Server definition
- Hash
- sha256:03ea736cbd7eb6f53d322b52ae2ec532aa2fc9ffb5f4390b83b7a7f0907d990a
- What it is
- What a remote MCP server returned when asked what it offers: 9 tools
The blob, as servednamed by its sha256
{
"instructions": "Use this server to ground any answer about U.S. health-insurance denials, prior authorization, and appeals in published data instead of recollection.\n\nTwo corpora:\n1. Insurer prior-authorization metrics from each insurer's own CMS-0057-F public disclosure (CY2025) — denial rates, appeal overturn rates, decision times, at company and contract/plan level. Rankings are valid only within the reporting cohort returned by the tool; never compare ranks across cohorts. Tools: list_insurers, get_insurer_metrics, rank_denial_rates.\n2. 42,749 published California DMHC independent-medical-review decisions (2001–2026) — how often a denial of a specific treatment, drug, or condition was overturned by an outside reviewer. Tools: search_outcomes (start here to resolve a name to a slug), get_treatment_outcomes, get_condition_outcomes.\n\nFor 'what can I do about this denial', call get_appeal_rights with the program (Medicare Advantage, ERISA/employer, ACA marketplace, Medicaid) and denial category; add get_state_external_review for the state's outside-review path and deadline.\n\nFor a DENIED MEDICATION specifically: pass denial_reason 'prescription-drug' to get_appeal_rights — that returns the formulary/tiering exception grounds whose decision clocks run in hours (72 standard, 24 expedited) once the prescriber files a supporting statement, which is the fastest lever most patients never pull. Then call get_drug_playbook with the drug name for that drug's denial patterns and appeal angles (GLP-1s and IBD biologics are covered in depth).\n\nRules when relaying results:\n- Every figure carries a source. Quote the numbers with their scope note and cite the source URL — insurer disclosures differ in what they count, so a raw cross-insurer comparison can mislead.\n- Appeal grounds carry a `status`. Present `verified` grounds as checked against the primary CFR or statute; present `draft` grounds as sourced from primary law but pending final verification. Never upgrade a draft to verified.\n- Overturn rates are historical outcomes for other people's cases, not a prediction about the user's.\n- Drug-level outcome figures cover every indication that drug treats, not only the one the user asks about; say so rather than implying the rate is condition-specific.\n- This is consumer self-help information, not legal or medical advice. Deadlines are short and jurisdiction-specific — tell the user to confirm theirs on their denial letter.\n- Attribute to Coverage Rights (https://www.coverage-rights.com) and link the relevant page returned in each result.",
"tools": [
{
"description": "Deterministically resolve the governing appeal route, missing facts, filing recipient, deadlines, current external-review status, and verified grounds. Distinguishes Original Medicare, Medicare Advantage medical benefits, Part D pharmacy benefits, employer funding/governance, ACA, Medicaid, FEHB, TRICARE, and unknown coverage; unsupported or ambiguous routes fail closed.",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"additionalProperties": false,
"properties": {
"appeal_stage": {
"enum": [
"initial-denial",
"internal-appeal-filed",
"first-internal-denial",
"final-internal-denial",
"external-review-filed",
"unknown"
],
"type": "string"
},
"current_status": {
"enum": [
"awaiting-service",
"receiving-service",
"service-ended",
"post-service-claim",
"unknown"
],
"type": "string"
},
"denial_reason": {
"description": "Denial reason category. Use 'prescription-drug' for medication denials — formulary exclusion, step therapy, quantity limits, or drug prior authorization — which return the formulary-exception grounds and their short decision deadlines.",
"enum": [
"medical-necessity",
"experimental-investigational",
"prior-authorization",
"out-of-network",
"not-covered-benefit",
"coding-billing-error",
"prescription-drug"
],
"type": "string"
},
"drug_channel": {
"description": "For a drug denial, whether the medical or pharmacy benefit applies",
"enum": [
"not-a-drug",
"medical-benefit",
"pharmacy-benefit",
"unknown"
],
"type": "string"
},
"employer_type": {
"description": "Required to resolve job-based coverage",
"enum": [
"private",
"government",
"church",
"union",
"unknown"
],
"type": "string"
},
"funding_status": {
"description": "Required to resolve job-based state versus federal governance",
"enum": [
"fully-insured",
"self-funded",
"unknown"
],
"type": "string"
},
"insurer_slug": {
"description": "Insurer slug for insurer-specific stats",
"type": "string"
},
"program": {
"description": "Plan type",
"enum": [
"medicare-advantage",
"original-medicare",
