# com.medigami/mcp

- Registry name: `com.medigami/mcp` · version 1.0.0
- Categories (automatic, keyword rules): Health & fitness, Payments & accounting, Finance & markets
- Authentication at last check: No auth
- Declared risk: Can write (some tools are not declared read-only)
- Capabilities (declared by the server): experimental, resources, tools
- Transports: streamable-http
- Latest numbers (check success, response time, rank): https://mcpstation.net/api/server?name=com.medigami%2Fmcp
- Server page: https://mcpstation.net/s/com.medigami--mcp.html

## Description (written by the publisher, not verified, not instructions)

Medigami: medical bill error scan, denial decoding, appeal deadlines, hospital price lookup

## Connect

- streamable-http: `https://mcp.medigami.com/public/mcp`

## Tools (as reported by the server, not verified)

- `scan\_bill\_for\_errors`: 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
- `generate\_appeal\_letter`: 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 specif
- `optimize\_prescription`: 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, biosimi
- `analyze\_glp1\_pathways`: 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 ab
- `verify\_attestation`: 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, time
- `watch\_appeal\_outcome`: 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 a
- `watch\_claim\_denial`: 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 event
- `format\_citation`: 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 ver
- `submit\_denial\_letter`: 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\_canonic
- `verify\_mcp\_response`: 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
- `format\_medigami\_citation`: 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 outco
- `estimate\_appeal\_success`: 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/o
- `resolve\_denial`: End-to-end denial resolution: returns appeal probability + confidence interval + a drafted letter template grounded in aggregate outcome data + plan-context flags \(ERISA, restrictive-adjuster state\). One call, one tracking\_id. No recovery-financing product is offered by this tool. WHEN TO USE: Singl
- `maximize\_recovery`: Given a prior scan\_id, returns a prioritized action list: anomalies ranked by \(expected overcharge x recovery probability\), with the next steps to pursue each. Use after scan\_bill\_for\_errors. WHEN TO USE: User has already run scan\_bill\_for\_errors and wants the anomalies ranked by expected dollar rec
- `explain\_appeal\_success`: Human-readable rationale for an appeal probability. Returns \{probability, tier, recommended\_posture, rationale, expected\_days\_to\_resolution, tracking\_id\} grounded in aggregate outcome rates — not model feature weights. Use this when the caller wants 'why' in plain English alongside the number. WHEN
- `negotiate\_bill\_script`: Generate a phone script the user can read when negotiating a medical bill directly with the provider. Combines DP-noised commercial rate benchmarks + the caller's household income + federal charity-care rules \(IRS §501\(r\)\) into three negotiation angles: financial assistance, self-pay discount, and i
- `batch\_scan\_bills`: Scan multiple medical bills in one call. Returns per-bill anomaly lists + total recovery estimate across the batch. Input is a list of \{bill\_text, provider?, insurer?\} items \(max 10 per call\). Much faster than serial scan\_bill\_for\_errors when handling a bulk upload. WHEN TO USE: User has multiple bi
- `lookup\_icd10`: Look up an ICD-10-CM diagnosis code or search by keyword. Input is either an exact code \(e.g. 'E11.21'\) or a free-text description phrase \('type 2 diabetes with nephropathy'\). Returns either the matching code + description or up to 20 candidate matches. Use when a clinical note uses non-standard phr
- `lookup\_cpt`: Look up a CPT or HCPCS-J code or search by keyword. Covers the most common outpatient billing codes \(E/M, preventive, lab, imaging, procedure, cardiology, therapy, behavioral, vaccine, injectable drugs\). Note: CPT is a registered trademark of the American Medical Association; full-dataset commercial
