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io.github.laureennicholson635/automatedrcm-billing-mcp

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by laureennicholson635 · JavaScript

Medical-billing tools for AI agents: prior-auth checks, denial decoding, claim triage, appeals.

io.github.laureennicholson635/automatedrcm-billing-mcp — MCP Server

This MCP server provides medical-billing tools for AI agents, focused on prior-authorization determinations, claim-denial decoding, unpaid-claim triage, appeal assessments, and a PHI de-identification demo. It is described as using server-side rules engines with deterministic outputs and no PHI accepted on the “paid path.”

🛠️ Key Features

  • Prior-authorization determinations
  • Claim-denial decoding
  • Unpaid-claim triage
  • Appeal assessments
  • PHI de-identification demo
  • Server-side rules engines; deterministic responses
  • No LLM on the paid path; no PHI accepted

🚀 Use Cases

  • Automating prior-auth checks in healthcare RCM workflows
  • Translating denial reasons via claim-denial decoding
  • Triage of unpaid claims for follow-up actions
  • Preparing appeal assessments

⚡ Developer Benefits

  • Deterministic behavior via server-side rules engines
  • Clear scope around billing intelligence and PHI de-identification demo
  • Tools integrated via Model Context Protocol (MCP)

⚠️ Limitations

  • README excerpt does not enumerate the full tool list or tool count
  • “No PHI accepted” constraints apply on the paid path

Topics

ai-agentshealthcaremcpmcp-servermedical-billingmodel-context-protocolprior-authorizationrcmusdcx402