{
  "markdown": "# CoverageUnlocked MCP Server\n\n**Insurance denial appeal intelligence powered by 20 years of insider knowledge.**\n\nGet win probabilities, appeal strategies, payer behavioral intelligence, and regulatory leverage for any CPT code — directly inside your AI assistant.\n\n## What Questions Does This Answer?\n\n- \"What are my chances of winning an insurance denial appeal?\"\n- \"How do I appeal a denied claim for [procedure] with [payer]?\"\n- \"What's the denial rate for [CPT code] with [insurance company]?\"\n- \"What should I include in my appeal letter?\"\n- \"What are the appeal deadlines in my state?\"\n\n## Coverage\n\n- **480+ curated CPT codes** with deep insider commentary, payer-specific rates, and regulatory leverage — backed by a **17,000+ total** CPT/HCPCS coverage layer across 9 procedure categories (surgical, E&M, imaging, infusion/chemo, rehab, mental health, diagnostic, DME, lab/pathology)\n- **7 major payers** with behavioral profiles (UnitedHealthcare, Anthem, Aetna, Cigna, Humana, BCBS, TRICARE)\n- **15 state regulatory profiles** with appeal deadlines, prompt payment laws, and parity enforcement\n- **Category-level fallback** for any CPT code not in the detailed database\n\n## Tools\n\n| Tool | Tier | What It Does |\n|------|------|-------------|\n| `analyze_denial` | Free | Win probability + top denial reason + insider tip for any CPT code |\n| `check_denial_risk` | Free | Pre-submission risk assessment — check before you submit a claim |\n| `get_appeal_strategy` | Pro | Full appeal strategy with all denial reasons, counter-arguments, regulatory citations |\n| `get_payer_intelligence` | Pro | Payer behavioral profiles — known tactics and how to counter them |\n| `get_regulatory_leverage` | Pro | State-specific appeal deadlines, prompt payment laws, external review options |\n\n## Quick Start\n\n### Install via npx (no setup required)\n\n```bash\nnpx coverageunlocked-mcp\n```\n\n### Claude Desktop Configuration\n\nAdd to your `claude_desktop_config.json`:\n\n```json\n{\n  \"mcpServers\": {\n    \"coverageunlocked\": {\n      \"command\": \"npx\",\n      \"args\": [\"-y\", \"coverageunlocked-mcp\"]\n    }\n  }\n}\n```\n\n### Cursor / Windsurf\n\nAdd to your MCP settings:\n\n```json\n{\n  \"coverageunlocked\": {\n    \"command\": \"npx\",\n    \"args\": [\"-y\", \"coverageunlocked-mcp\"]\n  }\n}\n```\n\n## Pricing\n\n**Free Tier** — No API key required\n- 10 queries per day\n- Win probability and top denial reason\n- One insider tip per query\n- Basic state regulatory deadlines\n\n**Pro ($19/month)** — [Sign up](https://app.coverageunlocked.com/pricing)\n- 100 queries per day\n- Full appeal strategies with all denial reasons\n- Payer behavioral intelligence and counter-strategies\n- Complete regulatory leverage with specific citations\n- Documentation checklists\n- All insider tips from 20 years inside the industry\n\n**Enterprise** — [Contact us](mailto:ned@coverageunlocked.com)\n- Unlimited queries\n- Batch processing\n- Custom payer profiles\n- Integration support\n- API access to the full 480+ curated / 17,000+ total CPT/HCPCS database\n\n## Example\n\nAsk your AI assistant:\n\n> \"What are the chances of winning an appeal for CPT 90837 (psychotherapy, 60 min) denied by UnitedHealthcare in California?\"\n\nThe MCP server returns:\n- **Win Probability: 66%**\n- **Denial Rate: 28%** (highest of all Tier 1 codes — mental health is the most denied category)\n- **Top Denial Reason:** Concurrent review lapse (35% of denials, 70% appeal success)\n- **Insider Tip:** Visit limit denials have 72% overturn rate because of the Mental Health Parity Act — ALWAYS appeal these\n- **CA Regulatory Leverage:** DMHC Independent Medical Review (strongest external review in nation), SB 855 mental health parity\n\n## About CoverageUnlocked\n\nBuilt by Ned Lutz after 20 years inside the health insurance industry. CoverageUnlocked exists to close the knowledge gap between insurance companies and the people fighting denials.\n\n- **Website:** [coverageunlocked.com](https://coverageunlocked.com)\n- **App:** [app.coverageunlocked.com](https://app.coverageunlocked.com)\n- **Consulting:** [Book a session](https://coverageunlocked.com/consulting) ($497)\n- **Newsletter:** [Denial Dispatch](https://coverageunlocked.beehiiv.com)\n\n## License\n\nMIT\n",
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}