tatsuju/opdstar-nhi-mcp

The MCP server for Taiwan NHI billing intelligence
Rejection codes · audit clauses · drug payment rules · fee schedule · special materials · appeal precedents
Powered by OPDSTAR — 台灣門診醫師病歷翻譯 + 核刪防護 Co-Pilot
繁中總覽 ： OVERVIEW_ZH.md ·
Roadmap ： ROADMAP.md ·
Contributing ： CONTRIBUTING.md
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Who is this for?
**Taiwan healthcare professionals + AI agent developers** building tools that need authoritative Taiwan National Health Insurance reference data. Plug this MCP into Claude Desktop, Cursor, ChatGPT Desktop, Claude.ai, or any MCP-compatible agent to answer questions like:
- **Billing accuracy** — Will this code / diagnosis combination get rejected? What's the prior-auth status?
- **Audit guidelines** — What does the NHI 審查注意事項 say about this specialty / procedure?
- **Drug rules** — What's the NHI payment rule for this medication?
- **Appeal precedents** — Has anyone appealed this rejection code? What's the success rate?
- **Fee schedule** — What's the official point value and effective date for this code?
Scope
This MCP focuses exclusively on **Taiwan NHI-specific billing rules and reference data**.
**Out of scope:**
- International standards (SNOMED CT, LOINC, FHIR R4 generation, RxNorm)
- Drug interaction databases
- Clinical decision support / diagnosis suggestions
- General TFDA drug registry queries (OPDSTAR cross-references but doesn't replicate)
OPDSTAR focuses on Taiwan NHI billing intelligence — that's what it does best.
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Real-world examples
👩‍⚕️ Scenario 1 — Audit risk pre-check
You're writing a chart in Claude Desktop:
> **You:** 我給 L30.9 慢性濕疹病人開了 prednisolone 30mg QD 5 天會不會被核刪？
> **Claude** (auto-calls lookup_rejection_code + get_indicator):
>
> 依健保審查 **008 指標**，口服類固醇 + 濕疹類診斷若 PE 描述不足，會觸發核刪代碼 **0320A**。建議：PE 補充病灶面積 ≥ 30% 全身，或加入更嚴重的 ICD-10 佐證。
>
> 資料來源：OPDSTAR
🔍 Scenario 2 — Procedure lookup
> **You:** 中耳炎 H66.9 耳鼻喉科能申報哪些處置？
> **Claude** (auto-calls get_procedures_for_icd):
>
> - 27002C 耳鏡檢查（25 點）
> - 27018C 耳膜穿刺（120 點）
> - 36005C 鼓室通氣管置入
>
> Full list: NHI procedures across major specialties.
📚 Scenario 3 — Wiki Q&A
> **You:** 慢性病連續處方箋最長可以開多久？
> **Claude** (auto-calls search_nhi_wiki):
>
> 依健保署規定，慢性病連續處方箋每次調劑之藥品使用期間最長 3 個月。原文：nhi.gov.tw/ch/cp-XXX.html
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What is this?
@opdstar/nhi-mcp lets any Model Context Protocol client — Claude Desktop, Cursor, ChatGPT Desktop, custom agents — **directly query Taiwan's National Health Insurance dataset** curated and maintained by OPDSTAR.
Ask your AI in natural language:
> "慢性濕疹 L30.9 開 prednisolone 30mg 5 天會不會被核刪？"
It auto-calls the right tools and pulls real NHI data:
- **NHI rejection codes** (e.g. 0317A, 0338A) with severity + category, browsable by category (00–09)
- **NHI procedure codes** across major specialties, mapped to ICD-10
- **NHI audit indicators** with thresholds and applicable specialty
- **NHI 審查注意事項 (audit clauses)** by procedure code or specialty, with risk flags
- **NHI drug catalog and 藥品給付規定** — search formulary + look up payment rules
- **NHI fee schedule** — current effective 全民健康保險醫療服務給付項目及支付標準
- **NHI 重大傷病範圍** (major-illness coverage) lookup and ICD-10 reverse check
- **Semantic + full-text search** over the 健保署 official wiki
- **Aggregate dispute-resolution signals** by category or rejection code (no individual case details)
All served through the opdstar.com edge layer — zero configuration, cached globally, under 100ms response.
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Install
Two ways to use the OPDSTAR MCP server.
Option A — Remote (one-click, no install)
> Available via the Anthropic MCP Directory — listing under review.
Point any MCP-compatible client at the hosted JSON-RPC 2.0 endpoint:
Live status, tool list, and dataset freshness: opdstar.com/mcp/status.
Option B — Local (npm)
Requires **Node.js 18+**.
Claude Desktop config
Add to ~/Library/Application Support/Claude/claude_desktop_config.json (Mac) or %APPDATA%\Claude\claude_desktop_config.json (Windows):
Restart Claude Desktop. You should see **27 tools** appear in the tools menu.
Cursor config
Add to .cursor/mcp.json in your project root (or global ~/.cursor/mcp.json):
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Tools
1. lookup_rejection_code
Look up a Taiwan NHI rejection code (5-character, e.g. 0317A).
**Arguments**: { code: string }
**Example**:
2. get_procedures_for_icd
Given an ICD-10 code and specialty, return the NHI procedure codes applicable.
**Arguments**: { icd10: string, specialty: string, limit?: number }
**Example**:
3. get_indicator
Look up a Taiwan NHI audit indicator — threshold.
**Arguments**: { code: string }
**Example**: