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Appeal My Claim: Explain the denial codes on an Explanation of Benefits

appealmyclaim_explain_denial_code
Read-onlyIdempotent

Appeal My Claim. Explain the denial codes on an Explanation of Benefits. For requests like "my EOB says CO-50, what does that mean?", "what is denial code PR 204?" or "what does N130 mean?". Returns each code in plain words, who usually fixes it (the provider's billing office, an appeal, or the user), whether the provider can bill the user for it (from the group code CO, PR, OA or PI), and a letter link when an appeal fits.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
codeYesOne to four codes from the notice, like CO-50, PR 204, 197 or N130.
plan_typeNoSame values as plan_type in get_appeal_rights. Carried into the letter link.

Schema Changelog

Changes observed during successful MCP inspections.

  1. Changed1 schema field changed
    • changedInput schema / properties / plan_type / description
      Previous value: -"Same values as /v1/rights. Carried into the letter link."New value: +"Same values as plan_type in get_appeal_rights. Carried into the letter link."
  2. First observed

TDQS

A4.2/5.0
Behavior4/5

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

Annotations already declare readOnlyHint=true, destructiveHint=false and idempotentHint=true, so the safety profile is covered. The description adds genuine context beyond that: the tool returns plain-language meaning, the responsible party, billing liability derived from the group code, and a conditional letter link.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness3/5

Is the description appropriately sized, front-loaded, and free of redundancy?

Front-loads purpose well, but the first two sentences essentially restate the title and the second sentence duplicates the code examples already in the schema. The return-value sentence does the real work, so there is some avoidable redundancy.

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 no output schema, the description carries the full burden and does describe the returned fields (meaning, fixer, billing liability, letter link). It is complete enough to call correctly, though it does not specify multi-code input behavior despite saying 'each code'.

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 baseline is 3. The description goes further by explaining that the code's group prefix (CO, PR, OA, PI) drives the billing-liability output, which the schema's format examples do not convey, and it ties plan_type to get_appeal_rights semantics.

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 (explain) and resource (denial codes on an Explanation of Benefits), and the example utterances ('my EOB says CO-50', 'PR 204', 'N130') make the domain unmistakable. An agent can distinguish it from appealmyclaim_get_appeal_rights or draft_appeal_letter without opening a schema.

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 quoted user requests give strong, concrete triggers for when to reach for this tool, and the mention of a letter link signals its relationship to the appeal flow. There is no explicit when-not or named alternative, so it stops short of the 5 benchmark.

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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