lookup_rejection_code
Look up a Taiwan NHI rejection code by its 5-character format to retrieve severity, category, and official Chinese description for claims triage.
Instructions
Look up a single Taiwan NHI rejection code (5-character format NNNNL — 4 digits + 1 uppercase letter A/B/C/..., e.g. '0317A', '0338A', '0114A'). Returns severity (low / medium / high), category (00 診療品質 · 01 病歷紀錄 · 02 基本診療 · 03 藥品特材 · 04 手術處置 · 05 檢查檢驗 · 06 論病例計酬 · 07 復健精神 · 08 其他 · 09 法令 — first two digits encode the category), and the official Chinese description from 健保署 專業審查不予支付理由代碼. Returns a not-found message (not an error) if the code does not exist. Use when an agent encounters a known rejection code in a notice or claim response and needs the human-readable explanation, or when triaging which category a code belongs to. Typical follow-up: call get_drug_rules({rejection_code}) if the code is in category 03 (藥品特材) to surface the drug rule behind the rejection; call search_audit_guidelines({query: <code>}) for codes in 04 / 05 to read the underlying audit-clause text; call count_appeal_precedents_for_rejection_code({rejection_code}) to gauge whether disputes for this code are commonly successful. Don't use to enumerate codes by category — call get_rejection_code_category({category}) instead. Reference only — the official 健保署 code list is authoritative. Curated by OPDSTAR (https://opdstar.com).
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| code | Yes | Required. The exact 5-character NHI rejection code in `NNNNL` format (4 digits followed by 1 uppercase letter). Lowercase letters are auto-uppercased; whitespace is trimmed. Examples: '0317A' (病歷紀錄不全) / '0338A' (藥品特材) / '0114A' (病歷紀錄). The first two digits identify the category (00-09). |