mymedi-ai-mcp-server

Pre-submission claim code and date check

claims_validate

Read-only

Validate a claim before submission by checking ICD-10-CM/CPT/HCPCS code activity, modifiers, and future service dates without patient/provider identifiers; returns pass status, errors, and warnings.

Instructions

Pre-submission check of a claim's codes and dates — no patient or provider identifiers needed or accepted. Checks that the diagnosis (ICD-10-CM) and procedure (CPT/HCPCS Level II) codes exist and are active on the date of service, that modifiers are well-formed, and that the date of service is not in the future; returns whether the claim passed, with the errors and warnings found. A CPT code missing from the loaded CMS fee schedule file, or a modifier this reference does not list for DMEPOS, is a warning, not an error. Up to 25 diagnosis codes, 50 procedure codes and 20 modifiers per claim. It applies no NCCI edits — neither procedure-to-procedure (PTP) pairs nor MUE unit limits — and does not assess medical necessity or prior authorization.

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": {
      "claim": "<claim>"
    },
    "name": "claims_validate"
  }
}

Input Schema

Name	Required	Description	Default
`claim`	Yes	Claim data to validate

Schema Changelog

Changes observed during successful MCP inspections.

Changed11 schema fields changedv1.7.9Nov 2, 2026
- addedInput schema / properties / claim / properties / dateOfService / maxLength
```
Added value: +10
```
- addedInput schema / properties / claim / properties / diagnosisCodes / items / maxLength
```
Added value: +10
```
- addedInput schema / properties / claim / properties / diagnosisCodes / maxItems
```
Added value: +25
```
- addedInput schema / properties / claim / properties / modifiers / items / maxLength
```
Added value: +10
```
- addedInput schema / properties / claim / properties / modifiers / maxItems
```
Added value: +20
```
- removedInput schema / properties / claim / properties / patientId
```
Removed value: -{
-  "type": "string"
-}
```
- addedInput schema / properties / claim / properties / placeOfService / maxLength
```
Added value: +500
```
- addedInput schema / properties / claim / properties / procedureCodes / items / maxLength
```
Added value: +10
```
- addedInput schema / properties / claim / properties / procedureCodes / maxItems
```
Added value: +50
```
- removedInput schema / properties / claim / properties / providerId
```
Removed value: -{
-  "type": "string"
-}
```
- changedInput schema / properties / claim / required
```
Previous value: -[
-  "patientId",
-  "providerId",
-  "dateOfService",
-  "diagnosisCodes",
-  "procedureCodes"
-]New value: +[
+  "dateOfService",
+  "diagnosisCodes",
+  "procedureCodes"
+]
```
First observedApr 13, 2026

TDQS

A4.4/5.0

Behavior4/5

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

Adds real behavior beyond the annotations: what is checked, that a missing fee-schedule CPT or unlisted DMEPOS modifier is a warning rather than an error, per-claim limits, and what the response contains. It does not address the non-idempotent hint (idempotentHint=false on a pure validation), leaving a small unexplained trait.

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?

Dense and front-loaded, with the core check stated first and exclusions/edge cases after. A few clauses (limit counts, warning/error detail) are packed tightly but each carries decision-relevant information.

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 single nested-parameter, read-only validator with no output schema, the description covers inputs expected, limits, validation rules, warning-vs-error semantics, and return shape. An agent has everything needed to call it correctly and interpret results.

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 the schema does not: which code systems each array expects (ICD-10-CM vs CPT/HCPCS Level II), that modifiers must be well-formed, and that the date of service cannot be in the future. Cardinality limits restate schema maxItems, which is redundant but harmless.

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 and resource ('pre-submission check of a claim's codes and dates') and immediately bounds scope ('no patient or provider identifiers needed or accepted'). It is clearly distinguishable from code_validate / code_validate_batch, which operate on codes rather than a full claim.

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 strong when-to-use context (pre-submission) and explicit exclusions — no NCCI PTP/MUE edits, no medical necessity or prior authorization — which tells an agent when to reach for pa_required_check or compliance tools instead. It stops short of naming those siblings explicitly.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.