mcp-claims-triage
MCP server that helps AI agents analyze medical insurance claims, flag anomalies, score risk, and suggest next actions.
README
mcp-claims-triage
MCP Server for Medical Claims Triage & Anomaly Detection
An MCP (Model Context Protocol) server that helps AI agents analyze medical insurance claims, flag anomalies, score risk, and suggest next actions — pure computation, no external paid APIs required.
Problem it solves
Medical billing teams and healthcare AI agents drown in claims data. Manual review is slow and expensive. Agents need structured tools to triage claims, detect possible fraud/upcoding, and prioritize human review.
Why this is valuable for entrepreneurs
- Vertical-specific (Healthcare) → higher willingness to pay than generic tools
- Computation-heavy (no expensive API keys needed for core features)
- Solves real pain: claim denials, compliance risk, manual work
- Can be sold as $49–199/mo tool to billing companies, RCM firms, and health-tech startups
Main Tools
| Tool | Description |
|---|---|
triage_claim |
Score a claim 0-100 and return priority + flags |
detect_anomalies |
Find unusual patterns in a batch of claims |
suggest_cpt_codes |
Suggest possible CPT / procedure codes from description |
estimate_denial_risk |
Predict relative risk of claim denial |
generate_review_checklist |
Create a human review checklist for a claim |
batch_summary |
Summarize a list of claims for daily standup |
Quick Start
pip install -e .
python -m mcp_claims_triage
Pricing suggestion
- Free: limited daily claims
- Pro: $49/mo unlimited + export
- Enterprise: $199/mo + custom rules + audit log
Built for Prince Ruhul / Prevalid — Daily AI Project Builder
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