A
licenseNot graded
qualityC
maintenanceEnables querying US health-insurance claim denial rates and appeal outcomes by insurer, with tools for filtering by state and market and obtaining detailed profiles and coverage info.
352 npm
MIT
coverage-rights
Server Details
Insurer denial rates, appeal outcomes by treatment and condition, and appeal rights lookups.
If you are the author of this connector, you can claim ownership by verifying the domain or GitHub account it belongs to. Claimed connector authors can inspect health checks, view analytics, and manage their listing.
- Status
- Healthy
- Uptime
- 100.0% over 80 days
- Last Tested
- Transport
- Streamable HTTP · MCP 2025-11-25
- URL
- ChatGPT
- –
- Claude
- –
TDQS
A3.7/5.0
Scored across 10 tools
Disambiguation4/5
Most tools target a clearly distinct object: routing rules, state process, insurer metrics, rankings, drug playbook, treatment outcomes, condition outcomes, and search. The only genuine near-overlaps are search_outcomes vs. the two outcome-lookup tools and get_insurer_metrics vs. rank_denial_rates, but the descriptions make the boundary (slug lookup/headline vs. detail; per-insurer rows vs. cohort-relative ranking) legible.
Naming Consistency4/5
All snake_case with a verb_noun shape (get_*, list_*, search_*, rank_*, prepare_*), which is predictable and readable. The verb mix means callers can't assume get_ everywhere, but the pattern is consistent enough that this is a minor deviation rather than an inconsistency.
Tool Count4/5
Ten tools is well within a comfortable range and each generally maps to a distinct step in a denial/appeal research workflow. The only oddity is that one of the ten is a bespoke knee-injection preparation tool, which makes the set feel slightly lopsided rather than over-scoped.
Completeness3/5
The research surface is broad (routing, state process, outcomes, insurer metrics, rankings, drug context), but the lifecycle dead-ends at research: there is no tool to record a deadline, track a filed appeal, or draft/generate appeal content. The most visible asymmetry is preparation support: a dedicated knee-injection evidence tool exists while no general evidence-preparation equivalent does, so any non-knee denial has a hole in that step.
Available Tools
10 toolsget_appeal_rightsARead-onlyIdempotentInspect
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.
| Name | Required | Description | Default |
|---|---|---|---|
| state | No | Two-letter state code, e.g. 'ca' | |
| program | Yes | Plan type | |
| appeal_stage | No | ||
| drug_channel | No | For a drug denial, whether the medical or pharmacy benefit applies | |
| insurer_slug | No | Insurer slug for insurer-specific stats | |
| denial_reason | Yes | Denial category. For medication denials use 'prescription-drug' and supply the actual coverage program, benefit channel and routing facts. Applicable grounds and rule triggers depend on that route; preserve missing-fact and unsupported results. | |
| employer_type | No | Required to resolve job-based coverage | |
| current_status | No | ||
| funding_status | No | Required to resolve job-based state versus federal governance | |
| regulatory_marker | No | ||
| regulatory_state_basis | No |
Output Schema
| Name | Required | Description |
|---|---|---|
| page | Yes | |
| _note | Yes | |
| grounds | Yes | |
| route_id | Yes | |
| warnings | Yes | |
| _coverage | Yes | |
| deadlines | Yes | |
| statistics | Yes | |
| next_action | Yes | |
| route_label | Yes | |
| missing_facts | Yes | |
| why_this_route | Yes | |
| escalation_path | Yes | |
| primary_sources | Yes | |
| filing_recipient | Yes | |
| route_confidence | Yes | |
| can_generate_paid | Yes | Existing resolver capability flag, not payment acceptance or advice to purchase. |
| documents_to_gather | Yes | |
| prefilled_appeal_url | Yes | |
| external_review_track | Yes | |
| verified_ground_count | Yes | |
| corpus_verification_note | Yes | |
| external_review_current_status | Yes |
TDQS
A3.7/5.0
Behavior4/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare readOnly, idempotent, non-destructive and closed-world, so the safety profile is covered. The description adds genuinely new behavior: results are deterministic, missing facts are surfaced rather than guessed, and unsupported or ambiguous routes fail closed. That tells an agent how to interpret partial or refused results, which annotations do not.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness4/5
Is the description appropriately sized, front-loaded, and free of redundancy?
Two front-loaded sentences that lead with the resolved outputs rather than throat-clearing. The long program enumeration is dense but earns its place by signaling the disambiguation breadth. Slightly jargon-heavy phrasing ('governing appeal route', 'verified grounds') costs it the top score.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
With an output schema present, the description need not explain return values, yet it usefully names the primary outputs anyway. For an 11-parameter, multi-route regulatory tool it covers the fail-closed contract and the drug-denial path well. The remaining gap is not steering the agent away from the overlapping external-review sibling.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters3/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
The schema already carries 64% description coverage with 9 strongly enums, so the baseline is moderate. The description adds real meaning for one path, telling the agent to use 'prescription-drug' and supply actual coverage program, benefit channel and routing facts, and it gestures at employer funding/governance. However, state, insurer_slug, appeal_stage, current_status, regulatory_marker and regulatory_state_basis are never illuminated beyond the schema.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose4/5
Does the description clearly state what the tool does and how it differs from similar tools?
Specific verb+resource: it resolves the governing appeal route plus missing facts, filing recipient, deadlines, external-review status and grounds, and enumerates the coverage programs it disambiguates. It is clearly distinct from siblings like get_insurer_metrics or get_condition_outcomes, though it never explicitly positions itself against get_state_external_review, which overlaps on external-review routing.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines3/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
Usage is implied rather than stated: an agent infers this is the lookup to run when given a denial plus coverage facts. There is no explicit 'use this when…' or exclusion guidance naming an alternative sibling. The 'unsupported or ambiguous routes fail closed' clause gives useful behavioral framing but not selection criteria.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
get_condition_outcomesARead-onlyIdempotentInspect
External-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.
| Name | Required | Description | Default |
|---|---|---|---|
| slug | Yes | Condition slug, e.g. 'obesity', 'autism', 'hepatitis-c' |
Output Schema
| Name | Required | Description |
|---|---|---|
| page | No | Existing free information page when a matching record is available. |
| _note | Yes | |
| error | No | Lookup error text when _coverage.status is not_found or unsupported. |
| source | No | |
| _coverage | Yes | |
| condition | No | |
| decisions | No | |
| overturned | No | |
| overturn_rate_pct | No | |
| most_fought_treatments | No |
TDQS
A3.6/5.0
Behavior3/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare readOnlyHint, idempotentHint, non-destructive and closed-world, so the safety profile is covered. The description's added value is telling the agent the response is aggregate statistical content (overturn frequency, most-fought treatments) rather than raw cases, which is useful framing. It says nothing about result shape, sample size, or coverage limits, so credit is moderate.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness5/5
Is the description appropriately sized, front-loaded, and free of redundancy?
