Medigami: medical bill error scan, denial decoding, appeal deadlines, hospital price lookup
| Endpoint | https://mcp.medigami.com/public/mcp (streamable-http) |
|---|---|
| Registry version | 1.0.0 |
| Now | 87 tools · grade D (61) · pin ts_114313cb9c8c062265b9930283eaf96c · protocol 2025-06-18 |
| First / last listed | 2026-10-28 04:52 UTC / 2026-10-28 04:52 UTC |
| Grade over time | 2026-10-28: D (61), 87 tools |
Is this your server? Own a server? ToolFit hosted watch re-checks it every 24 h ($0.25 per 30 days) or 6 h ($0.60) and sends you an HMAC-signed webhook when its tools or grade change: POST https://api.youraitools.co/toolfit/v1/watch. To opt out, see About & opt-out.
Tools: scan_bill_for_errors generate_appeal_letter optimize_prescription analyze_glp1_pathways verify_attestation watch_appeal_outcome watch_claim_denial format_citation submit_denial_letter verify_mcp_response format_medigami_citation estimate_appeal_success resolve_denial maximize_recovery explain_appeal_success negotiate_bill_script batch_scan_bills lookup_icd10 lookup_cpt lookup_npi verify_dea_authorization lookup_provider_taxonomy resolve_codes code_conflict_detector fair_price_estimator price_variance_analyzer claim_consistency_checker bundling_violation_detector appeal_success_predictor generate_appeal_letter_v2 negotiation_strategy_generator insurance_response_interpreter settlement_optimizer patient_cost_forecaster insurance_plan_optimizer cash_vs_insurance_optimizer financial_risk_exposure_model cpt_to_icd_mapper icd_to_cpt_mapper code_bundle_validator unbundling_detector cash_price_estimator zip_based_price_variance regional_price_benchmark specialty_price_benchmark inflation_adjusted_price_model deductible_impact_calculator coinsurance_simulator copay_model billing_charge_vs_allowed_delta price_anomaly_detector overpriced_service_detector market_price_distribution_model price_outlier_detector procedure_cost_decomposition price_recommendation_engine claim_duplicate_line_detector denial_reason_classifier appeal_argument_generator denial_response_builder dispute_case_builder evidence_pack_generator claim_rebuttal_generator appeal_escalation_path_finder payer_specific_appeal_templates denial_code_explainer claim_reconsideration_builder supporting_document_selector out_of_pocket_optimizer financial_exposure_model procedure_affordability_ranker treatment_cost_comparator bill_shock_predictor payment_plan_optimizer financial_assistance_finder patient_cost_explainer healthcare_budget_forecaster medical_spending_analyzer insurance_value_optimizer patient_financial_risk_score decode_denial get_appeal_deadline get_venue medigami_odds medigami_roast medigami_deadline medigami_rate
scan_bill_for_errors | Scan a medical bill or EOB text for errors: duplicate charges, CPT unbundling, upcoding, facility-fee overcharges. Returns flagged anomalies with estimated dollar impact and a total recovery estimate.
PHI WARNING: bill text typically contains PHI (patient name, DOB, MRN, insurer ID). Medigami runs a server-side PHI redactor before any downstream LLM call when scan_bill is invoked from the public params: bill_text*, provider, insurer, total, zip_code |
generate_appeal_letter | Generate a legally-grounded insurance appeal letter for a denied claim. Returns the letter as a template with [PATIENT NAME] and [PROVIDER NAME] placeholders (structured-only PHI posture). Includes legal citations, recommended attachments, and appeal-deadline calendar.
WHEN TO USE: User has a specific claim denied and wants a drafted appeal letter. Requires insurer, denial_reason (CARC code), cpt params: insurer*, denial_reason*, cpt_code*, diagnosis*, amount*, state |
optimize_prescription | Find the lowest-cost path for a prescription: generics, biosimilars, GoodRx coupons, manufacturer assistance, 90-day fills, and mail-order vs retail comparison. Returns ranked options with annual savings vs current copay.
WHEN TO USE: User asks about prescription cost — lowest-price generic, biosimilar, GoodRx coupon, mail-order, manufacturer assistance, or 90-day fill options.
