About coverageunlocked
CoverageUnlocked is an MCP server for healthcare professionals assessing and appealing insurance claim denials. It combines CPT/HCPCS data, payer behavior, and state-level regulatory information to provide risk estimates and appeal guidance.
Key features
- 01Denial win-probability estimates
- 02Pre-submission denial risk checks
- 03Payer behavior profiles
- 04State appeal deadlines and regulations
- 05Appeal strategies and counterarguments
Use cases
- 01Estimate appeal prospects for a denied procedure
- 02Check claim risk before submission
- 03Prepare payer-specific appeal arguments
- 04Find state appeal deadlines and review options
MCP support
The MCP server exposes denial analysis, risk checks, payer intelligence, appeal strategies, and regulatory information as tools for AI clients.
Configuration
Local server config is the same for every client. Copy it into your client’s MCP config file.
Tools
5Saved tool list · updated 2w ago
| Parameter | Type | Required | Description |
|---|---|---|---|
| payer | string | No | Insurance company name (e.g., "UnitedHealthcare", "Anthem", "Aetna", "Cigna", "Humana", "BCBS") |
| state | string | No | Two-letter state code (e.g., "CA", "TX", "NY") for state-specific regulatory leverage |
| api_key | string | No | CoverageUnlocked API key for Pro access. Free tier: 10 queries/day with basic results. Get Pro at https://app.coverageunlocked.com/mcp |
| cpt_code | string | Yes | The CPT or HCPCS code that was denied (e.g., "99214", "70553", "E0601") |
| denial_reason | string | No | The reason given for the denial, if available |
Details
From the project READMECoverageUnlocked MCP Server
Insurance denial appeal intelligence powered by 20 years of insider knowledge.
Get win probabilities, appeal strategies, payer behavioral intelligence, and regulatory leverage for any CPT code — directly inside your AI assistant.
What Questions Does This Answer?
- "What are my chances of winning an insurance denial appeal?"
- "How do I appeal a denied claim for [procedure] with [payer]?"
- "What's the denial rate for [CPT code] with [insurance company]?"
- "What should I include in my appeal letter?"
- "What are the appeal deadlines in my state?"
Coverage
- 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)
- 7 major payers with behavioral profiles (UnitedHealthcare, Anthem, Aetna, Cigna, Humana, BCBS, TRICARE)
- 15 state regulatory profiles with appeal deadlines, prompt payment laws, and parity enforcement
- Category-level fallback for any CPT code not in the detailed database
Tools
| Tool | Tier | What It Does |
|---|---|---|
analyze_denial | Free | Win probability + top denial reason + insider tip for any CPT code |
check_denial_risk | Free | Pre-submission risk assessment — check before you submit a claim |
get_appeal_strategy | Pro | Full appeal strategy with all denial reasons, counter-arguments, regulatory citations |
get_payer_intelligence | Pro | Payer behavioral profiles — known tactics and how to counter them |
get_regulatory_leverage | Pro | State-specific appeal deadlines, prompt payment laws, external review options |
Quick Start
Install via npx (no setup required)
npx coverageunlocked-mcp
Claude Desktop Configuration
Add to your claude_desktop_config.json:
{
"mcpServers": {
"coverageunlocked": {
"command": "npx",
"args": ["-y", "coverageunlocked-mcp"]
}
}
}
Cursor / Windsurf
Add to your MCP settings:
{
"coverageunlocked": {
"command": "npx",
"args": ["-y", "coverageunlocked-mcp"]
}
}
Pricing
Free Tier — No API key required
- 10 queries per day
- Win probability and top denial reason
- One insider tip per query
- Basic state regulatory deadlines
Pro ($19/month) — Sign up
- 100 queries per day
- Full appeal strategies with all denial reasons
- Payer behavioral intelligence and counter-strategies
- Complete regulatory leverage with specific citations
- Documentation checklists
- All insider tips from 20 years inside the industry
Enterprise — Contact us
- Unlimited queries
- Batch processing
- Custom payer profiles
- Integration support
- API access to the full 480+ curated / 17,000+ total CPT/HCPCS database
Example
Ask your AI assistant:
"What are the chances of winning an appeal for CPT 90837 (psychotherapy, 60 min) denied by UnitedHealthcare in California?"
The MCP server returns:
- Win Probability: 66%
- Denial Rate: 28% (highest of all Tier 1 codes — mental health is the most denied category)
- Top Denial Reason: Concurrent review lapse (35% of denials, 70% appeal success)
- Insider Tip: Visit limit denials have 72% overturn rate because of the Mental Health Parity Act — ALWAYS appeal these
- CA Regulatory Leverage: DMHC Independent Medical Review (strongest external review in nation), SB 855 mental health parity
About CoverageUnlocked
Built 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.
- Website: coverageunlocked.com
- App: app.coverageunlocked.com
- Consulting: Book a session ($497)
- Newsletter: Denial Dispatch
License
MIT
Comments
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