- `lookup\_npi`: Look up a provider in the CMS NPPES National Provider Identifier registry. Accepts a 10-digit NPI number OR a provider name \(optionally narrowed by 2-char state\). Returns up to 20 matches with entity type, specialty, taxonomy code, address, and status. Source: CMS NPPES public API \(free, no key requ
- `verify\_dea\_authorization`: Validate the format + checksum of a DEA registration number \(format: \[A-Z\]\[A-Z9\]\[0-9\]\{7\}; public checksum algorithm\). Useful as a sanity check on a DEA number you were given \(e.g. on a prescription label or a provider's letterhead\). Scope note: this tool confirms the number is well-formed — it does
- `lookup\_provider\_taxonomy`: Look up a NUCC provider taxonomy code \(the specialty codes used on HIPAA transactions + NPI registrations\) or search by keyword. Returns classification + type + optional specialization. Source: NUCC Health Care Provider Taxonomy Code Set \(public; CMS-accepted\). WHEN TO USE: Resolving a NUCC provider
- `resolve\_codes`: \[Taxonomy A.1 — baseline response \(public data only\)\] Unified code resolver — free-form query or clinical description → ranked ICD-10-CM, CPT, and HCPCS codes with confidence scores. Use when you need to translate symptoms, procedures, or diagnoses into billable codes without running three separate
- `code\_conflict\_detector`: \[Taxonomy A.5 — delegates to scan\_bill\_for\_errors\] Detect CPT unbundling, mutually exclusive code pairs, and NCCI edit violations in a set of codes. Implemented by the bill scanner's anomaly engine. WHEN TO USE: User asks about medical codes: what a CPT/ICD/HCPCS code means, whether a code combinati
- `fair\_price\_estimator`: \[Taxonomy B.8 — delegates to benchmark\_payer\_rate\] Fair-market price distribution for a service: DP-noised percentiles \(p10, p25, p50, p75, p90\) for the given CPT in a ZIP3 region. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge
- `price\_variance\_analyzer`: \[Taxonomy B.9 — baseline response \(public data only\)\] Given a target price and a CPT+region, return how many standard deviations above/below the market the target sits, plus confidence. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or
- `claim\_consistency\_checker`: \[Taxonomy C.14 — delegates to scan\_bill\_for\_errors\] Detect internal contradictions in a claim: time mismatches, mutually exclusive codes, missing required fields, patient-gender/procedure mismatches. WHEN TO USE: Caller is building or validating a claim payload before submission — format, structure,
- `bundling\_violation\_detector`: \[Taxonomy C.16 — delegates to scan\_bill\_for\_errors\] Detect CPT unbundling \(billing components of a procedure separately to inflate the claim\). Uses the CMS NCCI edits plus payer-specific bundling rules. WHEN TO USE: Caller is building or validating a claim payload before submission — format, structu
- `appeal\_success\_predictor`: \[Taxonomy E.25 — delegates to estimate\_appeal\_success\] Given a denial, predict the probability of a successful appeal. Returns probability with 95% CI, sample size, and recommended appeal-strategy tags. WHEN TO USE: User or caller wants a probabilistic estimate \(denial likelihood, appeal success, pa
- `generate\_appeal\_letter\_v2`: \[Taxonomy F.28 — delegates to generate\_appeal\_letter\] \[Taxonomy alias\] Generate a state-specific insurance appeal letter with UPL-safe disclaimers for 19 US states. Same impl as generate\_appeal\_letter. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / e
- `negotiation\_strategy\_generator`: \[Taxonomy F.30 — baseline response \(public data only\)\] Given a bill + patient situation, generate a ranked negotiation strategy: hardship appeal, charity-care application, itemization request, phone scripts. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / eviden
- `insurance\_response\_interpreter`: \[Taxonomy F.31 — baseline response \(public data only\)\] Parse an insurer's response letter or EOB into structured fields: denial reason codes, appeal rights, deadlines, next-step recommendations. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalati
- `settlement\_optimizer`: \[Taxonomy F.32 — baseline response \(public data only\)\] For a disputed bill, compute the optimal settlement target price balancing probability of acceptance against amount saved. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one.
