Model Context Protocol
A hosted MCP server for claim scrubbing and denial resolution
MCP is the open standard that lets AI agents call external tools without custom glue code. Point any MCP-capable client at Denial7’s endpoint and it gets claim scrubbing, denial resolution and appeal drafting as first-class tools, no wrapper to write, no edit to guess at.
Setup
Add the server
Streamable HTTP transport, JSON-RPC 2.0, one URL, no local process to run.
Endpoint:
https://denial7.com/api/mcp
Config snippet for Claude Desktop, Claude Code, Cursor or any client that reads an mcpServers map. Every tool works with no Authorizationheader at the anonymous rate; a key raises the throttle to your plan's quota.
mcp config
{
"mcpServers": {
"denial7": {
"url": "https://denial7.com/api/mcp",
"headers": {
"Authorization": "Bearer <your-api-key>"
}
}
}
}Tools
What the server exposes
Six tools over the same engine the REST API and the free scrubber use. Each returns findings with their citation and a confidence flag; a status of no_data means not checked, never a pass.
check_claim
Scrub a claim against the NCCI PTP and MUE edits in force on its date of service. Every finding is pass, fail, bypassed, or no_data; no_data means the code or pair was never checked against our dataset, not that it passed. summary.clean is true only when every finding is pass and none are no_data. Free, no API key needed.
arguments {"dateOfService":"2026-07-01","lines":[{"code":"80053","modifiers":[],"units":1},{"code":"80048","modifiers":[],"units":1}]}
explain_denial
Explain a CARC and any RARCs from a remittance: plain meaning, ranked corrective actions, and appeal worthiness. found:false means we do not hold that CARC; the response says so rather than improvising. Free, no API key needed.
arguments {"carc":"CO-45","rarc":["N290"],"payer":"medicare"}
get_ncci_edits
Check a specific PTP pair (column1 + column2 + dateOfService) or list every pair involving a code (code alone). Pair-mode status is no_data (never checked), not_applicable (checked, does not apply on this date), or applies. Free, no API key needed.
arguments {"column1":"80053","column2":"80048","dateOfService":"2026-07-01"}
get_mue
Look up the MUE unit limit for one CPT/HCPCS code and what its MAI (adjudication indicator) means for units billed above the limit. status:no_data means we hold no MUE value for this code, not that none exists. Free, no API key needed.
arguments {"code":"36415"}
draft_appeal
Generate an appeal letter for a denial, assembled deterministically from cited facts. REQUIRES A PRO OR SCALE PLAN: called without one, this returns an upgrade_required error, never a fabricated letter. Facts not supplied render as an explicit placeholder and are listed in placeholders; grounded is true only when the CARC is one we hold.
arguments {"carc":"CO-45","payerSlug":"aetna","claimNumber":"CLM-10293"}
get_timely_filing
Days remaining (or over) to file an initial claim for a payer given a date of service. daysRemaining is null when we hold no published limit for that payer; check note before treating the result as a deadline. Free, no API key needed.
arguments {"payer":"aetna","dateOfService":"2026-01-15"}
check_claim
tools/call request
POST https://denial7.com/api/mcp
{
"jsonrpc": "2.0",
"id": 1,
"method": "tools/call",
"params": {
"name": "check_claim",
"arguments": {
"dateOfService": "2026-07-01",
"lines": [
{
"code": "80053",
"modifiers": [],
"units": 1
},
{
"code": "80048",
"modifiers": [],
"units": 1
}
]
}
}
}response
{
"jsonrpc": "2.0",
"id": 1,
"result": {
"content": [
{
"type": "text",
