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Appeal My Claim

Explain the denial codes on an Explanation of Benefits

explain_denial_code
Read-onlyIdempotent

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

A4.3/5.0
Behavior4/5

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

Annotations already establish readOnly/idempotent/non-destructive behavior, and the description adds genuinely useful context beyond that: it details what each result contains (plain-language meaning, responsible party, whether the provider can bill the user based on group code, and a letter link). No mention of rate limits or lookup-coverage limits, but the behavioral picture is substantially richer than the annotations alone.

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?

Purpose and return contents are front-loaded, with the illustrative queries placed after the core statement. The sentences are dense and earn their place, though the example quotes add length that could be trimmed.

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?

There is no output schema, so the description carries the burden of describing returns, and it does so thoroughly (per-code meaning, fixer, billability, appeal link). Given only two parameters and a simple read operation, an agent has everything needed to call it correctly.

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 description coverage is 100%, so a baseline of 3 applies, but the description adds meaning by showing accepted code formats (CO-50, PR 204, 197, N130) and explaining that the CO/PR/OA/PI group code governs whether the provider can bill the user. That elevates it above the schema's plain parameter text.

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 EOB) and immediately grounds it in concrete code formats. It is clearly distinguishable from the sibling action tools (draft_appeal_letter, get_appeal_deadlines, get_appeal_rights) because it is an informational lookup, not a drafting or rights-fetching operation.

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 three concrete trigger queries ("my EOB says CO-50...", "what is denial code PR 204?", "what does N130 mean?"), which makes the when-to-use condition unambiguous. It does not state exclusions or explicitly name the sibling alternatives, so it stops short of a 5.

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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