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