"text": "{\n \"data\": {\n \"input\": {\n \"dateOfService\": \"2026-07-01\",\n \"payerSlug\": null,\n \"lines\": [\n {\n \"code\": \"80053\",\n \"modifiers\": [],\n \"units\": 1\n },\n {\n \"code\": \"80048\",\n \"modifiers\": [],\n \"units\": 1\n }\n ]\n },\n \"editQuarter\": \"2026 Q3\",\n \"datasetQuarter\": \"2026 Q3\",\n \"findings\": [\n {\n \"kind\": \"ptp\",\n \"status\": \"fail\",\n \"lineIndexes\": [\n 0,\n 1\n ],\n \"codes\": [\n \"80053\",\n \"80048\"\n ],\n \"summary\": \"80048 is bundled into 80053 and no modifier can unbundle it\",\n \"rule\": \"PTP edit with modifier indicator 0. CMS rationale: CPT Manual or CMS manual coding instruction. Indicator 0 means no modifier is permitted to bypass this edit under any circumstances.\",\n \"remedy\": \"Remove 80048 from this claim, or bill 80048 alone on a date of service where 80053 is not billed. Appending a 59 or X modifier here would be an incorrect use of the modifier.\",\n \"citation\": {\n \"source\": \"CMS Medicare NCCI Procedure to Procedure Edits, Practitioner Services\",\n \"url\": \"https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits\",\n \"quarter\": \"2026 Q3\",\n \"retrievedAt\": \"2026-07-18\",\n \"confidence\": \"verified\"\n }\n },\n {\n \"kind\": \"mue\",\n \"status\": \"pass\",\n \"lineIndexes\": [\n 0\n ],\n \"codes\": [\n \"80053\"\n ],\n \"summary\": \"80053: 1 unit is within the MUE of 1\",\n \"rule\": \"MUE 1, adjudication indicator MAI 3. Date of service edit, clinical. Units above this limit are unlikely but not impossible. A higher count can be allowed on appeal when the medical record supports it.\",\n \"remedy\": \"\",\n \"citation\": {\n \"source\": \"CMS Medicare NCCI Medically Unlikely Edits, Practitioner Services\",\n \"url\": \"https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-medically-unlikely-edits\",\n \"quarter\": \"2026 Q3\",\n \"retrievedAt\": \"2026-07-18\",\n \"confidence\": \"verified\"\n }\n },\n {\n \"kind\": \"mue\",\n \"status\": \"pass\",\n \"lineIndexes\": [\n 1\n ],\n \"codes\": [\n \"80048\"\n ],\n \"summary\": \"80048: 1 unit is within the MUE of 2\",\n \"rule\": \"MUE 2, adjudication indicator MAI 3. Date of service edit, clinical. Units above this limit are unlikely but not impossible. A higher count can be allowed on appeal when the medical record supports it.\",\n \"remedy\": \"\",\n \"citation\": {\n \"source\": \"CMS Medicare NCCI Medically Unlikely Edits, Practitioner Services\",\n \"url\": \"https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-medically-unlikely-edits\",\n \"quarter\": \"2026 Q3\",\n \"retrievedAt\": \"2026-07-18\",\n \"confidence\": \"verified\"\n }\n }\n ],\n \"summary\": {\n \"total\": 3,\n \"failures\": 1,\n \"bypassed\": 0,\n \"noData\": 0,\n \"clean\": false\n },\n \"coverage\": {\n \"ptpPairsLoaded\": 40009,\n \"mueCodesLoaded\": 15162,\n \"note\": \"Checked against 40009 PTP pairs and 15162 MUE values curated from the published CMS 2026 Q3 files. This is a subset of the full CMS files. Codes marked no data were not checked and may still be subject to an edit. PTP edits carry their own effective and deletion dates, so a date of service in an earlier quarter is checked against the edit that was genuinely in force then. The MUE table carries no dates, so it is only applied to a date of service inside the quarter we hold.\"\n }\n },\n \"request_id\": \"req_2f9c41a7b0e84d15\",\n \"disclaimer\": \"Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.\",\n \"attribution\": \"Data from Denial7 (https://denial7.com): CMS NCCI/MUE edits and X12 CARC/RARC codes, cited by source and confidence. Free responses require this attribution.\"\n}"
}
]
}
}explain_denial
tools/call request
POST https://denial7.com/api/mcp
{
"jsonrpc": "2.0",
"id": 1,
"method": "tools/call",
"params": {
"name": "explain_denial",
"arguments": {
"carc": "CO-45",
"rarc": [
"N290"
],
"payer": "medicare"
}
}
}response
{
"jsonrpc": "2.0",
"id": 1,
"result": {
"content": [
{
"type": "text",
"text": "{\n \"data\": {\n \"found\": true,\n \"group\": {\n \"code\": \"CO\",\n \"meaning\": \"Contractual Obligation. The provider is responsible and the amount cannot be billed to the patient.\"\n },\n \"carc\": {\n \"code\": \"45\",\n \"commonGroups\": [\n \"CO\"\n ],\n \"title\": \"Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.\",\n \"plainMeaning\": \"The payer is telling you the billed charge is higher than the amount their fee schedule or contract allows for this service. The difference between what you billed and what the payer allows becomes a contractual write off, not something you can bill the patient for when an in network contract is in place.