Serveur MCP
coverage-rights
com.coverage-rights/coverage-rights
Ce que fait ce MCP
Provides health-insurance denial metrics, treatment and condition appeal outcomes, drug appeal guidance, and coverage appeal procedures.
Capacités
Outils
9
outils
get_appeal_rights
Deterministically resolve the governing appeal route, missing facts, filing recipient, deadlines, current external-review status, and verified grounds. Distinguishes Original Medicare, Medicare Advantage medical benefits, Part D pharmacy benefits, employer funding/governance, ACA, Medicaid, FEHB, TRICARE, and unknown coverage; unsupported or ambiguous routes fail closed.
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['program', 'denial_reason'], 'properties': {'state': {'type': 'string', 'maxLength': 2, 'minLength': 2, 'description': "Two-letter state code, e.g. 'ca'"}, 'program': {'enum': ['medicare-advantage', 'original-medicare', 'medicare-part-d', 'erisa-employer-plans', 'aca-marketplace', 'medicaid', 'fehb', 'tricare', 'other-unknown'], 'type': 'string', 'description': 'Plan type'}, 'appeal_stage': {'enum': ['initial-denial', 'internal-appeal-filed', 'first-internal-denial', 'final-internal-denial', 'external-review-filed', 'unknown'], 'type': 'string'}, 'drug_channel': {'enum': ['not-a-drug', 'medical-benefit', 'pharmacy-benefit', 'unknown'], 'type': 'string', 'description': 'For a drug denial, whether the medical or pharmacy benefit applies'}, 'insurer_slug': {'type': 'string', 'description': 'Insurer slug for insurer-specific stats'}, 'denial_reason': {'enum': ['medical-necessity', 'experimental-investigational', 'prior-authorization', 'out-of-network', 'not-covered-benefit', 'coding-billing-error', 'prescription-drug'], 'type': 'string', 'description': "Denial reason category. Use 'prescription-drug' for medication denials â\x80\x94 formulary exclusion, step therapy, quantity limits, or drug prior authorization â\x80\x94 which return the formulary-exception grounds and their short decision deadlines."}, 'employer_type': {'enum': ['private', 'government', 'church', 'union', 'unknown'], 'type': 'string', 'description': 'Required to resolve job-based coverage'}, 'current_status': {'enum': ['awaiting-service', 'receiving-service', 'service-ended', 'post-service-claim', 'unknown'], 'type': 'string'}, 'funding_status': {'enum': ['fully-insured', 'self-funded', 'unknown'], 'type': 'string', 'description': 'Required to resolve job-based state versus federal governance'}, 'regulatory_marker': {'enum': ['state-regulated', 'federal-or-self-funded', 'unknown'], 'type': 'string'}, 'regulatory_state_basis': {'enum': ['denial-letter', 'insurance-card', 'plan-document', 'residence-only', 'unknown'], 'type': 'string'}}, 'additionalProperties': False}
get_condition_outcomes
External-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['slug'], 'properties': {'slug': {'type': 'string', 'description': "Condition slug, e.g. 'obesity', 'autism', 'hepatitis-c'"}}, 'additionalProperties': False}
get_drug_playbook
Drug-specific denial patterns and appeal strategy for the medications plans fight hardest over: GLP-1s (Wegovy, Zepbound, Mounjaro, Ozempic, Saxenda) and IBD biologics (Humira, Skyrizi, Stelara, Entyvio, Remicade, Rinvoq). Returns FDA-approved indications stated conservatively, why plans deny that specific drug, what winning appeals argue, and the step-therapy exception framing â plus the published external-review record for the drug when the corpus has it. Accepts a brand or generic name.
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['drug'], 'properties': {'drug': {'type': 'string', 'maxLength': 80, 'minLength': 2, 'description': "Brand or generic drug name, e.g. 'Zepbound', 'ustekinumab'"}}, 'additionalProperties': False}
get_insurer_metrics
Get an insurer's verified CY2025 prior-authorization metrics (denial rate, appeal overturn rate, decision times) from its own CMS-0057-F disclosure, plus contract/plan-level rows where collected. Includes source URLs and scope notes.
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['slug'], 'properties': {'slug': {'type': 'string', 'description': "Insurer slug from list_insurers, e.g. 'unitedhealthcare'"}}, 'additionalProperties': False}
get_state_external_review
How a state's external review process works: filing deadline, regulator contact, and key facts. Verified detail currently covers 10 states (CA, TX, FL, NY, PA, IL, OH, GA, NC, MI); other states return the covered list.
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['state'], 'properties': {'state': {'type': 'string', 'maxLength': 2, 'minLength': 2, 'description': "Two-letter state code, e.g. 'ca', 'ny', 'fl'"}}, 'additionalProperties': False}
get_treatment_outcomes
External-review outcomes for a treatment: how often insurer denials of this treatment/drug/procedure were overturned by independent reviewers (42,749 published CA IMR decisions, 2001â2026). Accepts a category slug (e.g. 'pharmacy') or specific treatment slug (e.g. 'zepbound', 'speech-therapy').
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['slug'], 'properties': {'slug': {'type': 'string', 'description': "Treatment slug, e.g. 'zepbound', 'pharmacy', 'speech-therapy'. Use search_outcomes to find slugs."}}, 'additionalProperties': False}
list_insurers
List tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'properties': {}}
rank_denial_rates
Insurer prior-authorization denial rates (CY2025), ranked only within compatible reporting cohorts. Each row includes its cohort, rank within that cohort, exact source scope, calculation method, and source link. Never compare ranks across cohorts.
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'properties': {}}
search_outcomes
Search treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.
Lecture seule
Idempotent
Schéma d’entrée
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['query'], 'properties': {'limit': {'type': 'integer', 'maximum': 50, 'minimum': 1, 'description': 'Max results per type (default 10)'}, 'query': {'type': 'string', 'minLength': 2, 'description': "Search text, e.g. 'wegovy', 'back pain', 'imaging'"}}, 'additionalProperties': False}
Historique
Modifications récentes des outils
Ajouté
get_state_external_review
17 September 2026 12:34
Ajouté
get_drug_playbook
17 September 2026 12:34
Ajouté
get_appeal_rights
17 September 2026 12:34
Ajouté
search_outcomes
17 September 2026 12:34
Ajouté
get_condition_outcomes
17 September 2026 12:34
Ajouté
get_treatment_outcomes
17 September 2026 12:34
Ajouté
rank_denial_rates
17 September 2026 12:34
Ajouté
get_insurer_metrics
17 September 2026 12:34
Ajouté
list_insurers
17 September 2026 12:34
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