WHEN NOT: For ins params: drug_name*, current_insurance_cost_30day, is_maintenance_med, ndc_code, zip_code |
analyze_glp1_pathways | Find all access pathways for a GLP-1 drug (Ozempic, Wegovy, Mounjaro, Zepbound) given patient eligibility factors. Ranks pathways by monthly cost, flags prior-authorization rules and step-therapy, and returns the recommended appeal strategy if denial is likely.
WHEN TO USE: User specifically asks about GLP-1 drugs (Ozempic, Wegovy, Mounjaro, Zepbound) — coverage, prior-auth strategy, step-therapy params: bmi*, insurer*, has_diabetes, has_cvd, medicare, state, current_copay, tried_step_therapy |
verify_attestation | Verify an Ed25519-signed Medigami MCP response envelope — confirm a medical-bill / appeal / denial / rate answer came from Medigami and hasn't been tampered with. Input: the signed envelope + a public key (PEM) or expected-fingerprint you pinned out-of-band. Returns {valid, reason, tracking_id, timestamp, exp, public_key_fingerprint} so callers can cite the result as FRE 902(14) self-authenticatin params: envelope*, public_key_pem, expected_fingerprint |
watch_appeal_outcome | Subscribe to an appeal outcome by tracking_id. Blocks up to `timeout_seconds` (default 300). Returns the outcome payload as soon as it's recorded, or {status: 'timeout'} if nothing resolved within the window — caller re-invokes to keep watching. Tracking ids are returned by estimate_appeal_success and other Tier 3 moat tools.
WHEN TO USE: Caller wants to subscribe to the outcome of an in-flight a params: tracking_id*, timeout_seconds |
watch_claim_denial | Subscribe to a claim denial event for a given scan_id. Blocks up to `timeout_seconds`. Returns {status: 'denied', ...} as soon as the payer marks the claim denied in claim_status_history, or {status: 'timeout'} if no denial observed within the window.
WHEN TO USE: Caller wants to stream denial events for a set of claims.
WHEN NOT: One-shot queries. params: scan_id*, timeout_seconds |
format_citation | Format an LLM-citable reference to a previously-attested Medigami MCP response. Input: either the full signed envelope that an earlier attested tool returned, OR just a tracking_id. Returns a short citation string, a public verification URL a third party can open to inspect and cryptographically verify the payload, and a long-form attribution block. Use this after any substantive Medigami tool cal params: envelope, tracking_id, format |
submit_denial_letter | Submit a medical-claim denial letter to the Medigami Denial Common Crawl (public aggregate dataset). Consent-gated — caller must pass consent=true to attest the submission is voluntary. Server-side PHI scrubber runs before any storage; the public aggregate contains only coded fields (insurer_canonical, denial_reason_code, state, cpt_category, dollars_bin, days_to_resolution_bin). Raw text is never params: letter_text*, cpt_code, amount, state, outcome_code, days_to_resolution, tracking_id, consent* |
verify_mcp_response | DEPRECATED ALIAS of verify_attestation — kept for backward compatibility with v0.1.7 clients. New code should call verify_attestation directly.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or tracking an outcome.
WHEN NOT: For composite workflows use the higher-level tool that calls these internally. params: envelope*, public_key_pem, expected_fingerprint |
format_medigami_citation | DEPRECATED ALIAS of format_citation — kept for backward compatibility with v0.1.7 clients. New code should call format_citation directly.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or tracking an outcome.
WHEN NOT: For composite workflows use the higher-level tool that calls these internally. params: envelope, tracking_id, format |
estimate_appeal_success | Probability an appeal will be approved, derived from outcome-labeled data weighted by label provenance (IRO determinations, EOB reversals, physician confirmations). Returns probability + 95% CI + sample_size + expected_days_to_resolution + tracking_id. Report the actual outcome later via POST /api/outcomes/record with the same tracking_id to improve future estimates.
