Multi-Plan Coordination and Medical Claims Reasoning Dataset

#multi-hop question answering #claim order inference #amount calculation #reasoning step generation #medical claims processing #coverage coordination #claims review #insurance operations

5560
0.3GB
JSON
CATL
MOBIUSI INC

Updated:2026-11-05

AI Analysis & Value Prop

This dataset is built around medical claim case text covering multiple patient coverage plans, coordination rules, claim amounts, prior payments, pending charges, and related questions. Cases are represented with structured fields for coverage plans, payment order, processable amounts, reasoning steps, and answers. Models use plan rules and case facts to infer claim-processing order or calculate the amount available to the next plan, supporting multi-hop question answering, reasoning fine-tuning, and business logic evaluation.

Dataset Insights

Sample Examples

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Technical Specifications

Field	Type	Description
file_name	string	File name
answer	string	Direct answer to the claim-processing question, including the applicable processing order or amount.
claim_amount	number	Total claim or billed amount, when provided in the case.
currency_code	string	Currency used for the claim and payment amounts, when stated or inferable from the case.
payment_order	array	Sequence in which the coverage plans should process the claim.
coverage_plans	array	Coverage plans identified in the case, including relevant rules and payment facts.
pending_amount	number	Claim amount that remains unpaid or is available for further processing, based on the case facts.
reasoning_steps	array	Ordered explanation connecting plan rules and case facts to the payment order or amount calculation.
source_case_text	string	Original case text containing the patient's coverage plans, coordination rules, claim facts, and question.
processable_amount	number	Amount available for submission to or consideration by the next plan, based on the claim balance and prior payments.

Compliance Statement

Authorization Type	Proprietary - Commercial AI Training License (No Redistribution)
Commercial Use	Requires exclusive subscription or authorization contract (monthly or per-invocation charging)
Privacy and Anonymization	No PII, no real company names, simulated scenarios follow industry standards
Compliance System	Compliant with China's Data Security Law / EU GDPR / supports enterprise data access logs

Frequently Asked Questions

What claims information does the dataset contain?: Cases cover multiple patient coverage plans and their coordination rules, with fields for source case text, claim and pending amounts, currency, payment order, the amount available to the next plan, reasoning steps, and the final answer. Whether a field is populated depends on the information available in each case.

Which capabilities can this dataset train or evaluate?: It supports multi-hop question answering for medical claims, primary and secondary payment order inference, remaining balance calculations, and rule-based reasoning. It can also evaluate whether a model grounds its answer in both plan rules and case facts.

How are amounts and currencies represented?: Amount fields capture the claim total, pending amount, and amount available to the next plan when stated or determined from the case facts. The currency field records the currency explicitly stated or inferable in the case. Use each case's rules and amount details, and do not directly compare or combine values across different currencies.

How can I access the dataset, and what licensing applies?: Access methods, available formats, and licensing terms are defined by the dataset product listing or the agreement between the parties. Confirm the applicable license before commercial training, redistribution, or production deployment, and review the case content against your organization's data governance and compliance requirements.

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Cite this Work

@dataset{Mobiusi2026,
  title={Multi-Plan Coordination and Medical Claims Reasoning Dataset},
  author={MOBIUSI INC},
  year={2026},
  url={https://www.mobiusi.com/datasets/0d8eeba0b510c680dff4785ce3b1f4e3},
  urldate={2026-10-22},
  keywords={medical claims dataset,multi-plan coordination,claims reasoning data,health insurance QA,claim payment order,pending amount calculation,multi-hop QA training,AI claims review},
  version={1.0}
}

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