insurance-claim-medical-review
insurance-claim-medical-review is a Medical documentation & coding skill for AI agents, published by aliyun in the qwen-dianjin repository on GitHub. Skillspace rates insurance-claim-medical-review C (77/100) and it passed the safety scan; the rating is based on static analysis only.
对理赔费用清单中所有费用项（含检查、手术、耗材、护理、药品、床位费等）进行逐项合理性审核，识别不符合诊断的费用、超标准收费、重复收费；同时审查处方药品与诊断匹配性，识别超适应症用药、剂量异常、配伍禁忌，结合医保目录与临床指南输出核减建议，生成医学审查报告。当用户要求审核理赔费用明细、核定住院费用合理性、识别超标准或重复收费、审核药品合理性时触发。适用于医疗险理赔费用核定、住院费用审查、费用核减决策、理赔用药审核场景。触发词：住院费用、用药合理性、过度收费。
- Grade
- C
- Quality
- 77 / 100
- Safety
- Passed
- GitHub stars
- 571
Unproven: rated by static analysis only, not yet compared head-to-head.
Our two independent classifiers differ on this skill's category, so treat the placement as provisional.
This rating describes the version of the repository we crawled; it may have changed since, so go by its current files.
Our review
- Architecture
- 94 / 100
- Maturity
- Structured: ships references or scripts
- Security scan
- No issues found
- License
- Not declared. Check the repository before reusing it.
- Adoption
- Adopted by 0 other repositories, in 0 collections
- Scope
- Portable: works in any project. General insurance claim medical cost review methodology
Not checked yet
- Not judged on the rubric yet (not a contender in its category)
- No blind task eval yet
- Sibling files (scripts, references) not fetched; security scan covers SKILL.md only
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