WHEN TO USE: User or caller w params: insurer*, denial_reason*, cpt_code*, diagnosis, state, amount |
resolve_denial | End-to-end denial resolution: returns appeal probability + confidence interval + a drafted letter template grounded in aggregate outcome data + plan-context flags (ERISA, restrictive-adjuster state). One call, one tracking_id. No recovery-financing product is offered by this tool.
WHEN TO USE: Single-shot composite: user has a specific denial and wants scan + estimate + appeal + citation in one c params: insurer*, denial_reason*, cpt_code*, diagnosis, state, amount, plan_type_hint |
maximize_recovery | Given a prior scan_id, returns a prioritized action list: anomalies ranked by (expected overcharge x recovery probability), with the next steps to pursue each. Use after scan_bill_for_errors.
WHEN TO USE: User has already run scan_bill_for_errors and wants the anomalies ranked by expected dollar recovery.
WHEN NOT: As a first call — always scan first. params: scan_id* |
explain_appeal_success | Human-readable rationale for an appeal probability. Returns {probability, tier, recommended_posture, rationale, expected_days_to_resolution, tracking_id} grounded in aggregate outcome rates — not model feature weights. Use this when the caller wants 'why' in plain English alongside the number.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a params: insurer*, denial_reason*, cpt_code*, diagnosis, state, amount |
negotiate_bill_script | Generate a phone script the user can read when negotiating a medical bill directly with the provider. Combines DP-noised commercial rate benchmarks + the caller's household income + federal charity-care rules (IRS §501(r)) into three negotiation angles: financial assistance, self-pay discount, and itemized-bill coding review. Returns the script + reference-only benchmark range (for the user's own params: cpt_code*, billed_amount*, insurer, zip3, household_income_annual, household_size, state |
batch_scan_bills | Scan multiple medical bills in one call. Returns per-bill anomaly lists + total recovery estimate across the batch. Input is a list of {bill_text, provider?, insurer?} items (max 10 per call). Much faster than serial scan_bill_for_errors when handling a bulk upload.
WHEN TO USE: User has multiple bills or EOBs to review at once (e.g. a family's bills from one visit, or a year of statements).
WHE params: bills* |
lookup_icd10 | Look up an ICD-10-CM diagnosis code or search by keyword. Input is either an exact code (e.g. 'E11.21') or a free-text description phrase ('type 2 diabetes with nephropathy'). Returns either the matching code + description or up to 20 candidate matches. Use when a clinical note uses non-standard phrasing and the correct code is needed for billing.
WHEN TO USE: User asks about a specific ICD-10 di params: query* |
lookup_cpt | Look up a CPT or HCPCS-J code or search by keyword. Covers the most common outpatient billing codes (E/M, preventive, lab, imaging, procedure, cardiology, therapy, behavioral, vaccine, injectable drugs). Note: CPT is a registered trademark of the American Medical Association; full-dataset commercial use requires an AMA license. This tool provides short descriptors for identification in billing-rev params: query* |
lookup_npi | Look up a provider in the CMS NPPES National Provider Identifier registry. Accepts a 10-digit NPI number OR a provider name (optionally narrowed by 2-char state). Returns up to 20 matches with entity type, specialty, taxonomy code, address, and status. Source: CMS NPPES public API (free, no key required).
WHEN TO USE: User wants to verify a specific provider by NPI number, or find a provider by n params: query*, state |
verify_dea_authorization | Validate the format + checksum of a DEA registration number (format: [A-Z][A-Z9][0-9]{7}; public checksum algorithm). Useful as a sanity check on a DEA number you were given (e.g. on a prescription label or a provider's letterhead). Scope note: this tool confirms the number is well-formed — it does NOT verify current registration status or the specific controlled-substance schedule the holder is a params: dea_number*, cpt_code |
lookup_provider_taxonomy | Look up a NUCC provider taxonomy code (the specialty codes used on HIPAA transactions + NPI registrations) or search by keyword. Returns classification + type + optional specialization. Source: NUCC Health Care Provider Taxonomy Code Set (public; CMS-accepted).
WHEN TO USE: Resolving a NUCC provider taxonomy code to its specialty description.
