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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. Use for "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 /v1/rights. Carried into the letter link.

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A4.4/5.0
Behavior4/5

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 covered. The description adds genuinely useful behavioral detail beyond that: it explains the return content (plain-language meaning, who fixes it, billability derived from the CO/PR/OA/PI group code, and a conditional letter link), which is not inferable from annotations.

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?

The purpose and example triggers are front-loaded and every sentence carries information. Minor waste in restating the product/title ('Appeal My Claim. Explain the denial codes...') before the operational content, but the description remains tight and single-purpose.

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?

There is no output schema, so the description correctly takes on the burden of describing return values, and it does so thoroughly. For a two-parameter read-only lookup with full schema coverage, an agent has everything needed to call it correctly and interpret the result.

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 the baseline is 3, but the description adds meaning beyond the schema by naming real code formats (CO-50, PR 204, 197, N130) and explaining that the group-code prefix (CO, PR, OA, PI) drives the billability determination. That enriches interpretation of the required 'code' parameter.

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 states a specific verb and resource ('Explain the denial codes on an Explanation of Benefits') and is immediately distinguishable from siblings like appealmyclaim_draft_appeal_letter and appealmyclaim_get_appeal_rights. An agent can tell exactly what this tool returns 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?

Concrete trigger phrasings ('my EOB says CO-50, what does that mean?', 'what is denial code PR 204?', 'what does N130 mean?') give clear when-to-use context. However, it never names an alternative tool or an explicit when-not-to-use condition, so routing versus formguide/lore-style 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.

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