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coverage-rights

by com.coverage-rights
OverviewDiscussionsAdmin

get_insurer_metrics

Read-onlyIdempotent

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.

Tool call template

Replace each placeholder with a value matching the input schema. Only required parameters are included; add optional parameters as needed.

{
  "id": 1,
  "jsonrpc": "2.0",
  "method": "tools/call",
  "params": {
    "arguments": {
      "slug": "<slug>"
    },
    "name": "get_insurer_metrics"
  }
}

Input Schema

NameRequiredDescriptionDefault
slugYesInsurer slug from list_insurers, e.g. 'unitedhealthcare'

Output Schema

NameRequiredDescriptionDefault
pageNoExisting free information page when a matching record is available.
_noteYes
errorNoLookup error text when _coverage.status is not_found or unsupported.
rollupNo
insurerNo
_coverageYes
contract_rowsNo
rollup_statusNo

Schema Changelog

Changes observed during successful MCP inspections.

  1. Changed21 schema fields changed
    • changedInput schema / $schema
      Previous value: -"http://json-schema.org/draft-07/schema#"New value: +"https://json-schema.org/draft/2020-12/schema"
    • removedInput schema / additionalProperties
      Removed value: -false
    • changedOutput schema / $schema
      Previous value: -"http://json-schema.org/draft-07/schema#"New value: +"https://json-schema.org/draft/2020-12/schema"
    • changedOutput schema / additionalProperties
      Previous value: -trueNew value: +{}
    • changedOutput schema / properties / _coverage / properties / content_reviewed_at / anyOf
      Previous value: -[
-  {
-    "format": "date",
-    "type": "string"
-  },
-  {
-    "type": "null"
-  }
-]New value: +[
+  {
+    "format": "date",
+    "pattern": "^(?:(?:\\d\\d[2468][048]|\\d\\d[13579][26]|\\d\\d0[48]|[02468][048]00|[13579][26]00)-02-29|\\d{4}-(?:(?:0[13578]|1[02])-(?:0[1-9]|[12]\\d|3[01])|(?:0[469]|11)-(?:0[1-9]|[12]\\d|30)|(?:02)-(?:0[1-9]|1\\d|2[0-8])))$",
+    "type": "string"
+  },
+  {
+    "type": "null"
+  }
+]
    • removedOutput schema / properties / _coverage / properties / continuation / properties / url / $ref
      Removed value: -"#/properties/_coverage/properties/sources/items/properties/url"
    • addedOutput schema / properties / _coverage / properties / continuation / properties / url / format
      Added value: +"uri"
    • addedOutput schema / properties / _coverage / properties / continuation / properties / url / type
      Added value: +"string"
    • changedOutput schema / properties / _coverage / properties / sources / items / additionalProperties
      Previous value: -trueNew value: +{}
    • changedOutput schema / properties / contract_rows / items / additionalProperties
      Previous value: -trueNew value: +{}
    • removedOutput schema / properties / contract_rows / items / properties / appeal_overturn_pct / $ref
      Removed value: -"#/properties/rollup/anyOf/0/properties/pa_denial_rate_pct"
    • addedOutput schema / properties / contract_rows / items / properties / appeal_overturn_pct / anyOf
      Added value: +[
+  {
+    "maximum": 100,
+    "minimum": 0,
+    "type": "number"
+  },
+  {
+    "type": "null"
+  }
+]
    • removedOutput schema / properties / contract_rows / items / properties / exp_denied_pct / $ref
      Removed value: -"#/properties/rollup/anyOf/0/properties/pa_denial_rate_pct"
    • addedOutput schema / properties / contract_rows / items / properties / exp_denied_pct / anyOf
      Added value: +[
+  {
+    "maximum": 100,
+    "minimum": 0,
+    "type": "number"
+  },
+  {
+    "type": "null"
+  }
+]
    • changedOutput schema / properties / contract_rows / items / properties / source_url / anyOf
      Previous value: -[
-  {
-    "$ref": "#/properties/_coverage/properties/sources/items/properties/url"
-  },
-  {
-    "type": "null"
-  }
-]New value: +[
+  {
+    "format": "uri",
+    "type": "string"
+  },
+  {
+    "type": "null"
+  }
+]
    • removedOutput schema / properties / contract_rows / items / properties / std_denied_pct / $ref
      Removed value: -"#/properties/rollup/anyOf/0/properties/pa_denial_rate_pct"
    • addedOutput schema / properties / contract_rows / items / properties / std_denied_pct / anyOf
      Added value: +[
+  {
+    "maximum": 100,
+    "minimum": 0,
+    "type": "number"
+  },
+  {
+    "type": "null"
+  }
+]
    • removedOutput schema / properties / page / $ref
      Removed value: -"#/properties/_coverage/properties/sources/items/properties/url"
    • addedOutput schema / properties / page / format
      Added value: +"uri"
    • addedOutput schema / properties / page / type
      Added value: +"string"
    • changedOutput schema / properties / rollup / anyOf
      Previous value: -[
-  {
-    "additionalProperties": true,
-    "properties": {
-      "appeal_overturn_rate_pct": {
-        "$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"
-  }
-]New value: +[
+  {
+    "additionalProperties": {},
+    "properties": {
+      "appeal_overturn_rate_pct": {
+        "anyOf": [
+          {
+            "maximum": 100,
+            "minimum": 0,
+            "type": "number"
+          },
+          {
+            "type": "null"
+          }
+        ]
+      },
+      "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": {
+        "items": {
+          "type": "string"
+        },
+        "type": "array"
+      },
+      "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": {
+        "format": "uri",
+        "type": "string"
+      }
+    },
+    "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"
+  }
+]
  2. Changed1 schema field changed
    • changedOutput 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"
+}
  3. First observed

TDQS

A3.8/5.0
Behavior4/5

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

Annotations already establish a safe, idempotent, closed-world read, so the description's added value is provenance and coverage behavior: the data is 'verified', comes from the insurer's own CMS-0057-F disclosure, and may only have contract/plan rows 'where collected', signaling uneven coverage. It also notes that source URLs and scope notes accompany the data, which matters for trusting figures, though it says nothing about staleness or missing-data handling.

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 compact sentences that front-load the main deliverable before the secondary contract/plan rows and provenance note. No filler, though the parenthetical metric list and the phrase 'where collected' are slightly dense and could be clearer.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness5/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

For a one-parameter read tool with full schema coverage, annotations, and an output schema, the description covers what data is returned, where it originates, its verification status, and that scope notes travel with it. Nothing an agent needs to select or call it 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?

There is a single parameter with 100% schema coverage; the schema already explains that 'slug' comes from list_insurers and gives an example. The description adds no format, casing, or validation detail beyond that, 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 (Get) and resource (an insurer's verified CY2025 prior-authorization metrics) and enumerates the metrics returned: denial rate, appeal overturn rate, decision times. It also names the data source (CMS-0057-F disclosure) and the extra granularity (contract/plan-level rows), which separates it from ranking/listing siblings, though it never explicitly names an alternative tool.

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: an agent can infer this is the lookup for one insurer's metrics, but the description offers no when-to-use/when-not guidance and does not route to siblings like rank_denial_rates or get_appeal_rights. The prerequisite (slug from list_insurers) lives in the 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.

All coverage-rights toolsInspect
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