\",\n \"whyItFires\": [\n \"Billed charge exceeds the payer's fee schedule or contracted rate for the CPT/HCPCS code\",\n \"No modifier or documentation was included that could justify an exception to the fee schedule\",\n \"Fee schedule updated on the payer side (annual CMS or payer update) and the practice's charge master was not\"\n ],\n \"correctiveActions\": [\n {\n \"step\": \"Verify the contract rate\",\n \"detail\": \"Pull the current fee schedule or contract rate sheet for this payer and CPT code and confirm the allowed amount matches what was paid.\"\n },\n {\n \"step\": \"Write off per contract\",\n \"detail\": \"If the allowed amount is correct per contract, adjust off the difference. This is a standard contractual adjustment, not an error.\"\n },\n {\n \"step\": \"Check for a fee schedule update lag\",\n \"detail\": \"If the payer recently updated its fee schedule, confirm the correct effective date was applied to this date of service.\"\n }\n ],\n \"appealWorthiness\": \"low\",\n \"appealNote\": \"Appeal only if you can show the payer used the wrong fee schedule, wrong contract year, or the code is not actually subject to that schedule. Otherwise this is a routine contractual write off and not appealable.\",\n \"relatedRarc\": [],\n \"sourceUrl\": \"https://x12.org/codes/claim-adjustment-reason-codes\",\n \"confidence\": \"verified\"\n },\n \"rarc\": [\n {\n \"code\": \"N290\",\n \"type\": \"informational\",\n \"title\": \"Missing/incomplete/invalid rendering provider primary identifier\",\n \"plainMeaning\": \"The claim is missing the NPI of the provider who actually performed the service, or the rendering provider NPI submitted does not match an enrolled provider.\",\n \"correctiveActions\": [\n {\n \"step\": \"Verify the rendering provider's NPI\",\n \"detail\": \"Confirm the individual rendering provider's NPI is correctly entered in the rendering provider loop, not just the billing/group NPI.\"\n },\n {\n \"step\": \"Confirm the rendering provider is enrolled and credentialed\",\n \"detail\": \"Check that the rendering provider is credentialed with the payer and linked correctly to the billing group before resubmitting.\"\n }\n ],\n \"relatedCarc\": [\n \"16\"\n ],\n \"sourceUrl\": \"https://docs.claim.md/docs/remittance-advice-remarks-codes\",\n \"confidence\": \"verify\"\n }\n ],\n \"unknownRarc\": [],\n \"correctiveActions\": [\n {\n \"step\": \"Verify the contract rate\",\n \"detail\": \"Pull the current fee schedule or contract rate sheet for this payer and CPT code and confirm the allowed amount matches what was paid.\"\n },\n {\n \"step\": \"Write off per contract\",\n \"detail\": \"If the allowed amount is correct per contract, adjust off the difference. This is a standard contractual adjustment, not an error.\"\n },\n {\n \"step\": \"Check for a fee schedule update lag\",\n \"detail\": \"If the payer recently updated its fee schedule, confirm the correct effective date was applied to this date of service.\"\n },\n {\n \"step\": \"Verify the rendering provider's NPI\",\n \"detail\": \"Confirm the individual rendering provider's NPI is correctly entered in the rendering provider loop, not just the billing/group NPI.\"\n },\n {\n \"step\": \"Confirm the rendering provider is enrolled and credentialed\",\n \"detail\": \"Check that the rendering provider is credentialed with the payer and linked correctly to the billing group before resubmitting.\"\n }\n ],\n \"appeal\": {\n \"worthiness\": \"low\",\n \"note\": \"Appeal only if you can show the payer used the wrong fee schedule, wrong contract year, or the code is not actually subject to that schedule. Otherwise this is a routine contractual write off and not appealable.\",\n \"payer\": {\n \"payer\": \"Medicare (Original / Part B)\",\n \"slug\": \"medicare\",\n \"initialClaimLimitDays\": 365,\n \"limitText\": \"12 months (1 calendar year) from the date of service\",\n \"clockStartsFrom\": \"date of service\",\n \"appealLimitDays\": 120,\n \"notes\": \"Set by federal regulation at 42 CFR 424.44, not by contract, so this figure does not vary by Medicare Administrative Contractor. Claims denied for untimely filing carry no appeal rights for the timeliness issue itself; the 120-day figure is the standard redetermination (first-level appeal) deadline for a substantive denial, measured from the date of the initial determination.