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MyMedi-AI

mymedi-ai-mcp-server

by MyMedi-AI

PA/WOPD catalog exposure report (up to 100 codes)

pa_exposure_report
Read-only

Map supplier HCPCS codes to CMS prior authorization and face-to-face/written-order requirements, returning per-code compliance flags and catalog-level denial-risk exposure.

Instructions

Map a supplier HCPCS catalog against the current CMS Required Prior Authorization List and Required Face-to-Face Encounter & Written Order Prior to Delivery List on a date of service (default today). Per code: PA requirement and the date it applies from, F2F/WOPD requirement, documentation gates (SWO, UTN-before-claim, F2F/WOPD sequencing), and deterministic denial-risk flags — plus a catalog-level exposure summary. Some items are phased in by state: with a state the answer is definitive; without one they are reported as required in some states (paRequiredInSomeStates). Unknown or non-HCPCS codes are flagged and count as billable answers. Priced per code — $0.01 × number of codes, max 100 per call. Returns JSON. Original Medicare FFS scope. PHI-free: codes in, rules out.

Input Schema

NameRequiredDescriptionDefault
codesYesSupplier catalog HCPCS codes, e.g. ["E0651", "L0651", "K0856"] (1-100 per call)
stateNo2-letter US state or territory; needed for items phased in by state
dateOfServiceNoDate of service, YYYY-MM-DD (default today)

Schema Changelog

Changes observed during successful MCP inspections.

  1. Addedv1.7.9

TDQS

A3.8/5.0
Behavior4/5

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

Annotations already cover the safety profile (readOnlyHint true, destructive false), yet the description adds genuinely non-obvious behavior: per-code pricing ($0.01 × codes, max 100), that unknown/non-HCPCS codes are flagged but still billed, and that output is PHI-free JSON. It stops short of describing error handling or latency, so not a 5.

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?

Front-loads the core mapping action, then layers the state caveat, output shape, pricing, and scope in a dense but logical order. Nearly every sentence carries distinct information, though the long second sentence is somewhat run-on.

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?

With no output schema, the description carries the return-value burden and does so well: it enumerates per-code return fields (PA requirement and effective date, F2F/WOPD, documentation gates, denial-risk flags), the catalog-level summary, and the paRequiredInSomeStates fallback. An agent has enough to decide whether the result answers its question.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters3/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema coverage is 100% and each parameter is already documented (codes 1-100, state for phased-in items, dateOfService default today). The description's explanation of the state-dependent branch reinforces the schema rather than adding new parameter syntax or constraints, so baseline 3 applies.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose4/5

Does the description clearly state what the tool does and how it differs from similar tools?

States a specific verb and resource — mapping a supplier HCPCS catalog against the CMS PA and F2F/WOPD lists on a date of service — with explicit scope (up to 100 codes, Original Medicare FFS). It does not name a sibling to differentiate from pa_required_check or pa_required_check-style tools, so the boundary has to be inferred from the batch scope.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines3/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

The state caveat ('with a state the answer is definitive; without one they are reported as required in some states') implies when to supply the state parameter, and the 100-code cap implies batching. But there is no explicit when-to-use versus pa_required_check/pa_predict, and no prerequisites are stated beyond scope.

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