# 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.

## 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

```bash
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