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com.coverage-rights/coverage-rights

Part ofcoverage-rightsMCP server

Insurer denial rates, appeal outcomes, appeal rights, and drug denial playbooks.

First seen 2 Oct 2026. Evidence as of 11 Nov 2026.

10
Tools
From an anonymous probe
1
Source listings
Each with its own history
25
Recorded changes
Since first seen

Tools

ToolDescriptionBehaviour
get_appeal_rightsDeterministically 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.Read-only
get_condition_outcomesExternal-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.Read-only
get_drug_playbookCurated medication background, common denial patterns, preparation considerations, and available historical California review outcomes for covered GLP-1 and IBD drugs. Accepts a brand or generic name. Confirm current labeling, the actual benefit channel and plan criteria; the guide does not establish current coverage, an exception entitlement, an individual outcome, or an applicable deadline.Read-only
get_insurer_metricsGet 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.Read-only
get_state_external_reviewHow 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.Read-only
get_treatment_outcomesExternal-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').Read-only
list_insurersList tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.Read-only
prepare_knee_injection_evidencePrepare a free, category-level evidence checklist for a knee osteoarthritis hyaluronic-acid injection denial using routing facts, injection-series status, and record availability categories. Reuses the existing knee denial preparation kit. Does not inspect records or verify an insurer's specific criteria, provide clinical recommendations, draft an appeal, calculate deadlines, or estimate success. Send only the schema's bounded categories; never send names, identifiers, record text, or uploaded documents. Missing routing facts and unsupported routes remain explicit holds.Read-only
rank_denial_ratesInsurer 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.Read-only
search_outcomesSearch treatments (categories + specific drugs/procedures) and conditions by the names used in the published data. The query must appear in a name as a whole word or phrase (e.g. 'wegovy', 'back pain', 'ct scan'); generic names, abbreviations and drug classes are not translated, so search the brand or the specific treatment. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.Read-only

Change history

  1. search_outcomes: input schema changed
  2. rank_denial_rates: input schema changed
  3. prepare_knee_injection_evidence: input schema changed
  4. list_insurers: input schema changed
  5. get_treatment_outcomes: input schema changed
  6. get_state_external_review: input schema changed
  7. get_insurer_metrics: input schema changed
  8. get_drug_playbook: input schema changed
  9. get_condition_outcomes: input schema changed
  10. get_appeal_rights: input schema changed
  11. Description changed (registry)
  12. search_outcomes: input schema changed
  13. search_outcomes: description changed (+"the names used in the published data. The query must appear in a name as a whole word or phrase (e.g. 'wegovy', 'back pain', 'ct scan'); generic names, abbreviations and drug classes are not translated, so search the brand or the specific treatment." -"name.")
  14. search_outcomes: input schema changed
  15. rank_denial_rates: input schema changed
  16. prepare_knee_injection_evidence: tool added
  17. list_insurers: input schema changed
  18. get_treatment_outcomes: input schema changed
  19. get_state_external_review: input schema changed
  20. get_insurer_metrics: input schema changed
  21. get_drug_playbook: input schema changed
  22. get_drug_playbook: description changed (+"Curated medication background, common" +"patterns, preparation considerations," +"available historical California review outcomes")
  23. get_condition_outcomes: input schema changed
  24. get_appeal_rights: input schema changed
  25. server instructions changed (+"medication denial, use" +"with" +"actual program, benefit channel and confirmed routing facts. Preserve needs_context/unsupported results and")
Source listings
SourceListingFirst seenLast seenVersions
Official MCP Registrycom.coverage-rights/coverage-rights2 Oct 202611 Nov 20262
com.coverage-rights/coverage-rights on Official MCP Registry | InvokeRank