\",\n \"sourceUrl\": \"https://www.medicare.gov/providers-services/claims-appeals-complaints/claims\",\n \"confidence\": \"verified\"\n },\n \"deadlineDays\": 120\n },\n \"note\": \"\"\n },\n \"request_id\": \"req_2f9c41a7b0e84d15\",\n \"disclaimer\": \"Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.\",\n \"attribution\": \"Data from Denial7 (https://denial7.com): CMS NCCI/MUE edits and X12 CARC/RARC codes, cited by source and confidence. Free responses require this attribution.\"\n}"
}
]
}
}get_ncci_edits
tools/call request
POST https://denial7.com/api/mcp
{
"jsonrpc": "2.0",
"id": 1,
"method": "tools/call",
"params": {
"name": "get_ncci_edits",
"arguments": {
"column1": "80053",
"column2": "80048",
"dateOfService": "2026-07-01"
}
}
}response
{
"jsonrpc": "2.0",
"id": 1,
"result": {
"content": [
{
"type": "text",
"text": "{\n \"data\": {\n \"column1\": \"80053\",\n \"column2\": \"80048\",\n \"dateOfService\": \"2026-07-01\",\n \"editQuarter\": \"2026 Q3\",\n \"found\": true,\n \"appliesOnDate\": true,\n \"status\": \"applies\",\n \"edit\": {\n \"column1\": \"80053\",\n \"column2\": \"80048\",\n \"modifierIndicator\": \"0\",\n \"effectiveDate\": \"2000-07-01\",\n \"deletionDate\": null,\n \"rationale\": \"CPT Manual or CMS manual coding instruction\",\n \"note\": \"\",\n \"sourceUrl\": \"https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits\",\n \"confidence\": \"verified\"\n }\n },\n \"request_id\": \"req_2f9c41a7b0e84d15\",\n \"disclaimer\": \"Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.\",\n \"attribution\": \"Data from Denial7 (https://denial7.com): CMS NCCI/MUE edits and X12 CARC/RARC codes, cited by source and confidence. Free responses require this attribution.\"\n}"
}
]
}
}get_mue
tools/call request
POST https://denial7.com/api/mcp
{
"jsonrpc": "2.0",
"id": 1,
"method": "tools/call",
"params": {
"name": "get_mue",
"arguments": {
"code": "36415"
}
}
}response
{
"jsonrpc": "2.0",
"id": 1,
"result": {
"content": [
{
"type": "text",
"text": "{\n \"data\": {\n \"code\": \"36415\",\n \"status\": \"found\",\n \"limit\": {\n \"code\": \"36415\",\n \"mueValue\": 2,\n \"mai\": \"3\",\n \"maiMeaning\": \"Date of service edit, clinical. Units above this limit are unlikely but not impossible. A higher count can be allowed on appeal when the medical record supports it.\",\n \"serviceType\": \"Practitioner\",\n \"note\": \"CMS published rationale for this limit: CMS Policy.\",\n \"sourceUrl\": \"https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-medically-unlikely-edits\",\n \"confidence\": \"verified\"\n }\n },\n \"request_id\": \"req_2f9c41a7b0e84d15\",\n \"disclaimer\": \"Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.\",\n \"attribution\": \"Data from Denial7 (https://denial7.com): CMS NCCI/MUE edits and X12 CARC/RARC codes, cited by source and confidence. Free responses require this attribution.\"\n}"
}
]
}
}draft_appeal
tools/call request
POST https://denial7.com/api/mcp
{
"jsonrpc": "2.0",
"id": 1,
"method": "tools/call",
"params": {
"name": "draft_appeal",
"arguments": {
"carc": "CO-45",
"payerSlug": "aetna",
"claimNumber": "CLM-10293"
}
}
}response
{
"jsonrpc": "2.0",
"id": 1,
"result": {
"content": [
{
"type": "text",
"text": "{\n \"data\": {\n \"subject\": \"Request for reconsideration - claim CLM-10293 - CO-45\",\n \"body\": \"2026-08-11\\n\\nAetna\\nAttn: Claims Review / Appeals Department\\n\\nRe: Request for reconsideration\\nClaim number: CLM-10293\\nDate of service: [TO BE COMPLETED BY PRACTICE]\\nProcedure code(s) at issue: [TO BE COMPLETED BY PRACTICE]\\nProvider: [TO BE COMPLETED BY PRACTICE]\\n\\nTo whom it may concern,\\n\\nWe are writing to request reconsideration of the adjustment applied to the claim referenced above.\\n\\nThe remittance reports CO-45: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement..\\n\\nThe payer is telling you the billed charge is higher than the amount their fee schedule or contract allows for this service. The difference between what you billed and what the payer allows becomes a contractual write off, not something you can bill the patient for when an in network contract is in place.