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review_claim_requirements

Resolve claim documentation requirements by payer and CPT code, pulling live CMS or payer policy sources and returning structured requirements with document URIs.

Instructions

Resolve claim documentation requirements for a payer + CPT. Fetches live cataloged policy sources (CMS or payer) and optionally enriches from an RCI knowledge API when RCI_API_KEY is set. Returns structured requirements plus document URIs — never PDF/HTML bytes.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
cptYes
payerYes

Output Schema

TableJSON Schema
NameRequiredDescriptionDefault
resultYes

Schema Changelog

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

  1. First observedv0.4.0

TDQS

A4/5.0
Behavior4/5

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

With no annotations, the description carries the behavioral burden. It discloses that the tool fetches live cataloged policy sources, may enrich from an RCI API conditionally on RCI_API_KEY, and returns structured data plus URIs rather than raw bytes. This gives the agent useful operational context beyond the simple input schema.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness5/5

Is the description appropriately sized, front-loaded, and free of redundancy?

Two sentences, tightly written, with the core purpose in the first sentence and important behavioral constraints following. Every phrase adds value, including the explicit 'never PDF/HTML bytes' boundary.

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

Completeness4/5

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

Given the tool's moderate complexity—live fetching, optional API enrichment, and structured output—the description covers the important operational aspects well. An output schema exists, so return-value details are handled elsewhere. Minor gaps include no guidance on payer/CPT formats or what happens when the RCI key is absent, but these are not critical for tool selection.

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

Parameters3/5

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

The schema has 0% description coverage, so the description must compensate. It does identify both parameters ('payer' and 'CPT') and their role in the operation, but it adds no additional semantics such as expected formats, examples, or constraints. The description merely restates the parameter names in context rather than enriching them.

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 names a specific verb ('Resolve') with a clear resource ('claim documentation requirements') and identifies the key inputs (payer + CPT). It also differentiates from sibling tools by stating it returns structured requirements and document URIs, never PDF/HTML bytes, making it easy to distinguish from read_document_bytes and preview_pdf_pages.

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

Usage Guidelines3/5

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

The description establishes the context for use: resolving claim requirements for a payer and CPT, and it implies this is the right tool when structured requirements rather than file bytes are needed. However, it does not explicitly compare itself to siblings or state when not to use it, leaving the routing largely to inference.

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

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