nhi-mcp` and requires Node.js 18 or later. Run it locally with:

```bash
npx -y @opdstar/nhi-mcp
```

For Claude Desktop, add an MCP server entry with `npx` as the command and `-y`, `@opdstar/nhi-mcp` as the arguments. Cursor uses the same command and argument arrangement in its MCP configuration. The README also documents a hosted JSON-RPC endpoint at `https://opdstar.com/api/mcp`.

No environment variables or API credentials are specified in the provided setup material.

## Tools and capabilities

- Resolve known NHI rejection codes and browse codes by category.
- Find candidate procedures for an ICD-10 diagnosis within a specialty.
- Look up fee codes, points, effective dates, and audit notes.
- Search drugs across NHI and TFDA-linked records, then inspect payment rules.
- Find audit clauses by procedure or specialty and search audit guidance by topic.
- Explain prescribing-pattern and percentage-based audit indicators.
- Search official NHI wiki content and administrative interpretations.
- Check major-illness coverage, preventive-service eligibility, chronic-prescription rules, and point values.
- Review aggregate appeal signals and recent NHI amendments.

## Limitations and notes

tatsuju/opdstar-nhi-mcp MCP server is focused on Taiwan NHI billing and reference information. It does not provide international standards such as SNOMED CT, LOINC, FHIR generation, or RxNorm; drug-interaction checking; clinical decision support; diagnosis suggestions; or general-purpose drug-registry replication.

Returned content may be a working snapshot, curated subset, sparse mapping, excerpt, or first-sentence preview. Thresholds, payment rules, fee schedules, and audit guidance can change between official releases. The server does not expose individual appeal case details, arguments, or case numbers. Final coding, eligibility, prescribing, claim, and appeal decisions require review against current official material and appropriate professional judgment.

Use the dedicated lookup tool when a specific code or drug is known, and use the search tools for broader policy questions. Source URLs should be opened when the binding text or latest revision matters.

_Full upstream README: https://allmcps.com/mcp/tatsuju-opdstar-nhi-mcp/readme_