Prior-auth approval rate + CMS requirement facts
pa_predictPredict prior-authorization approval rates for a CPT/HCPCS code using your organization's own decided PAs, with CMS prior-auth requirement facts returned when no cohort exists.
Instructions
Historical prior-authorization approval rate for a procedure code, computed only from your organization's own decided prior authorizations for that code — never from other customers' records — and only from at least 10; an API key or account with no organization has no cohort. With a cohort it returns the rate with cohort size and confidence; without one it returns the verifiable facts instead — CMS Required Prior Authorization List status, category, and published review timeframes — and reports that no rate was computed (the call is refunded on this path). Either way its recommendation states the CMS requirement only. It reports past decisions and makes no coverage or prior-authorization determination. Original Medicare FFS scope.
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": {
"procedureCode": "<procedureCode>"
},
"name": "pa_predict"
}
}Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| payerId | No | Payer category, e.g. "MEDICARE", "AETNA" or "UNITED_HEALTHCARE" (any letter case) — narrows your organization's own decided-PA cohort to that payer. A payer's own ID number names no category, so it finds no cohort. | |
| procedureCode | Yes | CPT/HCPCS procedure code (e.g., "E0651", "K0800") |