DenialPath
Server Details
Deterministic CMS NCCI/MUE claim scrubbing and CARC/RARC denial explanations, cited to source.
- Status
- Healthy
- Last Tested
- Transport
- Streamable HTTP
- URL
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Tool Definition Quality
Average 4.4/5 across 6 of 6 tools scored.
Each tool addresses a distinct aspect of denial management: claim checking, appeal drafting, code explanation, MUE lookup, NCCI edits, and timely filing. No tools have overlapping purposes.
All tool names follow a consistent verb_noun pattern in snake_case (e.g., check_claim, draft_appeal, explain_denial). No deviations or mixed conventions.
With 6 tools, the server is appropriately scoped for its denial management domain. Each tool provides essential functionality without being overwhelming or insufficient.
The tool set covers core denial lifecycle tasks (check, explain, appeal, file) with supporting lookups. Minor gaps exist, such as no tool for appeal status tracking, but core workflows are well-covered.
Available Tools
6 toolscheck_claimAInspect
Scrub a claim against the NCCI procedure-to-procedure (PTP) edits and medically unlikely edits (MUE) in force on its date of service. Deterministic: no model, so identical input always returns an identical verdict. Every finding.status is one of pass (checked against a real edit and clean), fail (an edit fires), bypassed (an edit fires but a modifier already on the line legitimately resolves it), or no_data (we hold no edit for this code or pair in our dataset). no_data is NOT a pass: treat it as unchecked, since CMS may still deny the line under an edit outside our loaded subset. summary.clean is true only when every finding is pass and none are no_data - never report a claim clean because nothing failed if some lines were never checked. The response echoes editQuarter (the CMS quarter version the verdict was computed against) and coverage (how many PTP pairs and MUE codes are loaded), so you can tell a caller exactly what was checked. Free, no API key needed; a key only raises the rate limit.
| Name | Required | Description | Default |
|---|---|---|---|
| lines | Yes | The billed lines on this claim. | |
| payerSlug | No | Optional payer slug for context. Does not change the PTP/MUE verdict. | |
| dateOfService | Yes | ISO yyyy-mm-dd. Selects which CMS edit quarter applies. |
Tool Definition Quality
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
Extremely transparent: describes deterministic behavior, exact meanings of each finding.status (pass, fail, bypassed, no_data), cautions that no_data is not a pass, and explains summary.clean condition. Also discloses free usage and no API key requirement.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Is the description appropriately sized, front-loaded, and free of redundancy?
Description is somewhat long but front-loaded with purpose and every sentence adds value. Could be slightly more concise but remains focused and informative.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
Description covers all needed context: deterministic nature, status value definitions, handling of no_data, summary.clean condition, and response fields (editQuarter, coverage). No output schema exists, so description compensates fully.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
Schema description coverage is 100%, so baseline is 3. The description adds context (e.g., payerSlug does not change verdict, dateOfService selects edit quarter) but does not provide significant new semantic meaning beyond the schema.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Does the description clearly state what the tool does and how it differs from similar tools?
Description clearly states the action (scrub a claim) and the specific resource (NCCI PTP and MUE edits). It distinguishes this tool from siblings like get_mue and get_ncci_edits which likely return edit data rather than applying them to a claim.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Does the description explain when to use this tool, when not to, or what alternatives exist?
No explicit guidance on when to use this tool versus alternatives. While the action is clear, there is no mention of when to prefer check_claim over get_mue or get_ncci_edits.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
draft_appealAInspect
Generate an appeal letter for a denial, assembled deterministically from cited facts. REQUIRES A PRO OR SCALE PLAN. Called by an anonymous caller or a key on the free plan, this returns an upgrade_required error naming the pricing page - it never fabricates or partially generates a letter for a caller who cannot access the feature. The letter argues the billing question only: it never asserts anything about the patient's clinical condition. Any fact only the practice holds (providerName, claimNumber, dateOfService, codes, the signature) that is not supplied is rendered as an explicit "[TO BE COMPLETED BY PRACTICE]" placeholder in the letter body and listed by name in placeholders, never invented. grounded is true only when we hold the CARC supplied and could argue it with our own corrective-action data; when false, the letter still assembles around payer/claim details and any practiceNote given, but the substantive grounds section is left as a placeholder for the practice to write.
| Name | Required | Description | Default |
|---|---|---|---|
| carc | Yes | CARC code from the remittance, e.g. "CO-45" or "45". | |
| rarc | No | Optional RARC codes on the same remittance line. | |
| codes | No | Optional procedure codes at issue, numeric reference only. | |
| payerSlug | No | Optional payer slug, to cite that payer's appeal policy and window. | |
| claimNumber | No | Optional. Rendered as a placeholder if omitted. | |
| practiceNote | No | Optional free-text detail from the practice, appended to the argument section. | |
| providerName | No | Optional. Rendered as a placeholder if omitted. | |
| dateOfService | No | Optional. Rendered as a placeholder if omitted. |
Tool Definition Quality
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
With no annotations, the description fully discloses critical behaviors: it never fabricates facts, uses placeholders for missing practice-held data, explains the 'grounded' flag, and that it never asserts clinical conditions. This provides comprehensive transparency.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Is the description appropriately sized, front-loaded, and free of redundancy?
