MCP 서버
coverage-rights
com.coverage-rights/coverage-rights
이 MCP로 할 수 있는 일
Provides health-insurance denial metrics, treatment and condition appeal outcomes, drug appeal guidance, and coverage appeal procedures.
기능
도구
9
도구
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.
읽기 전용
멱등성
입력 스키마
{'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.
읽기 전용
멱등성
입력 스키마
{'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.
읽기 전용
멱등성
입력 스키마
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['drug'], 'properties': {'drug': {'type': 'string', 'maxLength': 80, 'minLength': 2, 'description': "Brand or generic drug name, e.g. 'Zepbound', 'ustekinumab'"}}, 'additionalProperties': False}
get_insurer_metrics
Get an insurer's verified CY2025 prior-authorization metrics (denial rate, appeal overturn rate, decision times) from its own CMS-0057-F disclosure, plus contract/plan-level rows where collected. Includes source URLs and scope notes.
읽기 전용
멱등성
입력 스키마
{'type': 'object', '$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.
읽기 전용
멱등성
입력 스키마
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'required': ['state'], 'properties': {'state': {'type': 'string', 'maxLength': 2, 'minLength': 2, 'description': "Two-letter state code, e.g. 'ca', 'ny', 'fl'"}}, 'additionalProperties': False}
get_treatment_outcomes
External-review outcomes for a treatment: how often insurer denials of this treatment/drug/procedure were overturned by independent reviewers (42,749 published CA IMR decisions, 2001â2026). Accepts a category slug (e.g. 'pharmacy') or specific treatment slug (e.g. 'zepbound', 'speech-therapy').
읽기 전용
멱등성
입력 스키마
{'type': 'object', '$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.
읽기 전용
멱등성
입력 스키마
{'type': 'object', '$schema': 'http://json-schema.org/draft-07/schema#', 'properties': {}}
rank_denial_rates
Insurer prior-authorization denial rates (CY2025), ranked only within compatible reporting cohorts. Each row includes its cohort, rank within that cohort, exact source scope, calculation method, and source link. Never compare ranks across cohorts.
읽기 전용
멱등성
입력 스키마
{'type': 'object', '$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.
읽기 전용
멱등성
입력 스키마
{'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}
기록
최근 도구 변경
추가됨
get_state_external_review
2026년 9월 17일 12:34 PM
추가됨
get_drug_playbook
2026년 9월 17일 12:34 PM
추가됨
get_appeal_rights
2026년 9월 17일 12:34 PM
추가됨
search_outcomes
2026년 9월 17일 12:34 PM
추가됨
get_condition_outcomes
2026년 9월 17일 12:34 PM
추가됨
get_treatment_outcomes
2026년 9월 17일 12:34 PM
추가됨
rank_denial_rates
2026년 9월 17일 12:34 PM
추가됨
get_insurer_metrics
2026년 9월 17일 12:34 PM
추가됨
list_insurers
2026년 9월 17일 12:34 PM
탐색
유사한 MCP 서버
mcp
com.medigami/mcp
Analyzes medical bills and insurance denials, estimates healthcare costs, identifies assistance options, and supports appeals and…
Medicare Coverage
io.github.pipeworx-io/medicare-coverage
Provides structured Medicare coverage documents, policy timelines, utilization, enrollment, supplier, and payment-related data fr…
Fda Drug Competition
io.github.pipeworx-io/fda-drug-competition
Analyzes FDA Orange Book drug applications, patents, exclusivities, generic competition, and loss-of-exclusivity timelines.
FDA Data MCP
io.github.medley/fda-data
Searches and analyzes FDA data covering drugs, devices, facilities, inspections, recalls, approvals, shortages, enforcement, and …
Cms Open Payments
io.github.pipeworx-io/cms-open-payments
Searches and analyzes CMS Open Payments data on payments from pharmaceutical and device companies to physicians, hospitals, and o…
Dailymed
io.github.pipeworx-io/dailymed
Retrieves FDA DailyMed structured drug labels, label histories and diffs, drug classes, recent updates, and label references by d…
Codex Gsfa
io.github.pipeworx-io/codex-gsfa
Queries Codex GSFA food-additive regulations, including permitted additives, food categories, maximum use levels, qualifying note…
Sfda Drugs
io.github.pipeworx-io/sfda-drugs
Provides Saudi Food and Drug Authority drug records and related regulatory and market research access.