analyze_denial
Analyze insurance denials to receive win probability, top denial reasons, and appeal guidance for any CPT code.
Instructions
Analyze an insurance denial and get win probability, top denial reasons, and appeal guidance. Covers 489+ CPT codes across 9 procedure categories with data from 20 years of industry experience. Use this when someone asks about insurance denials, claim denials, appeal chances, or how to fight a denied claim.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| payer | No | Insurance company name (e.g., "UnitedHealthcare", "Anthem", "Aetna", "Cigna", "Humana", "BCBS") | |
| state | No | Two-letter state code (e.g., "CA", "TX", "NY") for state-specific regulatory leverage | |
| api_key | No | CoverageUnlocked API key for Pro access. Free tier: 10 queries/day with basic results. Get Pro at https://app.coverageunlocked.com/mcp | |
| cpt_code | Yes | The CPT or HCPCS code that was denied (e.g., "99214", "70553", "E0601") | |
| denial_reason | No | The reason given for the denial, if available |