The description is a single dense paragraph that efficiently conveys many details without unnecessary words. It could be slightly more structured for readability, but it is appropriately concise given the amount of information.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
Given there is no output schema, the description effectively explains output behavior (grounded flag, placeholders, error condition). It covers all key aspects of a complex tool with 8 parameters and no output schema.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
All 8 parameters are described in the schema (100% coverage). The description adds behavioral context, such as that certain parameters become placeholders if omitted, and the purpose of each in the appeal process. This goes beyond basic schema descriptions.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Does the description clearly state what the tool does and how it differs from similar tools?
The description explicitly states the tool generates an appeal letter for a denial, assembled deterministically from cited facts. It clearly distinguishes from sibling tools that focus on checking claims, explaining denials, etc.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Does the description explain when to use this tool, when not to, or what alternatives exist?
The description specifies that a Pro or Scale plan is required, and that on the free plan it returns an upgrade_required error. It also clarifies the scope (billing questions only). However, it does not explicitly compare to siblings or state when not to use.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
explain_denialAInspect
Explain a CARC (Claim Adjustment Reason Code) and any RARCs (Remittance Advice Remark Codes) from a remittance: plain meaning, ranked corrective actions, and whether an appeal is worth filing. found:false means we do not hold that CARC in our dataset (X12 publishes far more codes than we have curated) - the response still returns the group-code meaning when a group prefix (CO/PR/OA/PI) was supplied, and note explains the gap rather than leaving it silent. unknownRarc reports, rather than silently drops, any RARC you passed that we do not hold. Passing payer additionally attaches that payer's appeal deadline where we hold one. Free, no API key needed.
| Name | Required | Description | Default |
|---|---|---|---|
| carc | Yes | CARC code, with or without a group prefix, e.g. "CO-45" or "45". | |
| rarc | No | Optional RARC codes on the same remittance line. | |
| payer | No | Optional payer slug, to attach a timely-filing appeal deadline. |
Tool Definition Quality
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
No annotations provided, but description fully discloses behavior for missing codes (found:false), unknown RARCs (unknownRarc announced), and optional payer behavior (appeal deadline). Also states free, no API key needed.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Is the description appropriately sized, front-loaded, and free of redundancy?
Three sentences, each providing distinct value. Front-loaded with core purpose. Slightly longer but not wasteful.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
No output schema, yet description adequately explains return value structure (plain meaning, corrective actions, appeal worthiness) and edge cases (found:false, unknownRarc). Complete for the tool's complexity.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
Schema coverage is 100%, but description adds meaning beyond parameter descriptions: explains 'carc' accepts group prefix, 'rarc' behavior if unknown, 'payer' attaches deadline if known.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Does the description clearly state what the tool does and how it differs from similar tools?
Description explicitly states 'explain a CARC and any RARCs' with specific outputs (plain meaning, corrective actions, appeal worthiness). Clearly distinguishes from siblings like check_claim or draft_appeal.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Does the description explain when to use this tool, when not to, or what alternatives exist?
Implies usage for understanding denial codes from remittance, but does not explicitly state when NOT to use or compare to alternatives. Sibling context helps, but description could be more explicit.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
get_mueAInspect
Look up the medically unlikely edit (MUE) unit limit for a single CPT/HCPCS code. status is found or no_data; no_data means we hold no MUE value for this code in our dataset, not that CMS publishes none. When found, the returned limit.mai (adjudication indicator: "1" line edit - denies the excess units on the line; "2" date-of-service absolute - never payable above the limit on that date, not even on appeal; "3" date-of-service clinical - may be allowed above the limit with supporting documentation) governs what a biller can do above the limit, explained in limit.maiMeaning. Free, no API key needed.
| Name | Required | Description | Default |
|---|---|---|---|
| code | Yes | CPT/HCPCS code, e.g. "36415". |
Tool Definition Quality
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
With no annotations, description fully explains output (status, limit.mai, limit.maiMeaning) and access conditions ('Free, no API key needed'). No contradictions.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Is the description appropriately sized, front-loaded, and free of redundancy?