- `patient\_cost\_forecaster`: \[Taxonomy H.38 — baseline response \(public data only\)\] Given a patient's plan + predicted care needs, forecast annual out-of-pocket spend across expected claims. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a pa
- `insurance\_plan\_optimizer`: \[Taxonomy H.39 — baseline response \(public data only\)\] Given a patient's historical claim patterns, rank available insurance plans by expected annual cost. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment
- `cash\_vs\_insurance\_optimizer`: \[Taxonomy H.41 — baseline response \(public data only\)\] For a given service + patient plan, determine whether cash-pay + charity-care beats insurance billing. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a paymen
- `financial\_risk\_exposure\_model`: \[Taxonomy H.42 — baseline response \(public data only\)\] Quantify a patient's financial exposure to medical-debt risk given current plan, health status, and historical claim volatility. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or tr
- `cpt\_to\_icd\_mapper`: \[Taxonomy II.21 — baseline response \(public data only\)\] For a given CPT, surface the ICD-10 codes typically paired with it for medical-necessity support. WHEN TO USE: User has a CPT code and wants to know what ICD-10 diagnoses commonly pair with it for medical-necessity support. WHEN NOT: For specif
- `icd\_to\_cpt\_mapper`: \[Taxonomy II.22 — baseline response \(public data only\)\] For a given ICD-10, surface the CPT codes typically billed for that diagnosis. WHEN TO USE: User has an ICD-10 diagnosis and wants to know what CPTs are commonly billed for it. WHEN NOT: For planning specific services \(use benchmark\_payer\_rate
- `code\_bundle\_validator`: \[Taxonomy II.25 — baseline response \(public data only\)\] Check a set of CPT codes against NCCI bundling rules \(distinct from modifier-based unbundling\). WHEN TO USE: User asks about medical codes: what a CPT/ICD/HCPCS code means, whether a code combination is valid, or how to map between them. WHEN N
- `unbundling\_detector`: \[Taxonomy II.26 — delegates to scan\_bill\_for\_errors\] Detect CPT unbundling patterns in a claim. Alias of scan\_bill\_for\_errors. WHEN TO USE: User asks about medical codes: what a CPT/ICD/HCPCS code means, whether a code combination is valid, or how to map between them. WHEN NOT: For full bill scans \(
- `cash\_price\_estimator`: \[Taxonomy III.39 — baseline response \(public data only\)\] Estimate a fair cash price for a service in a given region \(no-insurance path\). WHEN TO USE: Uninsured/self-pay user wants a fair-market cash price for a service. Returns Medicare national as a floor + commercial-multiple band. WHEN NOT: For i
- `zip\_based\_price\_variance`: \[Taxonomy III.41 — baseline response \(public data only\)\] Report price variance for a CPT across ZIP3 regions with DP noise. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable. WHEN NOT: For a s
- `regional\_price\_benchmark`: \[Taxonomy III.43 — baseline response \(public data only\)\] Regional price benchmark for a CPT at state/metro/ZIP3 granularity. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable. WHEN NOT: For a
- `specialty\_price\_benchmark`: \[Taxonomy III.44 — baseline response \(public data only\)\] Price benchmark for a CPT within a specific provider specialty. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable. WHEN NOT: For a spec
- `inflation\_adjusted\_price\_model`: \[Taxonomy III.46 — baseline response \(public data only\)\] Inflation-adjusted price comparison across years for a CPT. WHEN TO USE: User has a historical dollar amount and wants it adjusted for medical-care inflation to a given year. WHEN NOT: For current market prices \(benchmark\_payer\_rate\). EXAMPLES
- `deductible\_impact\_calculator`: \[Taxonomy III.48 — baseline response \(public data only\)\] Estimate how a planned service will draw against the member's deductible. WHEN TO USE: User wants to know how a specific charge affects their deductible \(how much draws down, remaining after, post-deductible exposure\). WHEN NOT: For total annu
- `coinsurance\_simulator`: \[Taxonomy III.49 — baseline response \(public data only\)\] Simulate member coinsurance exposure across plan-design variants. WHEN TO USE: User wants to model their coinsurance share of a post-deductible charge. Pass charge\_usd and optionally coinsurance\_rate. WHEN NOT: For flat-copay services \(copay\_m
- `copay\_model`: \[Taxonomy III.50 — baseline response \(public data only\)\] Model member copay for a service by plan-design class. WHEN TO USE: User wants the typical copay for a service type \(primary / specialist / er\). Uses KFF EHBS 2024 averages. WHEN NOT: For patient-specific plan details — copay varies by plan de
- `billing\_charge\_vs\_allowed\_delta`: \[Taxonomy III.51 — baseline response \(public data only\)\] Delta between billed charge and payer-allowed amount for a claim line. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable. WHEN NOT: For
- `price\_anomaly\_detector`: \[Taxonomy III.52 — baseline response \(public data only\)\] Detect service-line prices statistically anomalous versus market. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable. WHEN NOT: For a sp
- `overpriced\_service\_detector`: \[Taxonomy III.53 — baseline response \(public data only\)\] Flag services billed materially above market percentile thresholds. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable. WHEN NOT: For a
- `market\_price\_distribution\_model`: \[Taxonomy III.55 — baseline response \(public data only\)\] Full DP-noised market price distribution for a CPT+region pair. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable. WHEN NOT: For a spec
- `price\_outlier\_detector`: \[Taxonomy III.56 — baseline response \(public data only\)\] Detect claim-line outliers relative to a learned market distribution. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reasonable. WHEN NOT: For