A single well-formed sentence that front-loads what the tool returns and wastes no words. Nothing is duplicated or padded.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
An output schema exists, so return values need not be explained, and the single parameter is fully documented in the schema. The only meaningful gap is sibling disambiguation against the closely named get_treatment_outcomes and search_outcomes.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters3/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
With one parameter at 100% schema description coverage (including example slugs like 'obesity', 'autism', 'hepatitis-c'), the schema already carries parameter meaning. The description only implies the slug identifies the condition, adding no format or lookup-failure guidance beyond the schema.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose4/5
Does the description clearly state what the tool does and how it differs from similar tools?
The description names a specific resource (external-review outcomes for a medical condition) and enumerates its contents: denial overturn rates plus most-fought treatments. It is clearly a read/aggregate lookup. It stops short of distinguishing itself from siblings like get_treatment_outcomes, whose name suggests overlapping subject matter.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines3/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
Usage is implied by 'for a medical condition' — you call it when you need outcome statistics for a condition. There is no explicit when-to-use versus when-to-use-something-else guidance, and no help choosing between this tool and get_treatment_outcomes or search_outcomes.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
get_drug_playbookARead-onlyIdempotentInspect
Curated medication background, common denial patterns, preparation considerations, and available historical California review outcomes for covered GLP-1 and IBD drugs. Accepts a brand or generic name. Confirm current labeling, the actual benefit channel and plan criteria; the guide does not establish current coverage, an exception entitlement, an individual outcome, or an applicable deadline.
| Name | Required | Description | Default |
|---|---|---|---|
| drug | Yes | Brand or generic drug name, e.g. 'Zepbound', 'ustekinumab' |
Output Schema
| Name | Required | Description |
|---|---|---|
| note | No | |
| page | No | Existing free information page when a matching record is available. |
| _note | Yes | |
| brand | No | |
| error | No | Lookup error text when _coverage.status is not_found or unsupported. |
| covered | No | |
| generic | No | |
| _coverage | Yes | |
| appeal_angles | No | |
| step_therapy_note | No | |
| appeal_rights_hint | No | |
| published_outcomes | No | |
| common_denial_patterns | No | |
| fda_approved_indications | No |
TDQS
A3.9/5.0
Behavior4/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare readOnly, idempotent, non-destructive, and closed-world, so the safety profile is covered. The description adds substance beyond that: the jurisdictional limit (California historical outcomes) and an explicit enumeration of what the data cannot establish, which prevents an agent from treating the playbook as a coverage determination. Missing only details like result volume or freshness of the historical outcomes.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness4/5
Is the description appropriately sized, front-loaded, and free of redundancy?
Two sentences: the first front-loads the payload, the second front-loads the caveats. Every clause carries information, though the caveat sentence is dense enough to read as a run-on list. No filler or restated title.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
An output schema exists, so return structure need not be described, and annotations cover the safety profile. The description supplies scope, drug-class coverage, jurisdiction, and negative guarantees. The main residual gap is not signaling how to proceed when the drug is outside the GLP-1/IBD set.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters3/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
Schema coverage is 100% and the single parameter already documents brand-or-generic acceptance with examples. The description restates that both forms are accepted but adds no parsing rules, casing, or failure behavior for unrecognized names. Baseline 3 applies when the schema carries the semantics.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose4/5
Does the description clearly state what the tool does and how it differs from similar tools?
Names a specific resource (drug denial playbook) and enumerates its contents: curated medication background, common denial patterns, preparation considerations, and historical California review outcomes for GLP-1 and IBD drugs. An agent can tell this is a drug-level lookup rather than a condition, insurer, or outcome search. It never names a sibling to route against, which keeps it just short of a 5.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines4/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
Gives clear invocation context ('accepts a brand or generic name') and an explicit when-not clause: the guide does not establish current coverage, an exception entitlement, an individual outcome, or an applicable deadline, so the agent should confirm labeling and plan criteria elsewhere. It stops short of naming which sibling to use for individual outcomes or appeal rights, so no explicit alternative routing.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
get_insurer_metricsARead-onlyIdempotentInspect
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.
| Name | Required | Description | Default |
|---|---|---|---|
| slug | Yes | Insurer slug from list_insurers, e.g. 'unitedhealthcare' |
Output Schema
| Name | Required | Description |
|---|---|---|
| page | No | Existing free information page when a matching record is available. |
| _note | Yes | |
| error | No | Lookup error text when _coverage.status is not_found or unsupported. |
| rollup | No | |
| insurer | No | |
| _coverage | Yes | |
| contract_rows | No | |
| rollup_status | No |
TDQS
A3.5/5.0
Behavior3/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare readOnlyHint, idempotentHint, and destructiveHint=false, so the safety profile is covered. The description adds useful provenance and scope context ('verified', CY2025, from its own CMS-0057-F disclosure, includes source URLs and scope notes) plus the 'where collected' caveat that coverage may be partial. It stops short of stating freshness, whether missing insurers error or return empty, or what the scope notes mean in practice.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness4/5
Is the description appropriately sized, front-loaded, and free of redundancy?
A single front-loaded sentence with the resource first and the qualifiers after; nothing is wasted. The tail clause ('plus contract/plan-level rows where collected') is dense but earns its place by flagging variable granularity.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
An output schema exists, so return values need not be described, and annotations cover the safety profile. For a one-parameter read tool the description supplies provenance, granularity, and a data-completeness caveat. Only explicit routing to sibling tools and empty-result behavior are missing.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters3/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
Only one parameter exists and schema description coverage is 100%; the schema already explains slug and points to list_insurers with an example. The description adds nothing about slug format or resolution behavior, so the baseline of 3 applies.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose4/5
Does the description clearly state what the tool does and how it differs from similar tools?