WHEN NOT: For finding a provider by specialty in a re params: query* |
resolve_codes | [Taxonomy A.1 — baseline response (public data only)] Unified code resolver — free-form query or clinical description → ranked ICD-10-CM, CPT, and HCPCS codes with confidence scores. Use when you need to translate symptoms, procedures, or diagnoses into billable codes without running three separate lookups.
WHEN TO USE: User asks about medical codes: what a CPT/ICD/HCPCS code means, whether a cod params: query*, code_types, max_results |
code_conflict_detector | [Taxonomy A.5 — delegates to scan_bill_for_errors] Detect CPT unbundling, mutually exclusive code pairs, and NCCI edit violations in a set of codes. Implemented by the bill scanner's anomaly engine.
WHEN TO USE: User asks about medical codes: what a CPT/ICD/HCPCS code means, whether a code combination is valid, or how to map between them.
WHEN NOT: For full bill scans (use scan_bill_for_errors). params: cpt_codes*, icd10_codes |
fair_price_estimator | [Taxonomy B.8 — delegates to benchmark_payer_rate] Fair-market price distribution for a service: DP-noised percentiles (p10, p25, p50, p75, p90) for the given CPT in a ZIP3 region.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill params: cpt_code*, zip3*, insurer |
price_variance_analyzer | [Taxonomy B.9 — baseline response (public data only)] Given a target price and a CPT+region, return how many standard deviations above/below the market the target sits, plus confidence.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan params: cpt_code*, observed_price*, zip3* |
claim_consistency_checker | [Taxonomy C.14 — delegates to scan_bill_for_errors] Detect internal contradictions in a claim: time mismatches, mutually exclusive codes, missing required fields, patient-gender/procedure mismatches.
WHEN TO USE: Caller is building or validating a claim payload before submission — format, structure, completeness, alignment.
WHEN NOT: For an already-submitted and denied claim, use generate_appeal params: claim_payload* |
bundling_violation_detector | [Taxonomy C.16 — delegates to scan_bill_for_errors] Detect CPT unbundling (billing components of a procedure separately to inflate the claim). Uses the CMS NCCI edits plus payer-specific bundling rules.
WHEN TO USE: Caller is building or validating a claim payload before submission — format, structure, completeness, alignment.
WHEN NOT: For an already-submitted and denied claim, use generate_app params: cpt_codes*, dos, payer |
appeal_success_predictor | [Taxonomy E.25 — delegates to estimate_appeal_success] Given a denial, predict the probability of a successful appeal. Returns probability with 95% CI, sample size, and recommended appeal-strategy tags.
WHEN TO USE: User or caller wants a probabilistic estimate (denial likelihood, appeal success, payment delay, etc.) to decide whether to pursue a path.
WHEN NOT: For hard facts (dollar amounts, c params: insurer*, denial_reason*, cpt_code*, state |
generate_appeal_letter_v2 | [Taxonomy F.28 — delegates to generate_appeal_letter] [Taxonomy alias] Generate a state-specific insurance appeal letter with UPL-safe disclaimers for 19 US states. Same impl as generate_appeal_letter.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an app params: insurer*, denial_reason*, cpt_code*, diagnosis*, amount*, state |
negotiation_strategy_generator | [Taxonomy F.30 — baseline response (public data only)] Given a bill + patient situation, generate a ranked negotiation strategy: hardship appeal, charity-care application, itemization request, phone scripts.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting params: bill_amount*, provider, situation, insurance_status |
insurance_response_interpreter | [Taxonomy F.31 — baseline response (public data only)] Parse an insurer's response letter or EOB into structured fields: denial reason codes, appeal rights, deadlines, next-step recommendations.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, us params: response_text*, response_type |
settlement_optimizer | [Taxonomy F.32 — baseline response (public data only)] For a disputed bill, compute the optimal settlement target price balancing probability of acceptance against amount saved.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, use denial_code_exp params: bill_amount*, provider, patient_ability_to_pay, dispute_leverage |
patient_cost_forecaster | [Taxonomy H.38 — baseline response (public data only)] Given a patient's plan + predicted care needs, forecast annual out-of-pocket spend across expected claims.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (genera params: plan_id*, expected_procedures, chronic_conditions |
insurance_plan_optimizer | [Taxonomy H.39 — baseline response (public data only)] Given a patient's historical claim patterns, rank available insurance plans by expected annual cost.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_app params: zip_code*, household_size, income_band, historical_spend, chronic_conditions |
cash_vs_insurance_optimizer | [Taxonomy H.41 — baseline response (public data only)] For a given service + patient plan, determine whether cash-pay + charity-care beats insurance billing.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_a params: cpt_code*, insurance_cost_estimate, cash_price, deductible_remaining |
financial_risk_exposure_model | [Taxonomy H.42 — baseline response (public data only)] Quantify a patient's financial exposure to medical-debt risk given current plan, health status, and historical claim volatility.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or a params: plan_id*, household_income, emergency_savings, chronic_conditions |
cpt_to_icd_mapper | [Taxonomy II.21 — baseline response (public data only)] For a given CPT, surface the ICD-10 codes typically paired with it for medical-necessity support.