- `procedure\_cost\_decomposition`: \[Taxonomy III.57 — baseline response \(public data only\)\] Decompose the cost of a procedure into component services + facility + professional fees. WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is reason
- `price\_recommendation\_engine`: \[Taxonomy III.58 — baseline response \(public data only\)\] Recommend a reasonable price to propose to a provider for a service \(self-pay or negotiation\). WHEN TO USE: User wants to understand what a service typically costs, compare prices across regions/providers, or gauge whether a billed amount is r
- `claim\_duplicate\_line\_detector`: \[Taxonomy IV.75 — baseline response \(public data only\)\] Detect duplicated service lines within a single claim. WHEN TO USE: Caller is building or validating a claim payload before submission — format, structure, completeness, alignment. WHEN NOT: For an already-submitted and denied claim, use genera
- `denial\_reason\_classifier`: \[Taxonomy VI.106 — baseline response \(public data only\)\] Classify a denial letter or remittance advice into normalized denial-reason categories. WHEN TO USE: User or caller wants a probabilistic estimate \(denial likelihood, appeal success, payment delay, etc.\) to decide whether to pursue a path. WHE
- `appeal\_argument\_generator`: \[Taxonomy VII.120 — baseline response \(public data only\)\] Generate component arguments for an appeal letter: medical-necessity, contract, policy. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one. WHEN NOT: For explaining what a
- `denial\_response\_builder`: \[Taxonomy VII.121 — baseline response \(public data only\)\] Build a denial-response package tailored to the denial reason code. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one. WHEN NOT: For explaining what a denial code means w
- `dispute\_case\_builder`: \[Taxonomy VII.123 — baseline response \(public data only\)\] Assemble a complete dispute case file including claim, denial, evidence, and timeline. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one. WHEN NOT: For explaining what a
- `evidence\_pack\_generator`: \[Taxonomy VII.124 — baseline response \(public data only\)\] Generate an evidence package supporting a claim or appeal \(references, studies, policies\). WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one. WHEN NOT: For explaining wha
- `claim\_rebuttal\_generator`: \[Taxonomy VII.128 — baseline response \(public data only\)\] Generate a rebuttal to a payer's denial rationale point-by-point. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one. WHEN NOT: For explaining what a denial code means wit
- `appeal\_escalation\_path\_finder`: \[Taxonomy VII.129 — baseline response \(public data only\)\] Find the correct escalation path for a denied claim \(internal appeal → external review → DOI\). WHEN TO USE: User needs to know the deadlines and agencies for each step of appealing a denial. Pass state \(e.g. 'CA'\) and insurer for state-specif
- `payer\_specific\_appeal\_templates`: \[Taxonomy VII.130 — baseline response \(public data only\)\] Return payer-specific appeal templates known to perform well. WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one. WHEN NOT: For explaining what a denial code means without
- `denial\_code\_explainer`: \[Taxonomy VII.131 — baseline response \(public data only\)\] Explain a CARC/RARC denial code in plain language with common causes. WHEN TO USE: User asks 'what does CO-16 mean' or similar — any CARC/RARC code. Returns full X12 table entry when available with meaning, category, typical root cause, prima
- `claim\_reconsideration\_builder`: \[Taxonomy VII.132 — baseline response \(public data only\)\] Build a claim reconsideration request \(lighter-weight than a formal appeal\). WHEN TO USE: User has a denied claim and wants to appeal, or is preparing arguments / evidence / escalation steps for one. WHEN NOT: For explaining what a denial cod
- `supporting\_document\_selector`: \[Taxonomy VII.135 — baseline response \(public data only\)\] Select optimal supporting documents for an appeal from an available document pool. WHEN TO USE: User is preparing an appeal and needs a ranked list of supporting documents for the denial category. Pass denial\_code. WHEN NOT: Without denial\_co
- `out\_of\_pocket\_optimizer`: \[Taxonomy X.174 — baseline response \(public data only\)\] Optimize out-of-pocket spend across a sequence of planned services. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan. WHEN NOT: For billing-erro
- `financial\_exposure\_model`: \[Taxonomy X.176 — delegates to financial\_risk\_exposure\_model\] Model a member's financial exposure. Alias of financial\_risk\_exposure\_model. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan. WHEN NOT: F
- `procedure\_affordability\_ranker`: \[Taxonomy X.177 — baseline response \(public data only\)\] Rank a set of procedures by affordability for a given member. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan. WHEN NOT: For billing-error anal
- `treatment\_cost\_comparator`: \[Taxonomy X.178 — baseline response \(public data only\)\] Compare expected costs across treatment alternatives for a condition. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan. WHEN NOT: For billing-er
- `bill\_shock\_predictor`: \[Taxonomy X.179 — baseline response \(public data only\)\] Predict risk that a planned service will trigger an unexpected large bill. WHEN TO USE: User planning a service and wants to know if it will trigger an unexpected-large-bill situation. Pass expected\_charge\_usd and optionally cpt\_code to get Med
- `payment\_plan\_optimizer`: \[Taxonomy X.180 — baseline response \(public data only\)\] Optimize a payment plan structure for a patient balance. WHEN TO USE: User has a balance and wants to structure a payment plan. Pass balance\_usd and months. WHEN NOT: If user may qualify for charity care — run financial\_assistance\_finder first.