States a specific verb and resource ('Get an insurer's verified CY2025 prior-authorization metrics') and enumerates the metric families returned (denial rate, appeal overturn rate, decision times). It also discloses provenance (CMS-0057-F disclosure) and granularity (contract/plan-level rows). It does not name a sibling it is distinct from, so it falls short of 5.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines3/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
Usage is only implied: the description signals this is the per-insurer metrics lookup sourced from CMS filings, distinct from ranking or condition-outcome siblings by wording alone. There is no explicit 'use this when' or 'use rank_denial_rates instead for comparisons' guidance, and the dependency on list_insurers for the slug lives only in the schema.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
get_state_external_reviewARead-onlyIdempotentInspect
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.
| Name | Required | Description | Default |
|---|---|---|---|
| state | Yes | Two-letter state code, e.g. 'ca', 'ny', 'fl' |
Output Schema
| Name | Required | Description |
|---|---|---|
| page | No | Existing free information page when a matching record is available. |
| _note | Yes | |
| error | No | Lookup error text when _coverage.status is not_found or unsupported. |
| notes | No | |
| phone | No | |
| state | No | |
| covered | No | |
| process | No | |
| summary | No | |
| _coverage | Yes | |
| regulator | No | |
| regulator_url | No | |
| filing_deadline | No | |
| primary_sources | No | |
| filing_deadline_days | No |
TDQS
A3.7/5.0
Behavior4/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare readOnlyHint, idempotentHint, and openWorldHint=false, so safety is covered. The description adds genuinely new behavioral context: only 10 states are verified and unsupported states return the covered list rather than an error — a non-obvious fallback the agent needs to interpret results correctly.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness4/5
Is the description appropriately sized, front-loaded, and free of redundancy?
Two tight sentences: the first front-loads what is returned, the second immediately qualifies coverage. The state-code parenthetical is slightly long but serves a real purpose by letting the agent skip invalid calls.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
An output schema exists, so return-value shape need not be described, and the coverage caveat is the main thing an agent must know before calling. The definition is complete for a single-parameter lookup; only cross-tool routing guidance is missing.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters3/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
The schema documents the sole 'state' parameter at 100% coverage, including the two-letter constraint and examples. The description only implicitly reinforces the state scope via the enumerated state list; it adds no new syntax or format meaning, so the baseline 3 applies.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose4/5
Does the description clearly state what the tool does and how it differs from similar tools?
The description states the specific resource (a state's external review process) and enumerates the returned facts: filing deadline, regulator contact, and key facts. It is clearly distinct from siblings like get_appeal_rights or get_insurer_metrics by resource, though it does not explicitly name which sibling to prefer for adjacent questions.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines3/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
Usage is implied by the narrow state-code scope, and the coverage note tells the agent what happens for unsupported states. However, there is no explicit when-to-use guidance versus siblings such as get_appeal_rights, which covers a related topic and could be confused by an agent.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
get_treatment_outcomesARead-onlyIdempotentInspect
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, 2001–2026). Accepts a category slug (e.g. 'pharmacy') or specific treatment slug (e.g. 'zepbound', 'speech-therapy').
| Name | Required | Description | Default |
|---|---|---|---|
| slug | Yes | Treatment slug, e.g. 'zepbound', 'pharmacy', 'speech-therapy'. Use search_outcomes to find slugs. |
Output Schema
| Name | Required | Description |
|---|---|---|
| page | No | Existing free information page when a matching record is available. |
| type | No | |
| _note | Yes | |
| error | No | Lookup error text when _coverage.status is not_found or unsupported. |
| source | No | |
| _coverage | Yes | |
| decisions | No | |
| treatment | No | |
| overturned | No | |
| by_condition | No | |
| subcategories | No | |
| by_denial_reason | No | |
| overturn_rate_pct | No |
TDQS
A3.7/5.0
Behavior4/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare readOnly, idempotent, closed-world behavior, so the safety profile is covered. The description adds meaningful context beyond that: the data source and size (42,749 published CA IMR decisions), the coverage window (2001–2026), and the California scope, which tells the agent the results are jurisdiction-limited. It does not discuss rate limits or how missing/low-volume treatments are handled.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness4/5
Is the description appropriately sized, front-loaded, and free of redundancy?
Two sentences, front-loaded with the outcome definition before the input note. The examples are compact and earn their place. Slightly dense nested parentheticals cost it a point but nothing is wasted.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
With a single required parameter, full schema coverage, and an output schema, the description covers what is needed to call it correctly and understand the dataset's provenance. The main omission is routing guidance relative to the many overlapping sibling tools (condition outcomes, insurer metrics, denial-rate ranking).
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters3/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
Schema description coverage is 100% and the schema already says the slug may be a treatment, category, or example like 'pharmacy', so the description largely restates it. It does add the useful framing that category-level slugs are accepted, but no format rules, case sensitivity, or failure behavior for bad slugs. Baseline 3 is appropriate.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose4/5
Does the description clearly state what the tool does and how it differs from similar tools?
The description names a concrete resource ('external-review outcomes for a treatment') and a concrete metric ('how often insurer denials ... were overturned by independent reviewers'), so the agent knows exactly what it returns. The parenthetical 'this treatment/drug/procedure' clarifies the resource spans three entity types. It stops short of explicitly contrasting itself with siblings such as get_condition_outcomes or search_outcomes, which is the only thing keeping it from a 5.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines3/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
Usage is only implied: the agent can infer it should call this when it wants overturn statistics for a specific treatment or category. There is no statement of when to prefer get_condition_outcomes, get_insurer_metrics, or rank_denial_rates instead, nor any prerequisites. The pointer to search_outcomes for slug discovery lives in the input schema, not the description.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
list_insurersARead-onlyIdempotentInspect
List tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.
| Name | Required | Description | Default |
|---|---|---|---|
No parameters | |||
Output Schema
| Name | Required | Description |
|---|---|---|
| _note | Yes | |
| insurers | Yes | |
| _coverage | Yes |
TDQS
A3.7/5.0
Behavior3/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare readOnlyHint, idempotentHint, destructiveHint=false and openWorldHint=false, so the safety profile is fully covered without description help. The description adds the useful behavioral detail that results are scoped to "tracked" insurers and each row carries an availability flag, but says nothing about ordering, pagination, or how coverage gaps are represented.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness5/5
Is the description appropriately sized, front-loaded, and free of redundancy?
A single front-loaded sentence with a clear subject and no filler. The qualifier about metrics availability arrives in the same clause as the resource, so nothing is buried.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
The tool is a no-argument list with an output schema, so return-shape explanation is unnecessary, and the description covers both the entity scope and the key per-row distinction. Only the sequencing relationship to get_insurer_metrics is left implicit, which is a minor gap for a low-complexity tool.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters4/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
The input schema defines zero parameters, so there is no parameter meaning for the description to supply. Baseline 4 applies for a no-argument tool.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose4/5
Does the description clearly state what the tool does and how it differs from similar tools?
