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Multi-Step Claims Accumulator Reasoning Dataset for High-Deductible Health Plans
#multi-step reasoning #accumulator tracking #patient responsibility calculation #high-deductible health plan administration #medical claims processing #patient out-of-pocket cost estimation
- 5000
- 0.2GB
- JSON
- CATL
MOBIUSI INC
Updated:2026-11-02
AI Analysis & Value Prop
This dataset presents chronological high-deductible health plan rules, prior claims, and current claim scenarios, covering deductibles, coinsurance, copays, and annual out-of-pocket maximums. Each example combines plan rules and accumulated amounts to derive the deductible applied to the current claim, the patient's cost share, and the out-of-pocket limit status, with reasoning steps and a final answer. It supports health insurance claims analysis, benefit calculations, and the training and evaluation of reasoning-focused language models.
Dataset Insights
Sample Examples
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Technical Specifications
| Field | Type | Description |
|---|---|---|
| file_name | string | File name |
| final_answer | string | The direct answer to the reasoning question, including relevant calculated amounts and accumulator status. |
| prior_claims | string | Source text listing claims earlier in the plan year and their effects on deductible and out-of-pocket accumulators. |
| current_claim | string | Source text describing the current covered service, its allowed expense, and any relevant claim details. |
| plan_year_rules | string | Source text describing the plan-year deductible, coinsurance, copay, and out-of-pocket maximum rules. |
| reasoning_steps | string | A concise, ordered explanation of how prior accumulators and current claim expenses determine the calculation. |
| reasoning_question | string | The question to answer using the plan rules, prior claims, and current claim information. |
| applicable_cost_sharing | string | The cost-sharing rule applied to the current claim, such as a copay or a patient and plan coinsurance split. |
| total_patient_responsibility | number | The patient's total responsibility for the current claim after applying the deductible, cost sharing, and out-of-pocket maximum rules, in the currency units used by the input. |
| out_of_pocket_maximum_reached | boolean | Whether the plan-year out-of-pocket maximum has been reached after processing the current claim. |
| out_of_pocket_maximum_remaining | number | The amount remaining before the plan-year out-of-pocket maximum is reached, after processing the current claim, in the currency units used by the input. |
| deductible_remaining_after_claim | number | The deductible amount remaining after processing the current claim, in the currency units used by the input. |
| deductible_applied_to_current_claim | number | The amount of the current claim applied to the deductible, in the currency units used by the input. |
| patient_cost_share_after_deductible | number | The patient's cost share on the allowed amount remaining after the deductible, in the currency units used by the input. |
| out_of_pocket_accumulated_after_claim | number | The plan-year out-of-pocket accumulator after processing the current claim, in the currency units used by the input. |
| remaining_allowed_amount_after_deductible | number | The current claim's allowed amount remaining after the deductible portion is applied, in the currency units used by the input. |
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?
- Examples are built around plan-year rules, prior claims, and a current claim. They cover deductibles, coinsurance or copays, patient responsibility, and annual out-of-pocket accumulation, along with a reasoning question, calculated results, and reasoning steps.
- Which capabilities is the dataset suitable for training?
- It supports multi-step question answering that combines context, applies plan rules, calculates current cost sharing from historical accumulators, and determines whether the annual out-of-pocket maximum has been reached. It can also be used to evaluate related calculation and reasoning capabilities.
- Does the dataset include explicit calculation steps?
- Yes. Each example includes an ordered reasoning-steps field and a direct final-answer field, supporting supervision on how to derive conclusions from plan rules, prior accumulators, and current expenses.
- How can I confirm delivery options and licensing?
- Refer to the product listing or provider for the available delivery method, license, and usage restrictions. For use in health insurance products or services, verify that the data fits the target business rules and follow applicable data governance and compliance requirements.
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Verified for Enterprise UseCite this Work
@dataset{Mobiusi2026,
title={Multi-Step Claims Accumulator Reasoning Dataset for High-Deductible Health Plans},
author={MOBIUSI INC},
year={2026},
url={https://www.mobiusi.com/datasets/b6f99f8895f14cfd88d980b794d31d01?dataset_scene_cate_type=2},
urldate={2026-10-19},
keywords={high-deductible health plan,medical claims reasoning,deductible calculation,patient cost sharing,out-of-pocket maximum,multi-hop QA data,insurance claims dataset,reasoning SFT},
version={1.0}
}Using this in research? Please cite us.
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