coverageunlocked-mcp

CoverageUnlocked 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

• 489+ CPT codes 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 full 489-code 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