Names a specific verb ("List") and a specific resource ("tracked U.S. health insurers"), and adds a scope qualifier that the entries carry a metrics-availability flag. It does not explicitly name the sibling get_insurer_metrics as the follow-up, so differentiation is inferred rather than stated, which keeps it just short of a 5.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines3/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
The phrase "whether verified CMS-0057-F prior-authorization metrics are available for each" implies this is a discovery/index step that precedes pulling actual metrics, but the description never states when to use this versus get_insurer_metrics or any other sibling. Usage is implied rather than instructed.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
prepare_knee_injection_evidenceARead-onlyIdempotentInspect
Prepare a free, category-level evidence checklist for a knee osteoarthritis hyaluronic-acid injection denial using routing facts, injection-series status, and record availability categories. Reuses the existing knee denial preparation kit. Does not inspect records or verify an insurer's specific criteria, provide clinical recommendations, draft an appeal, calculate deadlines, or estimate success. Send only the schema's bounded categories; never send names, identifiers, record text, or uploaded documents. Missing routing facts and unsupported routes remain explicit holds.
| Name | Required | Description | Default |
|---|---|---|---|
| state | No | Lowercase state code from the notice or plan, not residence alone. | |
| program | No | ||
| records | No | Category availability only, not evidence contents or a finding of sufficiency. | |
| appeal_stage | No | ||
| drug_channel | No | This checklist covers medical-benefit injections only; do not infer the channel. | |
| denial_reason | No | ||
| employer_type | No | ||
| current_status | No | ||
| funding_status | No | ||
| injection_series | No | unknown | |
| regulatory_marker | No | ||
| regulatory_state_basis | No |
Output Schema
| Name | Required | Description |
|---|---|---|
| gaps | Yes | |
| _note | Yes | |
| route | Yes | |
| status | Yes | |
| _coverage | Yes | |
| missing_facts | Yes | |
| criteria_check | Yes | |
| injection_series | Yes | |
| public_resources | Yes | |
| reported_records | Yes | |
| preparation_scope | Yes | |
| questions_for_plan | Yes | |
| evidence_categories | Yes | |
| unsupported_reasons | Yes | |
| plan_criteria_verified | Yes | |
| questions_for_clinician | Yes | |
| evidence_sufficiency_assessed | Yes | |
| user_reported_categories_only | Yes |
TDQS
A4.3/5.0
Behavior5/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Beyond the annotations (readOnly, idempotent, non-destructive, closed-world), the description discloses a privacy contract ('send only the schema's bounded categories; never send names, identifiers, record text, or uploaded documents'), deterministic hold behavior for missing routing facts and unsupported routes, and the fact that it reuses an existing preparation kit. These are non-obvious behavioral traits the agent cannot get from structured fields.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness4/5
Is the description appropriately sized, front-loaded, and free of redundancy?
Front-loaded with what the tool produces, followed by exclusions and privacy constraints; every sentence carries information. It is dense but not padded, though the long single-paragraph negation run is slightly harder to scan than a split scope/limits structure.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
An output schema exists, so return values need not be described, and the description covers scope, privacy, and hold semantics for a complex 12-parameter tool. The remaining gap is that most enum parameters lack meaning guidance, leaving the agent to guess correct values for routing facts such as regulatory_state_basis.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters3/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
With only 25% schema description coverage across 12 parameters, most fields (program, appeal_stage, denial_reason, employer_type, funding_status, regulatory_marker, regulatory_state_basis) are unexplained in both schema and description. The description does clarify the key contract that only bounded categories may be passed and that record contents are out of scope, but it never explains individual routing facts or how they map to checklist output.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose5/5
Does the description clearly state what the tool does and how it differs from similar tools?
States a specific verb and resource: 'Prepare a free, category-level evidence checklist for a knee osteoarthritis hyaluronic-acid injection denial,' plus the inputs it consumes (routing facts, injection-series status, record availability categories). No sibling tool in the list produces a checklist, so the agent can immediately separate it from the get_*/list_* lookup tools.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines4/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
The description gives strong context for when this applies (a knee OA HA injection denial) and enumerates explicit exclusions: it does not inspect records, verify insurer criteria, give clinical recommendations, draft an appeal, calculate deadlines, or estimate success. It does not name an alternative tool for those excluded needs, so the agent must infer where to go instead.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
rank_denial_ratesARead-onlyIdempotentInspect
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.
| Name | Required | Description | Default |
|---|---|---|---|
No parameters | |||
Output Schema
| Name | Required | Description |
|---|---|---|
| page | Yes | |
| _note | Yes | |
| ranking | Yes | |
| _coverage | Yes | |
| ranking_basis | Yes |
TDQS
A3.9/5.0
Behavior4/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare this as a safe, idempotent, closed-world read. Beyond that, the description discloses the cohort-partitioning behavior of the result set and enumerates what each row carries (cohort, rank, source scope, calculation method, source link). The dataset vintage (CY2025) is also given, which is real behavioral context. It does not say how cohorts are determined or what happens if none match.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness5/5
Is the description appropriately sized, front-loaded, and free of redundancy?
Three short sentences: what it is, what each row contains, and the critical prohibition. The constraint is placed last for emphasis and nothing is repeated from the title or annotations. No filler.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
An output schema exists, so the description need not explain return values, yet it still frames the row contents usefully. Combined with an empty input schema and full annotation coverage, the definition gives an agent enough to invoke and interpret the tool. The remaining gap is that it never says how many cohorts exist or how to consume rows across them.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters4/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
The tool takes zero parameters, so baseline is 4. The description correctly implies a no-argument, fixed-scope call rather than hinting at implicit filtering options, which keeps expectations aligned with the empty schema.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose4/5
Does the description clearly state what the tool does and how it differs from similar tools?