WHEN TO USE: User has a CPT code and wants to know what ICD-10 diagnoses commonly pair with it for medical-necessity support.
WHEN NOT: For specific payer policy lookups (code_validation).
EXAMPLES:
- Common ICDs for 99213: `{"cpt_code":"99213 params: cpt_code* |
icd_to_cpt_mapper | [Taxonomy II.22 — baseline response (public data only)] For a given ICD-10, surface the CPT codes typically billed for that diagnosis.
WHEN TO USE: User has an ICD-10 diagnosis and wants to know what CPTs are commonly billed for it.
WHEN NOT: For planning specific services (use benchmark_payer_rate once the CPT is chosen).
EXAMPLES:
- Common CPTs for essential hypertension: `{"icd10_code":"I10" params: icd10_code* |
code_bundle_validator | [Taxonomy II.25 — baseline response (public data only)] Check a set of CPT codes against NCCI bundling rules (distinct from modifier-based unbundling).
WHEN TO USE: User asks about medical codes: what a CPT/ICD/HCPCS code means, whether a code combination is valid, or how to map between them.
WHEN NOT: For full bill scans (use scan_bill_for_errors). For appealing a coding-related denial (use gen params: cpt_codes* |
unbundling_detector | [Taxonomy II.26 — delegates to scan_bill_for_errors] Detect CPT unbundling patterns in a claim. Alias of scan_bill_for_errors.
WHEN TO USE: User asks about medical codes: what a CPT/ICD/HCPCS code means, whether a code combination is valid, or how to map between them.
WHEN NOT: For full bill scans (use scan_bill_for_errors). For appealing a coding-related denial (use generate_appeal_letter). params: none |
cash_price_estimator | [Taxonomy III.39 — baseline response (public data only)] Estimate a fair cash price for a service in a given region (no-insurance path).
WHEN TO USE: Uninsured/self-pay user wants a fair-market cash price for a service. Returns Medicare national as a floor + commercial-multiple band.
WHEN NOT: For insurance-covered scenarios (deductible_impact_calculator + coinsurance_simulator).
EXAMPLES:
- Ca params: cpt_code*, zip3 |
zip_based_price_variance | [Taxonomy III.41 — baseline response (public data only)] Report price variance for a CPT across ZIP3 regions with DP noise.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. For insurance-path estima params: none |
regional_price_benchmark | [Taxonomy III.43 — baseline response (public data only)] Regional price benchmark for a CPT at state/metro/ZIP3 granularity.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. For insurance-path estim params: none |
specialty_price_benchmark | [Taxonomy III.44 — baseline response (public data only)] Price benchmark for a CPT within a specific provider specialty.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. For insurance-path estimates params: none |
inflation_adjusted_price_model | [Taxonomy III.46 — baseline response (public data only)] Inflation-adjusted price comparison across years for a CPT.
WHEN TO USE: User has a historical dollar amount and wants it adjusted for medical-care inflation to a given year.
WHEN NOT: For current market prices (benchmark_payer_rate).
