coverage-rights

get_appeal_rights

Read-onlyIdempotent

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.

Input Schema

TableJSON Schema

Name	Required	Description
`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 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.
`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

TDQS

A4.2/5.0

Behavior5/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

Annotations already declare read-only, idempotent, and non-destructive behavior. The description adds meaningful behavioral context beyond annotations: deterministic resolution, fail-closed handling for unsupported or ambiguous routes, and the specific coverage categories it distinguishes. No contradiction is present.

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?

The description is two dense sentences with no filler. The front-loaded verb 'Deterministically resolve' immediately communicates the action, and every phrase contributes to scope, output, or behavioral boundaries.

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?

For an 11-parameter tool with no output schema, the description still lists the returned categories (appeal route, missing facts, filing recipient, deadlines, external-review status, verified grounds) and coverage scope. It is sufficient for selection and invocation, though it does not explain parameter prerequisites or offer usage examples.

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 descriptions cover 64% of parameters and most parameters have enums, so the structured schema does much of the work. The description reinforces the coverage-program taxonomy and denial reasons but does not add per-parameter syntax or clarify undocumented fields like state or current_status beyond what enums imply.

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?

The description opens with 'Deterministically resolve the governing appeal route, missing facts, filing recipient, deadlines, current external-review status, and verified grounds,' providing a specific verb and clear object. It distinguishes this tool from siblings like get_state_external_review and get_insurer_metrics by enumerating coverage programs and appeal-route scope.

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 no explicit 'use when' or 'use instead' guidance. The intended context is inferable from the coverage list and appeal-route focus, but exclusions and alternatives are not stated, so guidance is only implied.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

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TDQS

A4/5.0

Disambiguation3/5

Most tools have distinct purposes (e.g., get_appeal_rights vs. get_state_external_review), but get_condition_outcomes, get_treatment_outcomes, and get_drug_playbook overlap in the domain of external-review outcomes. An agent may confuse which to use for a given query, especially for drugs that appear in both drug_playbook and treatment_outcomes.

Naming Consistency5/5

All tool names follow a consistent verb_noun snake_case pattern: get_* for retrieval, list_* for enumeration, rank_* for rankings, and search_* for discovery. No mixed styles or inconsistent verb usage.

Tool Count5/5

Nine tools is well within the ideal 3-15 range. Each tool covers a distinct aspect of the coverage rights domain, and the count feels neither excessive nor thin.

Completeness4/5

The tool surface covers the core workflow: determining appeal rights, researching outcomes by condition/treatment, accessing insurer metrics, and understanding state processes. Minor gaps exist, such as no direct tool for state comparison or bulk retrieval of all states' external review rules, but these are not critical to the main purpose.

Resources

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