# MCP Server 🏥

Streamline insurance workflows with AI assistance through the Model Context Protocol (MCP). Connect Claude to your healthcare systems for automated insurance card scanning, eligibility verification, and claims contact extraction.

## Introduction

The Healthcare MCP Server provides HIPAA-compliant AI assistance for common healthcare administrative tasks. By connecting Claude to CardScan.ai's proven insurance processing APIs, healthcare practices can reduce manual verification work and streamline patient intake workflows.

**Key Benefits:**

* **Reduce Manual Work**: Automate insurance verification and card data extraction
* **HIPAA Compliant**: Secure processing with enterprise-grade data protection
* **Real-time Results**: Instant eligibility checks and benefit information
* **Proven Accuracy**: Built on CardScan.ai's battle-tested ML pipeline

**Target Audience:**

* Healthcare practices and billing departments
* Healthcare technology integrators
* Medical practice management systems
* Revenue cycle management companies

## Use Cases & Workflows

### Real-time Eligibility Verification

{% @mermaid/diagram content="sequenceDiagram
participant User
participant Claude
participant Healthcare MCP
participant CardScan API

```
User->>Claude: "Check eligibility for John Doe, member ID 12345"
Claude->>Healthcare MCP: eligibility_lookup()
Healthcare MCP->>CardScan API: POST /eligibility
CardScan API-->>Healthcare MCP: Coverage details
Healthcare MCP-->>Claude: Structured eligibility data
Claude-->>User: "John has active PPO coverage, $500 deductible remaining, 20% coinsurance for office visits..."" %}
```

**Business Impact**: Staff can instantly verify patient coverage without logging into multiple insurance portals, reducing verification time from 5-10 minutes to under 30 seconds.

### Insurance Card Scanning & Contact Extraction

{% @mermaid/diagram content="sequenceDiagram
participant User
participant Claude
participant Healthcare MCP
participant CardScan API

```
User->>Claude: "Extract claims phone number from this insurance card"
Claude->>Healthcare MCP: extract_card_info(image_url)
Healthcare MCP->>CardScan API: POST /cards
Healthcare MCP->>CardScan API: POST /cards/{id}/upload
CardScan API-->>Healthcare MCP: Extracted card data
Healthcare MCP-->>Claude: Claims phone: (800) 555-0123
Claude-->>User: "Claims contact: Aetna Claims (800) 555-0123"
Note over User: Can immediately call or save contact" %}
```

**Business Impact**: Eliminates manual card data entry and reduces phone number lookup time. Perfect for prior authorization calls and claims inquiries.

### Patient Card Update Requests

{% @mermaid/diagram content="sequenceDiagram
participant User
participant Claude
participant Healthcare MCP
participant CardScan API
participant Patient

```
User->>Claude: "Jane's insurance card expired, send her an update link"
Claude->>Healthcare MCP: create_card_update_link(patient_id)
Healthcare MCP->>CardScan API: POST /generate-magic-link
CardScan API-->>Healthcare MCP: Secure upload URL
Healthcare MCP-->>Claude: Generated secure link
Claude-->>User: "Sent Jane a secure link to upload her new card"
Claude->>Patient: SMS/Email with upload link
Note over Patient: Uploads new card securely" %}
```

**Business Impact**: Streamlines patient card collection with secure, time-limited upload links. Reduces staff phone calls and improves patient experience.

## Available Tools & Resources

### Core Tools

#### `eligibility_lookup`

Real-time insurance eligibility verification with comprehensive benefit details.

**Parameters:**

* `member_id` (string, required): Insurance member identification number
* `subscriber_first_name` (string, required): Primary member first name
* `subscriber_last_name` (string, required): Primary member last name
* `date_of_birth` (string, required): Format YYYYMMDD (e.g., "19850315")
* `provider_npi` (string, required): 10-digit National Provider Identifier
* `provider_name` (string, optional): Provider first/last name or organization name
* `service_codes` (array, optional): Specific medical service codes to check

**Returns:**

* Coverage status (active/inactive)
* Deductible information (individual/family, remaining amounts)
* Co-pay amounts by service type
* Co-insurance percentages
* Out-of-pocket maximums
* Prior authorization requirements
* Network status for provider

#### `extract_card_info`

Scan insurance cards and extract structured data including contact information.