The description states a specific resource (insurer prior-authorization denial rates, CY2025) and a specific operation (ranked within compatible reporting cohorts). An agent can distinguish it from get_insurer_metrics or search_outcomes by the word 'ranked'. It stops short of naming a sibling to contrast against, so not a 5.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines3/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
There is one hard usage constraint — 'ranked only within compatible reporting cohorts' and 'Never compare ranks across cohorts' — which tells the agent what not to do with the output. However, it gives no positive guidance on when to pick this tool over get_insurer_metrics or get_condition_outcomes, so selection between siblings is left to inference.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
search_outcomesARead-onlyIdempotentInspect
Search treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.
| Name | Required | Description | Default |
|---|---|---|---|
| limit | No | Max results per type (default 10) | |
| query | Yes | Search text, e.g. 'wegovy', 'back pain', 'imaging' |
Output Schema
| Name | Required | Description |
|---|---|---|
| _note | Yes | |
| corpus | Yes | |
| source | Yes | |
| results | Yes | |
| _coverage | Yes |
TDQS
A4.4/5.0
Behavior4/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Annotations already declare readOnly, idempotent, non-destructive, and closed-world, so the safety profile is covered. The description adds value beyond that by stating what comes back: slugs plus headline overturn rates, which tells the agent the response can preview outcomes without a second call. Pagination/ordering of results is not disclosed, keeping it below a 5.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness5/5
Is the description appropriately sized, front-loaded, and free of redundancy?
Two sentences, each carrying distinct information: the first defines the search domain, the second defines the return payload and the follow-up tools. Nothing is redundant with the name or title.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Completeness4/5
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
With an output schema present, the description does not need to enumerate return fields, and it correctly summarizes rather than repeats them. For a two-parameter read-only search tool this is nearly complete; only the limit parameter's per-type behavior and result ordering are left implicit.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Parameters4/5
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
Schema coverage is 100%, so both parameters are already documented, setting a baseline of 3. The description earns an extra point by clarifying what the query string actually matches against (category names, specific drugs/procedures, and conditions), which is more than the schema's bare examples.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Purpose5/5
Does the description clearly state what the tool does and how it differs from similar tools?
Uses a specific verb (search) against a clearly enumerated resource set: treatment categories, specific drugs/procedures, and conditions matched by name. It also distinguishes itself from the retrieval siblings by naming get_treatment_outcomes and get_condition_outcomes as downstream consumers of the slugs it returns.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines4/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
The description makes the workflow role clear — this is the lookup step that produces slugs for get_treatment_outcomes / get_condition_outcomes — so an agent knows to call it first when it has a name but not an identifier. It stops short of explicit when-not guidance (e.g., what to do if you already have a slug, or whether ranking/insurer tools are alternatives).
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
Tool Schema Changelog
Recent tool additions, removals, and schema changes observed during successful MCP inspections.
10 tool updates
- Changed
get_appeal_rights2 fields changed- changed
Input schema / properties / denial_reason / descriptionPrevious value: -"Denial reason category. Use 'prescription-drug' for medication denials — formulary exclusion, step therapy, quantity limits, or drug prior authorization — which return the formulary-exception grounds and their short decision deadlines."New value: +"Denial category. For medication denials use 'prescription-drug' and supply the actual coverage program, benefit channel and routing facts. Applicable grounds and rule triggers depend on that route; preserve missing-fact and unsupported results." - changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "can_generate_paid": { + "description": "Existing resolver capability flag, not payment acceptance or advice to purchase.", + "type": "boolean" + }, + "corpus_verification_note": { + "type": "string" + }, + "deadlines": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "source": { + "type": "string" + }, + "sourceUrl": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "trigger": { + "type": "string" + }, + "value": { + "type": "string" + } + }, + "required": [ + "label", + "value", + "trigger", + "source", + "sourceUrl" + ], + "type": "object" + }, + "type": "array" + }, + "documents_to_gather": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "escalation_path": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "external_review_current_status": { + "additionalProperties": true, + "properties": { + "detail": { + "type": "string" + }, + "historicalExtension": { + "additionalProperties": true, + "properties": {}, + "type": "object" + }, + "instructionsUrl": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "sourceUrl": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "status": { + "enum": [ + "available", + "temporarily-unavailable", + "not-applicable", + "confirm-with-plan" + ], + "type": "string" + }, + "verifiedDate": { + "type": "string" + } + }, + "required": [ + "status", + "detail", + "verifiedDate" + ], + "type": "object" + }, + "external_review_track": { + "type": "string" + }, + "filing_recipient": { + "type": "string" + }, + "grounds": { + "items": { + "additionalProperties": true, + "properties": { + "citation": { + "type": "string" + }, + "deadline_rules": { + "items": { + "$ref": "#/properties/external_review_current_status/properties/historicalExtension" + }, + "type": "array" + }, + "deadlines": { + "additionalProperties": { + "type": "string" + }, + "type": "object" + }, + "plain_language": { + "type": "string" + }, + "source_title": { + "type": [ + "string", + "null" + ] + }, + "source_url": { + "anyOf": [ + { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + { + "type": "null" + } + ] + }, + "status": { + "type": "string" + }, + "title": { + "type": "string" + }, + "verification": { + "type": "string" + } + }, + "required": [ + "title", + "plain_language", + "citation", + "source_url", + "source_title", + "deadlines", + "deadline_rules", + "status", + "verification" + ], + "type": "object" + }, + "type": "array" + }, + "missing_facts": { + "items": { + "additionalProperties": false, + "properties": { + "field": { + "type": "string" + }, + "message": { + "type": "string" + } + }, + "required": [ + "field", + "message" + ], + "type": "object" + }, + "type": "array" + }, + "next_action": { + "additionalProperties": true, + "properties": { + "detail": { + "type": "string" + }, + "href": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "label": { + "type": "string" + } + }, + "required": [ + "label", + "detail" + ], + "type": "object" + }, + "page": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "prefilled_appeal_url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "primary_sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/label" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "type": "array" + }, + "route_confidence": { + "enum": [ + "resolved", + "needs-input", + "unsupported" + ], + "type": "string" + }, + "route_id": { + "type": "string" + }, + "route_label": { + "type": "string" + }, + "statistics": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "source": { + "type": "string" + }, + "value": { + "type": "string" + } + }, + "required": [ + "label", + "value", + "source" + ], + "type": "object" + }, + "type": "array" + }, + "verified_ground_count": { + "minimum": 0, + "type": "integer" + }, + "warnings": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "why_this_route": { + "$ref": "#/properties/_coverage/properties/limitations" + } + }, + "required": [ + "_note", + "_coverage", + "route_id", + "route_label", + "route_confidence", + "can_generate_paid", + "why_this_route", + "missing_facts", + "warnings", + "next_action", + "filing_recipient", + "external_review_track", + "external_review_current_status", + "documents_to_gather", + "grounds", + "verified_ground_count", + "corpus_verification_note", + "deadlines", + "escalation_path", + "statistics", + "primary_sources", + "page", + "prefilled_appeal_url" + ], + "type": "object" +}
- Changed
get_condition_outcomes1 field changed- changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "condition": { + "type": "string" + }, + "decisions": { + "minimum": 0, + "type": "integer" + }, + "error": { + "description": "Lookup error text when _coverage.status is not_found or unsupported.", + "type": "string" + }, + "most_fought_treatments": { + "items": { + "additionalProperties": true, + "properties": { + "overturned": { + "$ref": "#/properties/decisions" + }, + "total": { + "$ref": "#/properties/decisions" + } + }, + "required": [ + "total", + "overturned" + ], + "type": "object" + }, + "type": "array" + }, + "overturn_rate_pct": { + "anyOf": [ + { + "maximum": 100, + "minimum": 0, + "type": "number" + }, + { + "type": "null" + } + ] + }, + "overturned": { + "$ref": "#/properties/decisions" + }, + "page": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url", + "description": "Existing free information page when a matching record is available." + }, + "source": { + "additionalProperties": true, + "properties": { + "name": { + "type": "string" + }, + "records": { + "$ref": "#/properties/decisions" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "yearsCovered": { + "type": "string" + } + }, + "required": [ + "name", + "url", + "records", + "yearsCovered" + ], + "type": "object" + } + }, + "required": [ + "_note", + "_coverage" + ], + "type": "object" +}
- Changed
get_drug_playbook1 field changed- changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "appeal_angles": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "appeal_rights_hint": { + "type": "string" + }, + "brand": { + "type": "string" + }, + "common_denial_patterns": { + "items": { + "additionalProperties": false, + "properties": { + "detail": { + "type": "string" + }, + "pattern": { + "type": "string" + } + }, + "required": [ + "pattern", + "detail" + ], + "type": "object" + }, + "type": "array" + }, + "covered": { + "items": { + "additionalProperties": true, + "properties": { + "brand": { + "type": "string" + }, + "generic": { + "type": "string" + }, + "slug": { + "type": "string" + } + }, + "required": [ + "slug", + "brand", + "generic" + ], + "type": "object" + }, + "type": "array" + }, + "error": { + "description": "Lookup error text when _coverage.status is not_found or unsupported.", + "type": "string" + }, + "fda_approved_indications": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "generic": { + "type": "string" + }, + "note": { + "type": "string" + }, + "page": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url", + "description": "Existing free information page when a matching record is available." + }, + "published_outcomes": { + "anyOf": [ + { + "additionalProperties": false, + "properties": { + "decisions": { + "minimum": 0, + "type": "integer" + }, + "overturn_rate_pct": { + "anyOf": [ + { + "maximum": 100, + "minimum": 0, + "type": "number" + }, + { + "type": "null" + } + ] + }, + "overturned": { + "$ref": "#/properties/published_outcomes/anyOf/0/properties/decisions" + }, + "source": { + "type": "string" + }, + "source_url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "decisions", + "overturned", + "overturn_rate_pct", + "source", + "source_url" + ], + "type": "object" + }, + { + "type": "null" + } + ] + }, + "step_therapy_note": { + "type": "string" + } + }, + "required": [ + "_note", + "_coverage" + ], + "type": "object" +}
- Changed
get_insurer_metrics1 field changed- changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "contract_rows": { + "items": { + "additionalProperties": true, + "properties": { + "appeal_overturn_pct": { + "$ref": "#/properties/rollup/anyOf/0/properties/pa_denial_rate_pct" + }, + "appeals_count": { + "type": [ + "number", + "null" + ] + }, + "appeals_overturned": { + "type": [ + "number", + "null" + ] + }, + "brand": { + "type": [ + "string", + "null" + ] + }, + "exp_approved": { + "type": [ + "number", + "null" + ] + }, + "exp_denied": { + "type": [ + "number", + "null" + ] + }, + "exp_denied_pct": { + "$ref": "#/properties/rollup/anyOf/0/properties/pa_denial_rate_pct" + }, + "exp_requests": { + "type": [ + "number", + "null" + ] + }, + "id": { + "type": "string" + }, + "label": { + "type": [ + "string", + "null" + ] + }, + "lob": { + "type": [ + "string", + "null" + ] + }, + "source_url": { + "anyOf": [ + { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + { + "type": "null" + } + ] + }, + "state": { + "type": [ + "string", + "null" + ] + }, + "std_approved": { + "type": [ + "number", + "null" + ] + }, + "std_denied": { + "type": [ + "number", + "null" + ] + }, + "std_denied_pct": { + "$ref": "#/properties/rollup/anyOf/0/properties/pa_denial_rate_pct" + }, + "std_requests": { + "type": [ + "number", + "null" + ] + } + }, + "required": [ + "id" + ], + "type": "object" + }, + "type": "array" + }, + "error": { + "description": "Lookup error text when _coverage.status is not_found or unsupported.", + "type": "string" + }, + "insurer": { + "type": "string" + }, + "page": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url", + "description": "Existing free information page when a matching record is available." + }, + "rollup": { + "anyOf": [ + { + "additionalProperties": true, + "properties": { + "appeal_overturn_rate_pct": { + "$ref": "#/properties/rollup/anyOf/0/properties/pa_denial_rate_pct" + }, + "avg_decision_hours_expedited": { + "type": [ + "number", + "null" + ] + }, + "avg_decision_hours_standard": { + "type": [ + "number", + "null" + ] + }, + "calculation": { + "type": "string" + }, + "decision_time_calculation": { + "type": "string" + }, + "lines_of_business": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "pa_denial_rate_pct": { + "anyOf": [ + { + "maximum": 100, + "minimum": 0, + "type": "number" + }, + { + "type": "null" + } + ] + }, + "pa_requests": { + "type": [ + "number", + "null" + ] + }, + "reporting_cohort": { + "enum": [ + "multi-line", + "medicare-advantage", + "marketplace" + ], + "type": "string" + }, + "reporting_year": { + "type": "number" + }, + "scope_note": { + "type": [ + "string", + "null" + ] + }, + "source_scope": { + "type": "string" + }, + "source_url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "reporting_year", + "pa_requests", + "pa_denial_rate_pct", + "appeal_overturn_rate_pct", + "avg_decision_hours_standard", + "avg_decision_hours_expedited", + "decision_time_calculation", + "reporting_cohort", + "lines_of_business", + "source_scope", + "scope_note", + "source_url" + ], + "type": "object" + }, + { + "type": "null" + } + ] + }, + "rollup_status": { + "type": "string" + } + }, + "required": [ + "_note", + "_coverage" + ], + "type": "object" +}
- Changed
get_state_external_review1 field changed- changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "covered": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "error": { + "description": "Lookup error text when _coverage.status is not_found or unsupported.", + "type": "string" + }, + "filing_deadline": { + "additionalProperties": true, + "properties": { + "amount": { + "type": "number" + }, + "note": { + "type": "string" + }, + "sourceUrl": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "trigger": { + "type": "string" + }, + "unit": { + "enum": [ + "calendar-days", + "calendar-months" + ], + "type": "string" + }, + "verifiedDate": { + "type": "string" + } + }, + "required": [ + "amount", + "unit", + "trigger", + "sourceUrl" + ], + "type": "object" + }, + "filing_deadline_days": { + "anyOf": [ + { + "minimum": 0, + "type": "integer" + }, + { + "type": "null" + } + ] + }, + "notes": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "page": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url", + "description": "Existing free information page when a matching record is available." + }, + "phone": { + "type": "string" + }, + "primary_sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/label" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "type": "array" + }, + "process": { + "type": "string" + }, + "regulator": { + "type": "string" + }, + "regulator_url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "state": { + "type": "string" + }, + "summary": { + "type": "string" + } + }, + "required": [ + "_note", + "_coverage" + ], + "type": "object" +}
- Changed
get_treatment_outcomes1 field changed- changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "by_condition": { + "items": { + "additionalProperties": true, + "properties": { + "overturned": { + "$ref": "#/properties/decisions" + }, + "total": { + "$ref": "#/properties/decisions" + } + }, + "required": [ + "total", + "overturned" + ], + "type": "object" + }, + "type": "array" + }, + "by_denial_reason": { + "items": { + "additionalProperties": true, + "properties": { + "denial_type": { + "type": "string" + }, + "overturn_rate_pct": { + "$ref": "#/properties/overturn_rate_pct" + }, + "overturned": { + "$ref": "#/properties/decisions" + }, + "total": { + "$ref": "#/properties/decisions" + } + }, + "required": [ + "denial_type", + "total", + "overturned", + "overturn_rate_pct" + ], + "type": "object" + }, + "type": "array" + }, + "decisions": { + "minimum": 0, + "type": "integer" + }, + "error": { + "description": "Lookup error text when _coverage.status is not_found or unsupported.", + "type": "string" + }, + "overturn_rate_pct": { + "anyOf": [ + { + "maximum": 100, + "minimum": 0, + "type": "number" + }, + { + "type": "null" + } + ] + }, + "overturned": { + "$ref": "#/properties/decisions" + }, + "page": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url", + "description": "Existing free information page when a matching record is available." + }, + "source": { + "additionalProperties": true, + "properties": { + "name": { + "type": "string" + }, + "records": { + "$ref": "#/properties/decisions" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "yearsCovered": { + "type": "string" + } + }, + "required": [ + "name", + "url", + "records", + "yearsCovered" + ], + "type": "object" + }, + "subcategories": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "overturn_rate_pct": { + "$ref": "#/properties/overturn_rate_pct" + }, + "overturned": { + "$ref": "#/properties/decisions" + }, + "total": { + "$ref": "#/properties/decisions" + } + }, + "required": [ + "label", + "total", + "overturned", + "overturn_rate_pct" + ], + "type": "object" + }, + "type": "array" + }, + "treatment": { + "type": "string" + }, + "type": { + "enum": [ + "category", + "specific" + ], + "type": "string" + } + }, + "required": [ + "_note", + "_coverage" + ], + "type": "object" +}
- Changed
list_insurers1 field changed- changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "insurers": { + "items": { + "additionalProperties": true, + "properties": { + "has_verified_metrics": { + "type": "boolean" + }, + "lines_of_business": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "metrics_scope": { + "anyOf": [ + { + "additionalProperties": true, + "properties": { + "lines_of_business": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "reporting_cohort": { + "enum": [ + "multi-line", + "medicare-advantage", + "marketplace" + ], + "type": "string" + }, + "source_scope": { + "type": "string" + } + }, + "required": [ + "reporting_cohort", + "lines_of_business", + "source_scope" + ], + "type": "object" + }, + { + "type": "null" + } + ] + }, + "name": { + "type": "string" + }, + "parent_org": { + "type": [ + "string", + "null" + ] + }, + "slug": { + "type": "string" + } + }, + "required": [ + "slug", + "name", + "parent_org", + "lines_of_business", + "has_verified_metrics", + "metrics_scope" + ], + "type": "object" + }, + "type": "array" + } + }, + "required": [ + "_note", + "_coverage", + "insurers" + ], + "type": "object" +}
- Added
prepare_knee_injection_evidence - Changed
rank_denial_rates1 field changed- changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "page": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "ranking": { + "items": { + "additionalProperties": true, + "properties": { + "appeal_overturn_rate_pct": { + "$ref": "#/properties/ranking/items/properties/pa_denial_rate_pct" + }, + "calculation": { + "type": "string" + }, + "insurer": { + "type": "string" + }, + "lines_of_business": { + "$ref": "#/properties/_coverage/properties/limitations" + }, + "pa_denial_rate_pct": { + "anyOf": [ + { + "maximum": 100, + "minimum": 0, + "type": "number" + }, + { + "type": "null" + } + ] + }, + "rank_within_cohort": { + "anyOf": [ + { + "minimum": 0, + "type": "integer" + }, + { + "type": "null" + } + ] + }, + "reporting_cohort": { + "enum": [ + "multi-line", + "medicare-advantage", + "marketplace" + ], + "type": "string" + }, + "scope_note": { + "type": [ + "string", + "null" + ] + }, + "slug": { + "type": "string" + }, + "source_scope": { + "type": "string" + }, + "source_url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "reporting_cohort", + "rank_within_cohort", + "insurer", + "slug", + "lines_of_business", + "source_scope", + "pa_denial_rate_pct", + "appeal_overturn_rate_pct", + "scope_note", + "source_url" + ], + "type": "object" + }, + "type": "array" + }, + "ranking_basis": { + "type": "string" + } + }, + "required": [ + "_note", + "_coverage", + "ranking_basis", + "page", + "ranking" + ], + "type": "object" +}
