Medical Claims Cost-Sharing Multi-Hop Reasoning Dataset
#multi-hop reasoning #cost-sharing calculation #insurance policy interpretation #medical insurance claims processing #healthcare cost-sharing calculation #insurance benefit assessment
- 5000
- 0.2GB
- JSON
- CATL
MOBIUSI INC
Updated:2026-10-19
AI Analysis & Value Prop
This dataset contains medical claim scenarios and questions involving deductibles, copayments, coinsurance rates, plan limits, and prior accumulations. Each example provides the patient responsibility amount, insurer payment amount, and a step-by-step explanation, supporting models that must combine multiple plan rules to calculate cost sharing. It is suitable for medical claims processing, coverage verification, and reasoning-oriented supervised fine-tuning.
Dataset Insights
Sample Examples
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Technical Specifications
| Field | Type | Description |
|---|---|---|
| file_name | string | File name |
| question | string | The original question asking for claim payment responsibility or cost-sharing amounts. |
| reasoning | string | A step-by-step explanation of the applicable deductible, copayment, coinsurance, plan limits, prior accumulations, and how they determine the amounts owed. |
| claim_case | string | The original text describing the medical claim, plan terms, limits, and any prior accumulations. |
| insurer_payment_amount | number | The calculated amount payable by the insurer, expressed in the currency used in the claim scenario. |
| patient_responsibility_amount | number | The calculated amount the patient must pay, expressed in the currency used in the claim scenario. |
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 does the dataset contain?
- Each example includes a medical claim scenario, a question, the patient responsibility amount, the insurer payment amount, and a step-by-step reasoning explanation. Scenarios may cover deductibles, copayments, coinsurance, plan limits, and prior accumulations.
- Which capabilities can the dataset support?
- It supports multi-hop question answering, cost-sharing calculations, numerical reasoning, and reasoning generation. It can also be used to evaluate how well a model applies multiple claims rules together.
- How are monetary amounts and calculations represented?
- Patient responsibility and insurer payment amounts use the currency specified in each scenario. The accompanying reasoning explains the basis for the calculation; users should verify that the rules match their target business requirements.
- How can I access the dataset and check its license?
- Check the current product page for available access methods, file specifications, and licensing terms. Usage rights are governed by the license published on that page.
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Verified for Enterprise UseCite this Work
@dataset{Mobiusi2026,
title={Medical Claims Cost-Sharing Multi-Hop Reasoning Dataset},
author={MOBIUSI INC},
year={2026},
url={https://www.mobiusi.com/datasets/cdb39dad87d071ab3c98e41df7f56249},
urldate={2026-10-19},
keywords={medical claims dataset,cost-sharing calculation,insurance claims reasoning,deductible calculation,copayment calculation,coinsurance,patient responsibility,multi-hop QA data},
version={1.0}
}Using this in research? Please cite us.
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