**Parameters:**

* `image_url` (string, required): URL of insurance card image (front/back)
* `enable_backside_scan` (boolean, optional): Process both card sides for complete data
* `enable_payer_match` (boolean, optional): Match to canonical payer database

**Returns:**

* Member information (name, ID, DOB, gender)
* Payer details (name, address, phone numbers)
* Plan information (group number, plan name, effective dates)
* Prescription details (BIN, PCN, issuer, plan)
* Claims contact phone numbers
* Customer service contacts
* Confidence scores for each extracted field

#### `create_card_update_link`

Generate secure, time-limited upload links for patients to submit new insurance cards.

**Parameters:**

* `patient_identifier` (string, required): Internal patient ID or email
* `expiration_hours` (integer, optional): Link expiration time (default: 24 hours, max: 168)
* `notification_method` (string, optional): "email" or "sms" for automated delivery
* `custom_message` (string, optional): Personalized message for the patient

**Returns:**

* Secure upload URL (single-use)
* Expiration timestamp
* Magic link identifier for tracking
* Optional notification confirmation

#### `search_member_cards`

Find existing insurance card records by member information or payer details.

**Parameters:**

* `query` (string, required): Search term (member name, payer name, member ID)
* `limit` (integer, optional): Maximum results to return (default: 20, max: 100)
* `date_range` (object, optional): Filter by card scan date
  * `start_date` (string): ISO date format
  * `end_date` (string): ISO date format

**Returns:**

* Array of matching card records
* Card metadata (scan date, processing state)
* Basic member and payer information
* Card IDs for detailed data retrieval

### Available Resources

#### `eligibility/recent`

Browse recent eligibility verification requests across your account.

**Access Pattern:** List recent verifications with pagination support.

#### `eligibility/by_patient/{patient_id}`

Retrieve eligibility verification history for a specific patient.

**Access Pattern:** Get all eligibility checks for a given patient identifier.

#### `card_scans/pending`

Monitor insurance card uploads currently being processed.

**Access Pattern:** Check status of pending card scans and processing queue.

## Getting Started

### Prerequisites

Before integrating the Healthcare MCP Server, ensure you have:

* **HIPAA Compliance**: Your organization must have appropriate HIPAA safeguards in place
* **CardScan.ai Account**: Active account with eligibility verification feature enabled
* **Provider Information**: National Provider Identifier (NPI) for your practice
* **Patient Demographics**: Basic patient information for eligibility requests

{% hint style="info" %}
**NPI Lookup**: Find provider NPIs using the [NPPES NPI Registry](https://npiregistry.cms.hhs.gov/search).
{% endhint %}

### Integration Overview

The Healthcare MCP Server acts as a secure bridge between Claude and CardScan.ai's healthcare APIs:

1. **Authentication**: Server-side API key management with JWT token generation
2. **Data Processing**: HIPAA-compliant handling of protected health information
3. **Real-time Updates**: WebSocket notifications for eligibility and card processing status
4. **Error Handling**: Healthcare-specific error codes and retry logic

### Security & Compliance

* **HIPAA Compliance**: All data processing follows HIPAA requirements
* **Encryption**: End-to-end encryption for all PHI transmission
* **Access Controls**: Role-based access with audit logging
* **Data Retention**: Configurable retention policies for different data types

### Contact for Access

The Healthcare MCP Server is currently in limited preview. To request access:

**Contact the CardScan team** for integration details, pricing, and deployment assistance.

* Include your use case and expected volume
* Specify any custom requirements or integrations needed
* We'll work with you to set up a pilot deployment

{% hint style="success" %}
**Early Access**: We're actively seeking healthcare partners to help refine the MCP server capabilities. Contact us to discuss pilot opportunities.
{% endhint %}

## Example Integration

Here's how the MCP server integrates with your existing workflow:

```python
# Example: Staff uses Claude for eligibility check
claude_query = """
Check eligibility for Sarah Johnson, DOB 03/15/1985, 
member ID SJ123456789, using our main NPI 1234567890.
"""

# MCP server handles the API calls automatically
# Returns formatted eligibility summary in natural language
```

The MCP server abstracts away API complexity while providing rich, structured healthcare data that Claude can interpret and present in user-friendly formats.