EXAMPLES:
- Adjust $1K 3yr forward at medical CPI: `{"base_amount_usd":1000,"years":3}` params: base_amount_usd*, years* |
deductible_impact_calculator | [Taxonomy III.48 — baseline response (public data only)] Estimate how a planned service will draw against the member's deductible.
WHEN TO USE: User wants to know how a specific charge affects their deductible (how much draws down, remaining after, post-deductible exposure).
WHEN NOT: For total annual out-of-pocket across a year (healthcare_budget_forecaster).
EXAMPLES:
- Compute deductible dra params: charge_usd*, deductible_remaining_usd |
coinsurance_simulator | [Taxonomy III.49 — baseline response (public data only)] Simulate member coinsurance exposure across plan-design variants.
WHEN TO USE: User wants to model their coinsurance share of a post-deductible charge. Pass charge_usd and optionally coinsurance_rate.
WHEN NOT: For flat-copay services (copay_model).
EXAMPLES:
- Simulate 20% coinsurance on $1K: `{"charge_usd":1000,"coinsurance_rate":0.2}` params: charge_usd*, coinsurance_rate |
copay_model | [Taxonomy III.50 — baseline response (public data only)] Model member copay for a service by plan-design class.
WHEN TO USE: User wants the typical copay for a service type (primary / specialist / er). Uses KFF EHBS 2024 averages.
WHEN NOT: For patient-specific plan details — copay varies by plan design.
EXAMPLES:
- Typical specialist copay: `{"service_type":"specialist"}` params: service_type |
billing_charge_vs_allowed_delta | [Taxonomy III.51 — baseline response (public data only)] Delta between billed charge and payer-allowed amount for a claim line.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. For insurance-path es params: billed_usd*, allowed_usd* |
price_anomaly_detector | [Taxonomy III.52 — baseline response (public data only)] Detect service-line prices statistically anomalous versus market.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. For insurance-path estimat params: none |
overpriced_service_detector | [Taxonomy III.53 — baseline response (public data only)] Flag services billed materially above market percentile thresholds.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. For insurance-path estim params: none |
market_price_distribution_model | [Taxonomy III.55 — baseline response (public data only)] Full DP-noised market price distribution for a CPT+region pair.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. For insurance-path estimates params: none |
price_outlier_detector | [Taxonomy III.56 — baseline response (public data only)] Detect claim-line outliers relative to a learned market distribution.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. For insurance-path est params: none |
procedure_cost_decomposition | [Taxonomy III.57 — baseline response (public data only)] Decompose the cost of a procedure into component services + facility + professional fees.
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionable. Fo params: none |
price_recommendation_engine | [Taxonomy III.58 — baseline response (public data only)] Recommend a reasonable price to propose to a provider for a service (self-pay or negotiation).
WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable.
WHEN NOT: For a specific bill they have in hand, scan_bill_for_errors is more actionabl params: none |
claim_duplicate_line_detector | [Taxonomy IV.75 — baseline response (public data only)] Detect duplicated service lines within a single claim.
WHEN TO USE: Caller is building or validating a claim payload before submission — format, structure, completeness, alignment.
WHEN NOT: For an already-submitted and denied claim, use generate_appeal_letter. For market pricing context, use benchmark_payer_rate. params: claim* |
denial_reason_classifier | [Taxonomy VI.106 — baseline response (public data only)] Classify a denial letter or remittance advice into normalized denial-reason categories.
WHEN TO USE: User or caller wants a probabilistic estimate (denial likelihood, appeal success, payment delay, etc.) to decide whether to pursue a path.
WHEN NOT: For hard facts (dollar amounts, code definitions, deadlines). Predictions carry confidence params: none |
appeal_argument_generator | [Taxonomy VII.120 — baseline response (public data only)] Generate component arguments for an appeal letter: medical-necessity, contract, policy.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, use denial_code_explainer first. For finding a nego params: denial_code, cpt_code, icd10_code, insurer |
denial_response_builder | [Taxonomy VII.121 — baseline response (public data only)] Build a denial-response package tailored to the denial reason code.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, use denial_code_explainer first. For finding a negotiation path on a no params: denial_reason, insurer, cpt_code, amount |
dispute_case_builder | [Taxonomy VII.123 — baseline response (public data only)] Assemble a complete dispute case file including claim, denial, evidence, and timeline.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, use denial_code_explainer first. For finding a negot params: none |
evidence_pack_generator | [Taxonomy VII.124 — baseline response (public data only)] Generate an evidence package supporting a claim or appeal (references, studies, policies).