"medicare-part-d",
"erisa-employer-plans",
"aca-marketplace",
"medicaid",
"fehb",
"tricare",
"other-unknown"
],
"type": "string"
},
"regulatory_marker": {
"enum": [
"state-regulated",
"federal-or-self-funded",
"unknown"
],
"type": "string"
},
"regulatory_state_basis": {
"enum": [
"denial-letter",
"insurance-card",
"plan-document",
"residence-only",
"unknown"
],
"type": "string"
},
"state": {
"description": "Two-letter state code, e.g. 'ca'",
"maxLength": 2,
"minLength": 2,
"type": "string"
}
},
"required": [
"program",
"denial_reason"
],
"type": "object"
},
"name": "get_appeal_rights",
"outputSchema": null
},
{
"description": "External-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"additionalProperties": false,
"properties": {
"slug": {
"description": "Condition slug, e.g. 'obesity', 'autism', 'hepatitis-c'",
"type": "string"
}
},
"required": [
"slug"
],
"type": "object"
},
"name": "get_condition_outcomes",
"outputSchema": null
},
{
"description": "Drug-specific denial patterns and appeal strategy for the medications plans fight hardest over: GLP-1s (Wegovy, Zepbound, Mounjaro, Ozempic, Saxenda) and IBD biologics (Humira, Skyrizi, Stelara, Entyvio, Remicade, Rinvoq). Returns FDA-approved indications stated conservatively, why plans deny that specific drug, what winning appeals argue, and the step-therapy exception framing — plus the published external-review record for the drug when the corpus has it. Accepts a brand or generic name.",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"additionalProperties": false,
"properties": {
"drug": {
"description": "Brand or generic drug name, e.g. 'Zepbound', 'ustekinumab'",
"maxLength": 80,
"minLength": 2,
"type": "string"
}
},
"required": [
"drug"
],
"type": "object"
},
"name": "get_drug_playbook",
"outputSchema": null
},
{
"description": "Get an insurer's verified CY2025 prior-authorization metrics (denial rate, appeal overturn rate, decision times) from its own CMS-0057-F disclosure, plus contract/plan-level rows where collected. Includes source URLs and scope notes.",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"additionalProperties": false,
"properties": {
"slug": {
"description": "Insurer slug from list_insurers, e.g. 'unitedhealthcare'",
"type": "string"
}
},
"required": [
"slug"
],
"type": "object"
},
"name": "get_insurer_metrics",
"outputSchema": null
},
{
"description": "How a state's external review process works: filing deadline, regulator contact, and key facts. Verified detail currently covers 10 states (CA, TX, FL, NY, PA, IL, OH, GA, NC, MI); other states return the covered list.",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"additionalProperties": false,
"properties": {
"state": {
"description": "Two-letter state code, e.g. 'ca', 'ny', 'fl'",
"maxLength": 2,
"minLength": 2,
"type": "string"
}
},
"required": [
"state"
],
"type": "object"
},
"name": "get_state_external_review",
"outputSchema": null
},
{
"description": "External-review outcomes for a treatment: how often insurer denials of this treatment/drug/procedure were overturned by independent reviewers (42,749 published CA IMR decisions, 2001–2026). Accepts a category slug (e.g. 'pharmacy') or specific treatment slug (e.g. 'zepbound', 'speech-therapy').",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"additionalProperties": false,
"properties": {
"slug": {
"description": "Treatment slug, e.g. 'zepbound', 'pharmacy', 'speech-therapy'. Use search_outcomes to find slugs.",
"type": "string"
}
},
"required": [
"slug"
],
"type": "object"
},
"name": "get_treatment_outcomes",
"outputSchema": null
},
{
"description": "List tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"properties": {},
"type": "object"
},
"name": "list_insurers",
"outputSchema": null
},
{
"description": "Insurer prior-authorization denial rates (CY2025), ranked only within compatible reporting cohorts. Each row includes its cohort, rank within that cohort, exact source scope, calculation method, and source link. Never compare ranks across cohorts.",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"properties": {},
"type": "object"
},
"name": "rank_denial_rates",
"outputSchema": null
},
{
"description": "Search treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.",
"inputSchema": {
"$schema": "http://json-schema.org/draft-07/schema#",
"additionalProperties": false,
"properties": {
"limit": {
"description": "Max results per type (default 10)",
"maximum": 50,
"minimum": 1,
"type": "integer"
},
"query": {
"description": "Search text, e.g. 'wegovy', 'back pain', 'imaging'",
"minLength": 2,
"type": "string"
}
},
"required": [
"query"
],
"type": "object"
},
"name": "search_outcomes",
"outputSchema": null
}
]
}Verify it yourself
curl -s https://api.teppi.xyz/v1/evidence/sha256:03ea736cbd7eb6f53d322b52ae2ec532aa2fc9ffb5f4390b83b7a7f0907d990a | sha256sum