Single paragraph efficiently communicates purpose and nuances, but could be structured with bullet points for readability.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
For a tool with one parameter and no output schema, description adequately explains return values, their meanings, and access info, ensuring the agent can use it correctly.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
Schema covers the single parameter with an example; description adds no additional parameter detail beyond what schema provides, though coverage is 100%.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Does the description clearly state what the tool does and how it differs from similar tools?
Clearly states 'Look up the medically unlikely edit (MUE) unit limit for a single CPT/HCPCS code,' specifying verb, resource, and input. Distinct from siblings like get_ncci_edits.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Does the description explain when to use this tool, when not to, or what alternatives exist?
Implies usage for looking up MUE values but provides no explicit guidance on when to use this vs. alternatives or when not to use it.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
get_ncci_editsAInspect
Look up NCCI procedure-to-procedure (PTP) edits, in two modes. Pair mode: pass column1, column2 (either order) and dateOfService to check whether that specific pair bundles on that date; status is no_data (we hold no edit for this pair in our dataset - NOT confirmation CMS has none), not_applicable (we hold the edit but it does not apply on this date, either outside its effective/deletion window or modifierIndicator "9" meaning the edit is deleted or never applicable), or applies. List mode: pass code alone to get every pair in the dataset involving that code, in either column, with no date filtering. modifierIndicator "0" means no modifier may ever bypass the edit; "1" means a modifier may bypass it, but only where the services were genuinely distinct. Free, no API key needed.
| Name | Required | Description | Default |
|---|---|---|---|
| code | No | List mode: a single code, returning every pair involving it. | |
| column1 | No | A CPT/HCPCS code. Pair mode: use with column2 and dateOfService. | |
| column2 | No | The other code in the pair. | |
| dateOfService | No | ISO yyyy-mm-dd. Required in pair mode. |
Tool Definition Quality
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
With no annotations, the description fully discloses behavior: explains status meanings, modifier indicators, no date filtering in list mode, and clarifies that 'no_data' is not confirmation of no edit. Very transparent.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Is the description appropriately sized, front-loaded, and free of redundancy?
The description is informative and well-structured, with the main action upfront. A bit lengthy but every sentence adds value. Could be slightly more concise, but still efficient.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
Given no output schema, the description covers return values (statuses, modifierIndicator) comprehensively. Addresses both modes, parameter usage, and edge cases. Complete for the tool's complexity.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?
Schema coverage is 100%, and the description adds significant context beyond schema: explains modes, status values, modifier meanings, and edge cases like not_applicable. Greatly enhances parameter understanding.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Does the description clearly state what the tool does and how it differs from similar tools?
The description clearly states it looks up NCCI PTP edits and explains two modes (pair and list). It uses specific verbs and resources, and distinguishes itself from sibling tools like get_mue or check_claim.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Does the description explain when to use this tool, when not to, or what alternatives exist?
Explicitly tells when to use pair mode vs list mode, what parameters to pass, and interprets status values. Lacks explicit when-not-to-use or alternatives but provides sufficient guidance.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
get_timely_filingAInspect
Days remaining to file an initial claim (or, if already past, how far over) for a payer given a date of service. daysRemaining and expired are null when we hold no published timely filing limit for that payer, which is common since many limits are contract-specific - check note before treating the result as an actual deadline. Free, no API key needed.
| Name | Required | Description | Default |
|---|---|---|---|
| payer | Yes | Payer slug, e.g. "aetna". | |
| dateOfService | Yes | ISO yyyy-mm-dd. |
Tool Definition Quality
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
With no annotations, the description discloses the null behavior when no limit is held, contract-specific caveats, and the free nature. It does not mention idempotency or rate limits, but the read-only nature is implied.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Is the description appropriately sized, front-loaded, and free of redundancy?
Two sentences, front-loaded with the main purpose, efficiently covering behavior, caveats, and cost. No wasted words.
Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.
Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?
Given no output schema, the description usefully states the returned fields (daysRemaining, expired) and null handling. It could be more explicit about the exact output structure, but the context is largely sufficient.
Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.
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 adds context by explaining the purpose of payer and dateOfService in relation to the result, but does not significantly extend beyond the schema's descriptions.
Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.
Does the description clearly state what the tool does and how it differs from similar tools?
The description clearly states the tool returns 'Days remaining to file an initial claim' with specific conditions, using a precise verb and resource. It distinguishes itself from sibling tools like check_claim or draft_appeal by focusing on timely filing deadlines.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Does the description explain when to use this tool, when not to, or what alternatives exist?
Provides clear guidance to 'check note before treating the result as an actual deadline' and notes it's free with no API key. However, it does not explicitly compare with alternatives or state when not to use this tool.
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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