- `financial\_assistance\_finder`: \[Taxonomy X.181 — baseline response \(public data only\)\] Find applicable financial-assistance programs \(hospital charity, 340B, state, pharma\). WHEN TO USE: User needs help paying a medical bill. Pass household\_income\_usd and family\_size for FPL-based eligibility flags across 6 programs \(501\(r\) chari
- `patient\_cost\_explainer`: \[Taxonomy X.182 — baseline response \(public data only\)\] Explain why a specific charge appears on a bill in plain language. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan. WHEN NOT: For billing-error
- `healthcare\_budget\_forecaster`: \[Taxonomy X.183 — baseline response \(public data only\)\] Forecast a household's annual healthcare spend based on plan + utilization. WHEN TO USE: User planning annual healthcare spend, comparing plans, or estimating worst-case exposure. WHEN NOT: For a specific procedure cost \(benchmark\_payer\_rate\).
- `medical\_spending\_analyzer`: \[Taxonomy X.184 — baseline response \(public data only\)\] Analyze a patient's medical spending over a period and surface optimization opportunities. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan. WHE
- `insurance\_value\_optimizer`: \[Taxonomy X.185 — baseline response \(public data only\)\] Recommend insurance-plan selections to maximize value given projected utilization. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan. WHEN NOT: F
- `patient\_financial\_risk\_score`: \[Taxonomy X.186 — baseline response \(public data only\)\] Score a patient's financial risk exposure from planned or ongoing care. WHEN TO USE: User is planning for a medical expense, comparing plan options, looking for financial assistance, or trying to structure a payment plan. WHEN NOT: For billing-
- `decode\_denial`: Decode a CARC \(Claim Adjustment Reason Code\) denial code into plain English. Returns meaning, category, whether it's typically reversible on appeal, and appeal guidance. Source: public X12 External Code List + CMS/ERISA public rules. Free, no auth. WHEN TO USE: Reference lookups: individual code det
- `get\_appeal\_deadline`: External-review filing deadline for a state + the date of the FINAL adverse determination. Returns the deadline date, the statutory window label + citation, and whether the exact state-specific window still needs verification \(most states carry a conservative NAIC-model 4-month floor unless statute-
- `get\_venue`: Where and how to file an external review for a given state — the venue name, filing channel \(portal/mail/fax\), portal URL, and whether expedited review is available. Free, no auth. WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami
- `medigami\_odds`: Historical external-review overturn rate published by the state regulator for the insurer you name, in a regulated venue \(CA/NY/MD/NJ/MI/OH/NC\). Returns one insurer's own rate — not a comparison or ranking against other insurers. Public regulator data, k-anonymity floored, not legal advice. WHEN TO
- `medigami\_roast`: Compare a billed charge against a hospital's own MRF-published negotiated rate for a CPT code; returns the markup multiple. Public regulator data, k-anonymity floored, not legal advice. WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Med
- `medigami\_deadline`: Federal appeal-deadline window \(ERISA §503 internal-appeal / ACA §2719 external-review / NSA IDR\) for a plan type. Public regulator data, k-anonymity floored, not legal advice. WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medigami res
- `medigami\_rate`: A hospital's own MRF-published negotiated rate for a CPT code \(no billed-amount comparison — use medigami\_roast for that\). Public regulator data, k-anonymity floored, not legal advice. WHEN TO USE: Reference lookups: individual code details, verifying a provider registry entry, checking a prior Medi

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