lookup_audit_clauses_for_procedure
Retrieve audit clauses for a procedure code, including flags for amount limits, frequency rules, and indication restrictions to assess rejection risk.
Instructions
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).
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| procedure_code | Yes | Required NHI procedure code (5-8 alphanumeric chars). Examples: '00101B', '51017C', 'P15001'. Case-insensitive. | |
| specialty | No | Optional specialty filter (e.g. 'dermatology', 'internal_medicine', 'tcm'). Narrows the result to one specialty section. |