An MCP server for healthcare prior authorization and insurance coverage verification using synthetic payer rules and FHIR patient context
PriorMCP has 10 tools with complete input schemas and descriptions, but quality is uneven. All tools follow verb_noun naming (verify_coverage, check_prior_auth, etc.) and include parameter descriptions. However, descriptions are generic (avg ~60 chars, well below the 194-char baseline for A+ tools) and lack actionable context about when to use each tool vs. alternatives. No output schemas are documented, LLMs cannot predict response structure for downstream chaining. Patient lookup tools (GetPatientAge, GetPatientAllergies, FindPatientId) accept optional patientId but lack guidance on resolution order or error recovery. Coverage/auth tools (verifyCoverage, checkPriorAuth, estimateCost) have overlapping responsibilities without clear composition guidance. No error handling patterns visible, tools return strings but no structured error classification or recovery hints.
Finds a patient id given a first name and last name
Gets the age of a patient.
Gets the known allergies of a patient.
Runs the full PriorMCP coverage, prior authorization, cost, alternative, and draft packet workflow.
Determines whether prior authorization is required.
Estimates patient responsibility from synthetic benefit rules.
Explains coverage details in patient-friendly language.
No output schemas documented. Tools return plain text strings; LLMs cannot predict structure for chaining or field extraction. E.g., verifyCoverage returns formatted text but no schema shows coverage/prior_auth_required/cost fields.
Descriptions are too brief (avg 45 chars vs. 194-char baseline). Missing WHEN to use each tool and how it differs from similar tools. E.g., verifyCoverage vs. checkPriorAuth vs. assessTreatmentAccess all check coverage but lack disambiguation.
Patient lookup tools (GetPatientAge, GetPatientAllergies) accept optional patientId but lack guidance on fallback behavior or error recovery if context is missing. No dependency hints for multi-step resolution.
| Scored | Grade | Overall | Spec posture | Rubric |
|---|---|---|---|---|
| 2026-09-23 | D | 54 | 2026-07-28+ | v2 |
Generates a reviewable prior authorization draft.
Suggests covered alternatives from synthetic payer rules.
Checks synthetic payer coverage for a requested treatment.
No error handling patterns visible. Tools return plain strings with no structured error classification (retryable vs. user-fixable vs. fatal). No recovery guidance for missing patients, invalid plans, or coverage lookup failures.
Tool composition unclear. assessTreatmentAccess appears to be a wrapper around verifyCoverage + checkPriorAuth + estimateCost + suggestAlternatives + generatePriorAuth, but no guidance on when to call the wrapper vs. individual tools.