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princeruhulofficial

mcp-claims-triage

by princeruhulofficial
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Python
Remote

mcp-claims-triage

MCP Server for Medical Claims Triage & Anomaly Detection

An MCP (Model Context Protocol) server that helps AI agents analyze medical insurance claims, flag anomalies, score risk, and suggest next actions — pure computation, no external paid APIs required.

Problem it solves

Medical billing teams and healthcare AI agents drown in claims data. Manual review is slow and expensive. Agents need structured tools to triage claims, detect possible fraud/upcoding, and prioritize human review.

Related MCP server: Claim Pilot MCP Server

Why this is valuable for entrepreneurs

  • Vertical-specific (Healthcare) → higher willingness to pay than generic tools

  • Computation-heavy (no expensive API keys needed for core features)

  • Solves real pain: claim denials, compliance risk, manual work

  • Can be sold as $49–199/mo tool to billing companies, RCM firms, and health-tech startups

Main Tools

Tool

Description

triage_claim

Score a claim 0-100 and return priority + flags

detect_anomalies

Find unusual patterns in a batch of claims

suggest_cpt_codes

Suggest possible CPT / procedure codes from description

estimate_denial_risk

Predict relative risk of claim denial

generate_review_checklist

Create a human review checklist for a claim

batch_summary

Summarize a list of claims for daily standup

Quick Start

pip install -e .
python -m mcp_claims_triage

Pricing suggestion

  • Free: limited daily claims

  • Pro: $49/mo unlimited + export

  • Enterprise: $199/mo + custom rules + audit log

Built for Prince Ruhul / Prevalid — Daily AI Project Builder

This server cannot be installed

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A
license - permissive license
Not graded
quality - not tested
C
maintenance

How are these scores calculated?

Maintenance

UpdatingMaintainers
UpdatingResponse time
–Release cycle
0Releases (12mo)
Commit activity

Resources

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