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, use denial_code_explainer first. For finding a n params: none |
claim_rebuttal_generator | [Taxonomy VII.128 — baseline response (public data only)] Generate a rebuttal to a payer's denial rationale point-by-point.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, use denial_code_explainer first. For finding a negotiation path on a non- params: none |
appeal_escalation_path_finder | [Taxonomy VII.129 — baseline response (public data only)] Find the correct escalation path for a denied claim (internal appeal → external review → DOI).
WHEN TO USE: User needs to know the deadlines and agencies for each step of appealing a denial. Pass state (e.g. 'CA') and insurer for state-specific and insurer-specific values.
WHEN NOT: Without state/insurer — still works but returns generic params: state, insurer |
payer_specific_appeal_templates | [Taxonomy VII.130 — baseline response (public data only)] Return payer-specific appeal templates known to perform well.
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, use denial_code_explainer first. For finding a negotiation path on a non-deni params: none |
denial_code_explainer | [Taxonomy VII.131 — baseline response (public data only)] Explain a CARC/RARC denial code in plain language with common causes.
WHEN TO USE: User asks 'what does CO-16 mean' or similar — any CARC/RARC code. Returns full X12 table entry when available with meaning, category, typical root cause, primary remediation, and reversibility flag.
WHEN NOT: For drafting an appeal (generate_appeal_letter). params: code* |
claim_reconsideration_builder | [Taxonomy VII.132 — baseline response (public data only)] Build a claim reconsideration request (lighter-weight than a formal appeal).
WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
WHEN NOT: For explaining what a denial code means without drafting an appeal, use denial_code_explainer first. For finding a negotiation pat params: none |
supporting_document_selector | [Taxonomy VII.135 — baseline response (public data only)] Select optimal supporting documents for an appeal from an available document pool.
WHEN TO USE: User is preparing an appeal and needs a ranked list of supporting documents for the denial category. Pass denial_code.
WHEN NOT: Without denial_code — still returns generic docs but category-specific ranking is the high-value output.
EXAMPLES: params: denial_code, denial_reason |
out_of_pocket_optimizer | [Taxonomy X.174 — baseline response (public data only)] Optimize out-of-pocket spend across a sequence of planned services.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_appeal_letter). params: none |
financial_exposure_model | [Taxonomy X.176 — delegates to financial_risk_exposure_model] Model a member's financial exposure. Alias of financial_risk_exposure_model.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_appeal_letter). params: none |
procedure_affordability_ranker | [Taxonomy X.177 — baseline response (public data only)] Rank a set of procedures by affordability for a given member.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_appeal_letter). params: none |
treatment_cost_comparator | [Taxonomy X.178 — baseline response (public data only)] Compare expected costs across treatment alternatives for a condition.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_appeal_letter). params: none |
bill_shock_predictor | [Taxonomy X.179 — baseline response (public data only)] Predict risk that a planned service will trigger an unexpected large bill.
WHEN TO USE: User planning a service and wants to know if it will trigger an unexpected-large-bill situation. Pass expected_charge_usd and optionally cpt_code to get Medicare-ratio context.
WHEN NOT: For a bill already received — scan_bill_for_errors first.
EXAMPLES params: expected_charge_usd*, cpt_code, threshold_usd |
payment_plan_optimizer | [Taxonomy X.180 — baseline response (public data only)] Optimize a payment plan structure for a patient balance.
WHEN TO USE: User has a balance and wants to structure a payment plan. Pass balance_usd and months.
WHEN NOT: If user may qualify for charity care — run financial_assistance_finder first.
EXAMPLES:
- 12-month plan for $3K balance: `{"balance_usd":3000,"months":12}` params: balance_usd*, months |
financial_assistance_finder | [Taxonomy X.181 — baseline response (public data only)] Find applicable financial-assistance programs (hospital charity, 340B, state, pharma).
