Automatedrcm Billing MCP

What automatedrcm-billing-mcp does

The automatedrcm-billing-mcp MCP server exposes medical-billing operations as agent-callable MCP tools. Its rules engines return structured results for common revenue-cycle tasks rather than asking an LLM to generate the billing determination. Supported workflows include checking whether a procedure needs prior authorization, interpreting claim-adjustment reason codes, prioritizing unpaid claims, and assessing whether a denied claim should be appealed, corrected, or written off.

The server also includes two de-identification options. pii_scrub identifies and replaces broad categories of personal information, including names, contact details, Social Security numbers, payment-card numbers, IP addresses, addresses, and identifiers. phi_scrub_demo is limited to synthetic or test healthcare text. The server does not accept real PHI through the documented paid workflows.

How it works

MCP clients launch the package locally with npx or run its index.js entry point after installing from source. The client can then call catalog to inspect endpoints, prices, and input shapes, or use free_samples to view fixed-input example results. These two tools do not require payment configuration.

Paid operations are settled per call through the x402 protocol using USDC on Base mainnet. The documented approximate balance guidance is that $1 covers about 30 mixed calls, although the actual cost depends on the selected tools.

The automatedrcm-billing-mcp results reflect typical published payer policy. Plan-specific rules may differ, so outputs should be checked against the relevant plan before making a final operational decision.

Setup and configuration

The simplest setup adds an MCP server entry that runs npx -y automatedrcm-billing-mcp and supplies X402_PRIVATE_KEY in the environment. A source-based setup clones the repository, runs npm install, and starts /path/to/automatedrcm-billing-mcp/index.js with Node.

Free calls can run without environment configuration. Paid calls require X402_PRIVATE_KEY, containing a private key for a wallet funded with a small amount of USDC on Base mainnet. The README recommends using a dedicated, low-balance wallet rather than a primary wallet. Keep the key out of shared configuration and source control.

Tools and capabilities

• catalog: Lists available endpoints, prices, and expected input shapes.
• free_samples: Returns sample outputs for fixed inputs.
• pa_check: Uses a CPT code and payer to return an authorization requirement, criteria, documentation checklist, portal, and turnaround information. Price: $0.05 per call.
• denial_decode: Interprets CARC codes such as CO-50 and PR-204, including meaning, appealability, next action, and prevention guidance. Price: $0.02.
• claim_triage: Assigns an unpaid claim to a work bucket and returns risk flags, a priority score, next action, and deadline. Price: $0.03.
• appeal_assessment: Evaluates a denied claim for appeal, correction, or write-off; calculates deadline information; lists evidence; and drafts a structured appeal letter. Price: $1.50.
• pii_scrub: De-identifies general text and provides an interval-preserving date timeline plus a token map for local restoration. Price: $0.01.
• phi_scrub_demo: De-identifies healthcare text for synthetic or test data only. Price: $0.01.

The automatedrcm-billing-mcp README does not describe persistence, account creation, or an API-key authentication flow. It specifically states that the x402 wallet is used for payment and that the demo scrubber stores nothing. Do not treat scrubbed output or billing determinations as a substitute for verifying plan-specific requirements or handling production PHI in an approved environment.