MCP Server

Model Context Protocol (MCP) server for Revenue Cycle Management operations.

Overview

The RCM MCP Server provides AI-powered tools for managing the complete healthcare revenue cycle through the Model Context Protocol. It enables AI assistants like Claude to help with:

• Denial triage - Classify denials and get policy-based recommendations
• Cash leakage analysis - Identify patterns and recovery opportunities
• Pre-submission validation - Catch coding errors before claims are submitted
• Appeals management - Track appeal lifecycle and success rates
• Write-off tracking - Monitor preventable write-offs
• Rebill workflows - Track corrections and recovery
• Payment variance detection - Identify underpayments by payer

Setup

Prerequisites

• Node.js 20+
• PostgreSQL database (see Database Migrations)
• Yarn 4.2.2 (managed via corepack)

Build and Run

# Copy environment file
cp packages/mcp-server/.env.example packages/mcp-server/.env

# Build the server
yarn workspace @rcm/mcp-server build

# Start the server
yarn workspace @rcm/mcp-server start

For development with auto-rebuild:

yarn workspace @rcm/mcp-server dev

Claude Desktop Integration

Add this configuration to your Claude Desktop config file:

macOS: ~/Library/Application Support/Claude/claude_desktop_config.json

Windows: %APPDATA%\Claude\claude_desktop_config.json

{
  "mcpServers": {
    "rcm": {
      "command": "node",
      "args": ["/absolute/path/to/rcm/packages/mcp-server/dist/index.js"]
    }
  }
}

After configuring, restart Claude Desktop and look for the MCP connection indicator.

Test with seeded data:

What denials do we have in the system? Classify them and suggest next actions.

Available Tools

Claims Management

Tool	Description
normalize_claim	Normalize and validate claim data from various formats (837, 835, JSON)
list_claims	List claims with optional filters (patient, status)
get_claim	Retrieve claim details by ID
update_claim_status	Update claim status

Denial Classification

Tool	Description
classify_denial	Classify denial code and get resolution guidance
suggest_next_action	Get policy-based recommendation (appeal, rebill, write-off)
batch_classify_denials	Analyze multiple denials for patterns and insights
audit_coding	Pre-submission coding validation

Appeals Management

Tool	Description
create_appeal	Create appeal for a denied claim
update_appeal	Update appeal status, decision, payer response
list_appeals	Query appeals (status, priority, overdue, assignee)
get_appeal_analytics	Success rates, recovery metrics, insights

Write-offs

Tool	Description
create_write_off	Write off uncollectible amount with preventability tracking
list_write_offs	Query write-offs (reason, category, preventability)
get_write_off_analytics	Preventable write-off analysis

Rebills

Tool	Description
create_rebill	Create rebill after correcting denied claim
update_rebill	Update rebill status and resolution
list_rebills	Query rebills (status, reason, claim)
get_rebill_analytics	Success rates by correction type

Payment Variances

Tool	Description
create_payment_variance	Track underpayments/overpayments
update_payment_variance	Update resolution, link to appeals
list_payment_variances	Query variances (type, payer, severity)
get_payment_variance_analytics	Payer patterns and contract compliance

Architecture

Data Flow:

For production deployment, see the Infrastructure package.

Workflows

The MCP server supports several workflow patterns. See the detailed documentation for each:

• Denial Triage - Classify denials and get action recommendations
• Cash Leakage Analysis - Identify denial patterns and revenue loss
• Pre-Submission Validation - Prevent denials before submission
• Appeals Management - Track appeal lifecycle
• Write-off Analysis - Monitor preventable write-offs
• Rebilling Workflow - Track corrections and recovery
• Payment Variance Analysis - Detect underpayments

Customization

Add Organization Policies

INSERT INTO org_policies (policy_name, policy_type, min_amount, days_to_action, auto_appeal)
VALUES ('High Value Appeals', 'appeal_threshold', 1000.00, 10, true);

Add Payer-Specific Rules

INSERT INTO org_policies (policy_name, policy_type, payer_id, denial_category, min_amount, auto_appeal)
VALUES ('BCBS Auth Denials', 'appeal_threshold',
        (SELECT id FROM payers WHERE payer_id = 'BCBS-CA-001'),
        'AUTHORIZATION', 200.00, true);

Add Coding Rules

INSERT INTO coding_rules (rule_name, rule_type, cpt_code, required_modifier, error_message, severity)
VALUES ('Custom Modifier Rule', 'modifier_required', '12345', 'XX', 'Requires modifier XX', 'warning');

Troubleshooting

Server Not Appearing in Claude Desktop

1. Check the config file path is correct
2. Use absolute paths (not relative)
3. Verify the server builds: yarn workspace @rcm/mcp-server build
4. Check Claude Desktop logs

Database Connection Issues

1. Verify PostgreSQL is running: docker ps | grep postgres
2. Check DATABASE_URL in .env file
3. Ensure migrations have run: yarn workspace @rcm/migrations migrate:up
4. Test connectivity: psql $DATABASE_URL -c "SELECT 1"

Missing Reference Data

If classify_denial returns "unknown code":

1. Verify migrations ran: yarn workspace @rcm/migrations migrate:up
2. Check denial_code_library table has data
3. Run seed script: yarn workspace @rcm/migrations seed