WHEN TO USE: User needs help paying a medical bill. Pass household_income_usd and family_size for FPL-based eligibility flags across 6 programs (501(r) charity, Medicaid, PE, manufacturer PAPs, 340B, state pools).
WHEN NOT: For insured users with low expo params: household_income_usd, family_size |
patient_cost_explainer | [Taxonomy X.182 — baseline response (public data only)] Explain why a specific charge appears on a bill in plain language.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_appeal_letter). params: none |
healthcare_budget_forecaster | [Taxonomy X.183 — baseline response (public data only)] Forecast a household's annual healthcare spend based on plan + utilization.
WHEN TO USE: User planning annual healthcare spend, comparing plans, or estimating worst-case exposure.
WHEN NOT: For a specific procedure cost (benchmark_payer_rate).
EXAMPLES:
- Forecast annual spend range: `{}` params: plan_deductible_usd, plan_oop_max_usd |
medical_spending_analyzer | [Taxonomy X.184 — baseline response (public data only)] Analyze a patient's medical spending over a period and surface optimization opportunities.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_appeal_lette params: none |
insurance_value_optimizer | [Taxonomy X.185 — baseline response (public data only)] Recommend insurance-plan selections to maximize value given projected utilization.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_appeal_letter). params: none |
patient_financial_risk_score | [Taxonomy X.186 — baseline response (public data only)] Score a patient's financial risk exposure from planned or ongoing care.
WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan.
WHEN NOT: For billing-error analysis (scan_bill_for_errors) or appeal drafting (generate_appeal_letter). params: none |
decode_denial | Decode a CARC (Claim Adjustment Reason Code) denial code into plain English. Returns meaning, category, whether it's typically reversible on appeal, and appeal guidance. Source: public X12 External Code List + CMS/ERISA public rules. Free, no auth.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or track params: carc_code* |
get_appeal_deadline | External-review filing deadline for a state + the date of the FINAL adverse determination. Returns the deadline date, the statutory window label + citation, and whether the exact state-specific window still needs verification (most states carry a conservative NAIC-model 4-month floor unless statute-confirmed, e.g. CA/NY). Free, no auth.
WHEN TO USE: Reference lookups: individual code details, ver params: state, denial_date* |
get_venue | Where and how to file an external review for a given state — the venue name, filing channel (portal/mail/fax), portal URL, and whether expedited review is available. Free, no auth.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or tracking an outcome.
WHEN NOT: For composite workflows use the higher-le params: state |
medigami_odds | Historical external-review overturn rate published by the state regulator for the insurer you name, in a regulated venue (CA/NY/MD/NJ/MI/OH/NC). Returns one insurer's own rate — not a comparison or ranking against other insurers. Public regulator data, k-anonymity floored, not legal advice.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a pr params: insurer*, state* |
medigami_roast | Compare a billed charge against a hospital's own MRF-published negotiated rate for a CPT code; returns the markup multiple. Public regulator data, k-anonymity floored, not legal advice.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or tracking an outcome.
WHEN NOT: For composite workflows use the high params: hospital*, cpt*, billed_amount* |
medigami_deadline | Federal appeal-deadline window (ERISA §503 internal-appeal / ACA §2719 external-review / NSA IDR) for a plan type. Public regulator data, k-anonymity floored, not legal advice.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or tracking an outcome.
WHEN NOT: For composite workflows use the higher-level params: state*, plan_type* |
medigami_rate | A hospital's own MRF-published negotiated rate for a CPT code (no billed-amount comparison — use medigami_roast for that). Public regulator data, k-anonymity floored, not legal advice.
WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or tracking an outcome.
WHEN NOT: For composite workflows use the highe params: hospital*, cpt* |
Entries describe changes in tool definitions. They are not statements about a server, its quality or its author. The grade measures how the tool definitions fit model providers (token cost, schema compatibility, confusable names) as scored by the ToolFit engine at the time of the listing. JSON: append .json. Opt-out: how or hello@youraitools.co.