com.medigami/mcp

Scan a medical bill or EOB text for errors: duplicate charges, CPT unbundling, upcoding, facility-fee overcharges. Returns flagged anomalies with estimated dollar impact and a total recovery estimate. PHI WARNING: bill text typically contains PHI (patient name, DOB, MRN, insurer ID). Medigami runs a server-side PHI redactor before any downstream LLM call when scan_bill is invoked from the public SKU, but best practice is to redact client-side before passing the bill through an LLM tool call. For your own bill only — this tool is not for reviewing someone else's claims. WHEN TO USE: User pastes or uploads a medical bill, EOB, itemized statement, hospital charge summary, or similar. The bill text can be raw (OCR output fine) — the scanner parses it. Prefer this over manual line-by-line ana

Generate a legally-grounded insurance appeal letter for a denied claim. Returns the letter as a template with [PATIENT NAME] and [PROVIDER NAME] placeholders (structured-only PHI posture). Includes legal citations, recommended attachments, and appeal-deadline calendar. WHEN TO USE: User has a specific claim denied and wants a drafted appeal letter. Requires insurer, denial_reason (CARC code), cpt_code, diagnosis (ICD-10), and dollar amount. Returns an attested letter with reversal rate, insurer-specific tips, recommended attachments. WHEN NOT: If the user only wants to understand a denial code, use denial_code_explainer first. If they haven't received a formal denial yet, don't draft — clarify status first. For non-CARC disputes (e.g. billing errors pre-adjudication), use scan_bill_for_e

Find the lowest-cost path for a prescription: generics, biosimilars, GoodRx coupons, manufacturer assistance, 90-day fills, and mail-order vs retail comparison. Returns ranked options with annual savings vs current copay. WHEN TO USE: User asks about prescription cost — lowest-price generic, biosimilar, GoodRx coupon, mail-order, manufacturer assistance, or 90-day fill options. WHEN NOT: For insurance-covered Rx copay questions (use copay_model). For medical necessity appeals of formulary denials (use generate_appeal_letter). EXAMPLES: - Find cheapest path for atorvastatin 20mg: `{"drug_name":"atorvastatin 20mg","current_insurance_cost_30day":45,"is_maintenance_med":true}`

Find all access pathways for a GLP-1 drug (Ozempic, Wegovy, Mounjaro, Zepbound) given patient eligibility factors. Ranks pathways by monthly cost, flags prior-authorization rules and step-therapy, and returns the recommended appeal strategy if denial is likely. WHEN TO USE: User specifically asks about GLP-1 drugs (Ozempic, Wegovy, Mounjaro, Zepbound) — coverage, prior-auth strategy, step-therapy alternatives. WHEN NOT: For non-GLP-1 prescriptions (use optimize_prescription).

Verify an Ed25519-signed Medigami MCP response envelope — confirm a medical-bill / appeal / denial / rate answer came from Medigami and hasn't been tampered with. Input: the signed envelope + a public key (PEM) or expected-fingerprint you pinned out-of-band. Returns {valid, reason, tracking_id, timestamp, exp, public_key_fingerprint} so callers can cite the result as FRE 902(14) self-authenticating evidence. Usage: (a) Preferred: supply public_key_pem pinned out-of-band. (b) Otherwise: supply expected_fingerprint (SHA-256 of the pinned key); the envelope's embedded fingerprint is compared against it AND the key is fetched over HTTPS from the envelope's public_key_url (or Medigami's well-known URL) for signature verification. Freshness (exp) and fingerprint equality are both checked.

Subscribe to an appeal outcome by tracking_id. Blocks up to `timeout_seconds` (default 300). Returns the outcome payload as soon as it's recorded, or {status: 'timeout'} if nothing resolved within the window — caller re-invokes to keep watching. Tracking ids are returned by estimate_appeal_success and other Tier 3 moat tools. WHEN TO USE: Caller wants to subscribe to the outcome of an in-flight appeal by tracking_id. WHEN NOT: One-shot queries — prefer the callbacks via /api/outcomes/record.

Subscribe to a claim denial event for a given scan_id. Blocks up to `timeout_seconds`. Returns {status: 'denied', ...} as soon as the payer marks the claim denied in claim_status_history, or {status: 'timeout'} if no denial observed within the window. WHEN TO USE: Caller wants to stream denial events for a set of claims. WHEN NOT: One-shot queries.

Format an LLM-citable reference to a previously-attested Medigami MCP response. Input: either the full signed envelope that an earlier attested tool returned, OR just a tracking_id. Returns a short citation string, a public verification URL a third party can open to inspect and cryptographically verify the payload, and a long-form attribution block. Use this after any substantive Medigami tool call (scan, estimate, resolve, benchmark) so the user has a verifiable reference to the specific answer and its expiration date. WHEN TO USE: After a substantive tool call, generate a citable string + short URL the LLM can paste into its user-facing response for later verification. WHEN NOT: For non-substantive lookups where citation is unnecessary. EXAMPLES: - Generate a citable URL from a tracki

Submit a medical-claim denial letter to the Medigami Denial Common Crawl (public aggregate dataset). Consent-gated — caller must pass consent=true to attest the submission is voluntary. Server-side PHI scrubber runs before any storage; the public aggregate contains only coded fields (insurer_canonical, denial_reason_code, state, cpt_category, dollars_bin, days_to_resolution_bin). Raw text is never republished. Optional tracking_id closes the outcome loop to a prior Medigami scan / resolve call. WHEN TO USE: User wants to contribute a denial letter to the public Denial Common Crawl (consent-gated). PHI is scrubbed before aggregation. WHEN NOT: Just to explain a denial (denial_code_explainer). To draft a response (generate_appeal_letter).

DEPRECATED ALIAS of verify_attestation — kept for backward compatibility with v0.1.7 clients. New code should call verify_attestation directly. WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or tracking an outcome. WHEN NOT: For composite workflows use the higher-level tool that calls these internally.

DEPRECATED ALIAS of format_citation — kept for backward compatibility with v0.1.7 clients. New code should call format_citation directly. WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami response's signature, or tracking an outcome. WHEN NOT: For composite workflows use the higher-level tool that calls these internally.

Probability an appeal will be approved, derived from outcome-labeled data weighted by label provenance (IRO determinations, EOB reversals, physician confirmations). Returns probability + 95% CI + sample_size + expected_days_to_resolution + tracking_id. Report the actual outcome later via POST /api/outcomes/record with the same tracking_id to improve future estimates. WHEN TO USE: User or caller wants probability-of-reversal before spending time on an appeal. Returns probability + confidence interval. WHEN NOT: For picking among multiple appeal strategies (appeal_strategy_success_model). As a stand-alone — usually chain into generate_appeal_letter. EXAMPLES: - Gauge CO-50 appeal odds on Aetna: `{"insurer":"Aetna","denial_reason":"CO-50","cpt_code":"72148","state":"TX","amount":1200}`