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Glama

DenialPath

by io.github.maxbeech

Explain a CARC/RARC denial from a remittance

explain_denial
Read-onlyIdempotent

Explain a CARC (Claim Adjustment Reason Code) and any RARCs (Remittance Advice Remark Codes) from a remittance: plain meaning, ranked corrective actions, and whether an appeal is worth filing. found:false means we do not hold that CARC in our dataset (X12 publishes far more codes than we have curated) - the response still returns the group-code meaning when a group prefix (CO/PR/OA/PI) was supplied, and note explains the gap rather than leaving it silent. unknownRarc reports, rather than silently drops, any RARC you passed that we do not hold. Passing payer additionally attaches that payer's appeal deadline where we hold one. Free, no API key needed.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
carcYesCARC code, with or without a group prefix, e.g. "CO-45" or "45".
rarcNoOptional RARC codes on the same remittance line.
payerNoOptional payer slug, to attach a timely-filing appeal deadline.

Schema Changelog

Changes observed during successful MCP inspections. Dates show when Glama detected each change.

  1. Changed1 schema field changed
    • addedInput schema / properties / payer / enum
      Added value: +[
+  "medicare",
+  "medicaid",
+  "aetna",
+  "cigna",
+  "unitedhealthcare",
+  "anthem-bcbs",
+  "bcbs-general",
+  "humana",
+  "kaiser-permanente",
+  "tricare",
+  "molina",
+  "centene-ambetter",
+  "oscar-health",
+  "bright-health",
+  "wellcare",
+  "highmark",
+  "horizon-bcbs",
+  "independence-blue-cross",
+  "emblemhealth",
+  "health-net"
+]
  2. First observed

TDQS

A4.6/5.0
Behavior5/5

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

Annotations already mark the tool as read-only, idempotent, and non-destructive. The description adds meaningful behavioral detail beyond that: how unknown CARCs are handled (found:false), that unknown RARCs are reported rather than dropped (unknownRarc), the group-prefix fallback for group meanings, and the payer-dependent appeal deadline attachment. It also clarifies that no API key is needed, which is operational context not in annotations.

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?

The description is front-loaded with the core purpose, then efficiently details edge cases. It is somewhat dense, but each clause earns its place—no filler or repetition. The only mild issue is the slightly convoluted 'found:false' sentence, but it remains compact and informative.

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

Completeness5/5

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

Given the tool's moderate complexity (3 params, no output schema), the description covers essential usage aspects: inputs, outputs, edge cases, and operational requirements (free, no API key). It provides enough for an agent to select and invoke the tool correctly, including what happens when codes are missing.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters4/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema coverage is 100%, so the baseline is 3. The description enriches the parameters by explaining that carc accepts a group prefix, that rarc's unknownRarc behavior reports missing codes, and that payer affects appeal deadline retrieval. This goes beyond the schema's basic type/description while not diving into exhaustive syntax.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose5/5

Does the description clearly state what the tool does and how it differs from similar tools?

The description opens with a specific verb and resource: 'Explain a CARC... and any RARCs from a remittance' and enumerates concrete outputs: plain meaning, ranked corrective actions, and appeal worthiness. This clearly distinguishes it from siblings like check_claim, get_ncci_edits, or get_timely_filing, which address different facets of claim processing.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines4/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

The context of use is clear—when you need to interpret a denial from a remittance—but it does not explicitly contrast with alternatives or state when not to use it. The note about optionally passing payer to attach appeal deadlines hints at integration with appeal workflows without excluding any sibling tools.

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

All DenialPath toolsInspect
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TDQS

A4.2/5.0
Disambiguation5/5

Each tool targets a distinct function: claim checking, appeal drafting, denial explanation, MUE lookup, NCCI edits lookup, and timely filing. There is no overlap in purpose, and the descriptions make the boundaries clear.

Naming Consistency5/5

All tool names follow a consistent verb_noun pattern (check_claim, draft_appeal, explain_denial, get_mue, get_ncci_edits, get_timely_filing). The verbs are specific and the nouns are meaningful, creating a predictable and readable naming scheme.

Tool Count5/5

Six tools is well within the ideal range for a focused server. The count feels appropriate for the denial management domain, with each tool earning its place and no redundancy.

Completeness5/5

The toolset covers the full denial lifecycle: pre-claim checking (check_claim), denial explanation (explain_denial), appeal drafting (draft_appeal), and supporting lookups (get_mue, get_ncci_edits, get_timely_filing). No obvious gaps exist for the stated purpose.

Resources