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insurance-claim-mcp

insurance-claim-mcp

by seothief

Evaluate Claim

evaluate_claim

Estimates expected insurance payouts from receipt or prescription claim details, including US plan benefits from ICD-10 codes and plan schedules, without storing claim data.

Instructions

영수증/처방전 정보로 예상 보험금을 계산합니다. 입력된 진료 정보는 저장되지 않습니다.

Estimate benefits from a bill. US plans: send icd10_code, is_inpatient, inpatient_days, icu_days, is_injury, is_emergency. Claim data is never stored.

Input Schema

NameRequiredDescriptionDefault
pinNo
claimYesValues extracted from receipts/prescriptions. Used for one evaluation and never stored.
user_idYes

Output Schema

NameRequiredDescriptionDefault

No arguments

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observedv0.2.0

TDQS

B3.4/5.0
Behavior3/5

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

With no annotations, the description carries the full burden. It discloses one valuable behavioral trait — claim data is never stored, stated twice (Korean and English) — but says nothing about whether this is a pure calculation vs. a submission, what the pin requirement means, permission/auth needs, or behavior on unrecognized codes.

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?

Very short and front-loaded: purpose first, then the plan-specific field list, then the privacy note. The Korean and English sentences are near-duplicates, which is acceptable localization rather than waste.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness3/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

An output schema exists, so return values need no explanation, and the privacy note plus US field guidance cover the essentials. Still, for a nested-object input with 12+ claim fields and no annotations, the description leaves the non-US path and most cost/classification fields unexplained.

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?

Description enumerates six US-plan fields, which genuinely adds meaning by grouping them per plan type (icd10 vs kcd_code). But at 33% schema coverage many fields go undocumented in both places — cost_covered, cost_uncovered, hospital_type, treatment_code/name, prescribed_drugs, pin — so it only partially compensates.

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?

Names a specific verb and resource — estimate insurance benefits from receipt/prescription data — which is unambiguous. It does not differentiate against siblings (register_user_policy, resolve_user_rider, etc.), though those are clearly a different family so confusion is unlikely.

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?

'US plans: send icd10_code, is_inpatient...' is a conditional input guideline that implies kcd_code is for the Korean path, which is useful. However, there is no explicit when-to-use/when-not-to-use statement, no prerequisite for user_id registration or the pin parameter, and no routing against sibling tools.

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