MCP tools reference

MCP tools map 1:1 to REST. Use this index, then the REST guides for parameters.

Every MCP tool calls a /v1 route with the same API key. Parameter detail is in API Reference and the Guides linked below.

Tool	REST	Guide
resolve_knowledge	POST /v1/knowledge/resolve	Resolve
calculate_payment	POST /v1/knowledge/payment-calc	Payment calc
get_billing_guide	POST /v1/knowledge/billing-guide	Billing guide
lookup_policy	GET /v1/policies	Payer policies
list_policy_changes	GET /v1/policies/changes	Payer policies
resolve_340b_restrictions	GET /v1/340b/restrictions/resolve	340B
list_340b_manufacturers	GET /v1/340b/manufacturers	340B
get_340b_manufacturer_policy	GET /v1/340b/manufacturers/{id}/policy	340B
list_340b_changes	GET /v1/340b/changes	340B
check_pa_required	GET /v1/prior-auth/check	Prior authorization
check_encounter	POST /v1/encounter/check	Encounter check
lookup_mpfs / lookup_opps / lookup_dme / lookup_lab_fee	/v1/fee-schedules/...	Fee schedules
research_code	POST /v1/agents/code-research	Agents
check_medical_necessity	POST /v1/agents/medical-necessity	Agents
resolve_denial	POST /v1/agents/denial-resolution	Agents
search_npi / get_npi	/v1/npi/...	NPI
check_ncci_mue / check_ncci_ptp / check_ncci_aoc	/v1/ncci/...	NCCI

Core tool parameters are below. The rest of the catalog (IPPS, Medi-Cal APR-DRG, implants, dataset snapshots) is in API Reference.

resolve_knowledge

Resolves the full L1-L6 knowledge stack for a facility and optional service.

Parameters

Parameter	Type	Required	Description
ccn	string	Yes	6-digit Medicare Provider Number
lines	object[]	No	Claim lines {code, modifier?, units?, place_of_service?}. Same shape as calculate_claim_payment. Authoritative when present.
dx	string[]	No	ICD-10-CM diagnosis codes
cpt	string	No	Single CPT/HCPCS (legacy). Ignored when lines is sent.
payer	string	No	Payer name (defaults to Medicare)
care_setting	string	No	Care setting: inpatient, outpatient, office, etc.

Returns

L1–L4 always; first-line L5/L6 in layers + payment_estimate; per-line lines[].l5/l6/coverage; dx; NCCI PTP in ncci_conflicts / ncci_clean.

---

calculate_payment

Calculates expected Medicare payment using MPFS methodology.

Parameters

Parameter	Type	Required	Description
ccn	string	Yes	6-digit Medicare Provider Number
cpt	string	Yes	CPT procedure code
modifier	string	No	CPT modifier
payer	string	No	Payer (defaults to Medicare)

Returns

Estimated payment amount with full breakdown: Work RVU, PE RVU, MP RVU, GPCI adjustments, conversion factor, and facility/non-facility indicator.

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get_billing_guide

Returns billing guidelines for a facility and service combination.

Parameters

Parameter	Type	Required	Description
ccn	string	Yes	6-digit Medicare Provider Number
cpt	string	Yes	CPT procedure code
payer	string	No	Payer name

Returns

Billing form (CMS-1500 vs UB-04), type of bill codes, modifier requirements, consolidated billing rules, and any warnings or exceptions.

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research_code

Submits a billing code research query to the AI agent. This is an async operation — the tool returns when the agent completes its research.

Parameters

Parameter	Type	Required	Description
query	string	Yes	The code research question
cpt_code	string	No	Specific CPT code to research
hcpcs_code	string	No	Specific HCPCS code to research
ccn	string	No	Facility CCN for context enrichment

Returns

Structured code research results including code description, documentation requirements, common modifiers, and billing guidance.

---

resolve_denial

Analyzes denial codes and generates appeal strategies.

Parameters

Parameter	Type	Required	Description
query	string	Yes	Description of the denial or question
carc	string	No	Claim Adjustment Reason Code
rarc	string	No	Remittance Advice Remark Code
denial_code	string	No	Denial reason code
ccn	string	No	Facility CCN for payer context

Returns

Denial analysis with CARC/RARC interpretation, payer-specific appeal deadlines, recommended actions, and appeal strategy.

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search_payer

Searches GET /v1/payers/search (or lists by state), then loads GET /v1/payers/{slug} for the first match.

Parameters

Parameter	Type	Required	Description
payer_name	string	Yes	Payer name or alias (e.g., “Cigna”, “BCBS”, “UHC”)
state	string	No	Two-letter state — lists the directory for that state, then name-filters

Returns

matches from the directory plus payer profile (filing, appeals) when a slug is found.

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check_medical_necessity

Validates medical necessity for a procedure.

Parameters

Parameter	Type	Required	Description
cpt_code	string	Yes	CPT code to evaluate
dx_codes	array	No	ICD-10 diagnosis codes supporting necessity
clinical_notes	string	No	Relevant clinical notes excerpt
ccn	string	No	Facility CCN for context

Returns

Medical necessity assessment with supporting evidence, NCD/LCD references, documentation requirements, and risk level.

---

lookup_policy

Cited payer policy for a code, with geographic versioning.

Parameters

Parameter	Type	Required	Description
payer	string	Yes	Payer slug (medicare_ffs, uhc, …)
code	string	No	CPT/HCPCS
state	string	No	US state. MA and NY share Medicare MAC JK
plan_type	string	No	ffs / medicare_advantage / medicaid / commercial
scope	string	No	general = national only
as_of	string	No	YYYY-MM-DD

Returns

geo_scope, geo_codes, mac_jurisdiction, document_version per row, plus policy_type, codes_covered, codes_not_covered, icd10, delegated_entity when mart_policy_document has them. Maps to GET /v1/policies.