- Changed
search_outcomes1 field changed- changed
Output schema / (root)Previous value: -nullNew value: +{ + "$schema": "http://json-schema.org/draft-07/schema#", + "additionalProperties": true, + "properties": { + "_coverage": { + "additionalProperties": false, + "properties": { + "applicability": { + "additionalProperties": false, + "properties": { + "jurisdiction": { + "type": "string" + }, + "personal_deadline_calculated": { + "const": false, + "type": "boolean" + }, + "scope": { + "type": "string" + } + }, + "required": [ + "jurisdiction", + "scope", + "personal_deadline_calculated" + ], + "type": "object" + }, + "content_reviewed_at": { + "anyOf": [ + { + "format": "date", + "type": "string" + }, + { + "type": "null" + } + ], + "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted." + }, + "continuation": { + "additionalProperties": false, + "properties": { + "label": { + "type": "string" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + } + }, + "required": [ + "label", + "url" + ], + "type": "object" + }, + "limitations": { + "items": { + "type": "string" + }, + "type": "array" + }, + "schema_version": { + "const": "1.0", + "type": "string" + }, + "sources": { + "items": { + "additionalProperties": true, + "properties": { + "label": { + "type": "string" + }, + "role": { + "enum": [ + "primary_source", + "publisher_data", + "curated_guidance", + "methodology" + ], + "type": "string" + }, + "url": { + "format": "uri", + "type": "string" + } + }, + "required": [ + "label", + "url", + "role" + ], + "type": "object" + }, + "type": "array" + }, + "status": { + "enum": [ + "ok", + "no_matches", + "not_found", + "needs_context", + "unsupported" + ], + "type": "string" + }, + "summary": { + "type": "string" + }, + "tool": { + "type": "string" + } + }, + "required": [ + "schema_version", + "tool", + "content_reviewed_at", + "status", + "summary", + "applicability", + "sources", + "continuation", + "limitations" + ], + "type": "object" + }, + "_note": { + "type": "string" + }, + "corpus": { + "additionalProperties": true, + "properties": { + "decisions": { + "$ref": "#/properties/results/items/properties/decisions" + }, + "overall_overturn_rate_pct": { + "$ref": "#/properties/results/items/properties/overturn_rate_pct" + } + }, + "required": [ + "decisions", + "overall_overturn_rate_pct" + ], + "type": "object" + }, + "results": { + "items": { + "additionalProperties": true, + "properties": { + "decisions": { + "minimum": 0, + "type": "integer" + }, + "name": { + "type": "string" + }, + "overturn_rate_pct": { + "anyOf": [ + { + "maximum": 100, + "minimum": 0, + "type": "number" + }, + { + "type": "null" + } + ] + }, + "slug": { + "type": "string" + }, + "type": { + "enum": [ + "category", + "treatment", + "condition" + ], + "type": "string" + } + }, + "required": [ + "type", + "slug", + "name", + "decisions", + "overturn_rate_pct" + ], + "type": "object" + }, + "type": "array" + }, + "source": { + "additionalProperties": true, + "properties": { + "name": { + "type": "string" + }, + "records": { + "$ref": "#/properties/results/items/properties/decisions" + }, + "url": { + "$ref": "#/properties/_coverage/properties/sources/items/properties/url" + }, + "yearsCovered": { + "type": "string" + } + }, + "required": [ + "name", + "url", + "records", + "yearsCovered" + ], + "type": "object" + } + }, + "required": [ + "_note", + "_coverage", + "results", + "corpus", + "source" + ], + "type": "object" +}
1 tool update
- Changed
get_appeal_rights8 fields changed- added
Input schema / properties / appeal_stageAdded value: +{ + "enum": [ + "initial-denial", + "internal-appeal-filed", + "first-internal-denial", + "final-internal-denial", + "external-review-filed", + "unknown" + ], + "type": "string" +} - added
Input schema / properties / current_statusAdded value: +{ + "enum": [ + "awaiting-service", + "receiving-service", + "service-ended", + "post-service-claim", + "unknown" + ], + "type": "string" +} - added
Input schema / properties / drug_channelAdded value: +{ + "description": "For a drug denial, whether the medical or pharmacy benefit applies", + "enum": [ + "not-a-drug", + "medical-benefit", + "pharmacy-benefit", + "unknown" + ], + "type": "string" +} - added
Input schema / properties / employer_typeAdded value: +{ + "description": "Required to resolve job-based coverage", + "enum": [ + "private", + "government", + "church", + "union", + "unknown" + ], + "type": "string" +} - added
Input schema / properties / funding_statusAdded value: +{ + "description": "Required to resolve job-based state versus federal governance", + "enum": [ + "fully-insured", + "self-funded", + "unknown" + ], + "type": "string" +} - changed
Input schema / properties / program / enumPrevious value: -[ - "medicare-advantage", - "erisa-employer-plans", - "aca-marketplace", - "medicaid" -]New value: +[ + "medicare-advantage", + "original-medicare", + "medicare-part-d", + "erisa-employer-plans", + "aca-marketplace", + "medicaid", + "fehb", + "tricare", + "other-unknown" +] - added
Input schema / properties / regulatory_markerAdded value: +{ + "enum": [ + "state-regulated", + "federal-or-self-funded", + "unknown" + ], + "type": "string" +} - added
Input schema / properties / regulatory_state_basisAdded value: +{ + "enum": [ + "denial-letter", + "insurance-card", + "plan-document", + "residence-only", + "unknown" + ], + "type": "string" +}
2 tool updates
- Changed
get_appeal_rights2 fields changed- changed
Input schema / properties / denial_reason / descriptionPrevious value: -"Denial reason category"New value: +"Denial reason category. Use 'prescription-drug' for medication denials — formulary exclusion, step therapy, quantity limits, or drug prior authorization — which return the formulary-exception grounds and their short decision deadlines." - changed
Input schema / properties / denial_reason / enumPrevious value: -[ - "medical-necessity", - "experimental-investigational", - "prior-authorization", - "out-of-network", - "not-covered-benefit", - "coding-billing-error" -]New value: +[ + "medical-necessity", + "experimental-investigational", + "prior-authorization", + "out-of-network", + "not-covered-benefit", + "coding-billing-error", + "prescription-drug" +]
- Added
get_drug_playbook
8 tool updates
- First observed
get_appeal_rights - First observed
get_condition_outcomes - First observed
get_insurer_metrics - First observed
get_state_external_review - First observed
get_treatment_outcomes - First observed
list_insurers - First observed
rank_denial_rates - First observed
search_outcomes
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