\\n\\nBasis for reconsideration:\\n1. Verify the contract rate. Pull the current fee schedule or contract rate sheet for this payer and CPT code and confirm the allowed amount matches what was paid.\\n2. Write off per contract. If the allowed amount is correct per contract, adjust off the difference. This is a standard contractual adjustment, not an error.\\n3. Check for a fee schedule update lag. If the payer recently updated its fee schedule, confirm the correct effective date was applied to this date of service.\\n\\nThis request is submitted within the appeal window stated in our participation agreement.\\n\\nWe ask that the claim be reprocessed. Supporting documentation is enclosed. Please contact the billing office at the number on file if any further information would assist the review.\\n\\nSincerely,\\n\\n[TO BE COMPLETED BY PRACTICE]\\n[TO BE COMPLETED BY PRACTICE]\",\n \"citations\": [\n {\n \"source\": \"X12 Claim Adjustment Reason Codes\",\n \"url\": \"https://x12.org/codes/claim-adjustment-reason-codes\",\n \"confidence\": \"verified\"\n },\n {\n \"source\": \"Aetna timely filing and appeal policy\",\n \"url\": \"https://muni.health/blog/aetna-timely-filing-limits-2026\",\n \"confidence\": \"verify\"\n }\n ],\n \"placeholders\": [\n \"Provider or practice name\",\n \"Date of service\",\n \"Procedure codes at issue\",\n \"Signature, name and title of the person sending the letter\"\n ],\n \"grounded\": true\n },\n \"request_id\": \"req_2f9c41a7b0e84d15\",\n \"disclaimer\": \"Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.\",\n \"attribution\": \"Data from Denial7 (https://denial7.com): CMS NCCI/MUE edits and X12 CARC/RARC codes, cited by source and confidence. Free responses require this attribution.\"\n}"
}
]
}
}get_timely_filing
tools/call request
POST https://denial7.com/api/mcp
{
"jsonrpc": "2.0",
"id": 1,
"method": "tools/call",
"params": {
"name": "get_timely_filing",
"arguments": {
"payer": "aetna",
"dateOfService": "2026-01-15"
}
}
}response
{
"jsonrpc": "2.0",
"id": 1,
"result": {
"content": [
{
"type": "text",
"text": "{\n \"data\": {\n \"payerSlug\": \"aetna\",\n \"dateOfService\": \"2026-01-15\",\n \"checkedAt\": \"2026-08-11\",\n \"payer\": {\n \"payer\": \"Aetna\",\n \"slug\": \"aetna\",\n \"initialClaimLimitDays\": 90,\n \"limitText\": \"90 days from date of service for participating/in-network commercial providers; non-participating providers commonly have up to 12 months, per Aetna's published guidance\",\n \"clockStartsFrom\": \"date of service\",\n \"appealLimitDays\": null,\n \"notes\": \"The published default varies further by product (commercial, Medicare Advantage, Aetna Better Health Medicaid plans) and by the specific network contract. This entry reflects secondary-source reporting on Aetna's provider guidance rather than a directly confirmed page from aetna.com; verify against the current provider manual for the member's specific plan before acting.\",\n \"sourceUrl\": \"https://muni.health/blog/aetna-timely-filing-limits-2026\",\n \"confidence\": \"verify\"\n },\n \"daysElapsed\": 208,\n \"daysRemaining\": -118,\n \"expired\": true,\n \"note\": \"\"\n },\n \"request_id\": \"req_2f9c41a7b0e84d15\",\n \"disclaimer\": \"Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.\",\n \"attribution\": \"Data from Denial7 (https://denial7.com): CMS NCCI/MUE edits and X12 CARC/RARC codes, cited by source and confidence. Free responses require this attribution.\"\n}"
}
]
}
}Anonymous calls are rate-limited to 4/min and 20/day per IP, enough to try the server from an agent config, not enough to build on. A free test key raises every tool to 10/min against the real engine and never bills. Pass Authorization: Bearer <key> for production limits: 60/min and 1,000 calls/mo on Pro, up to 300/min and 10,000/mo on Scale. See pricing for the full table.
Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.
Point your agent at it
Every tool works keyless at the anonymous rate. A free test key raises the throttle against the real engine and never bills.