{
  "name": "payer-pa-metrics-mcp",
  "title": "HealthMesh · Payer Prior Authorization Metrics MCP",
  "version": "0.1.1",
  "description": "Prior authorization metrics that payers must post under the CMS Interoperability and Prior Authorization final rule (CMS-0057-F), served exactly as each payer published them: approval and denial rates, approvals after appeal or extension, and mean/median decision times for standard and expedited requests. CY2025 coverage: Humana (32 Medicare Advantage contracts, 9 Medicaid MCO states) and Aetna (42 MA contracts).",
  "healthmesh_domain": "Utilization Management",
  "datasets": [
    "UM-05"
  ],
  "mcp_endpoint": "https://payer-pa-metrics.healthmesh.ai/mcp",
  "transport": "Streamable HTTP (stateless, JSON responses)",
  "authorization": "none",
  "auth_mode": "off",
  "docs": "https://github.com/HendrikK/healthmesh/tree/main/servers/payer-pa-metrics-mcp#readme",
  "contact": "hendrik.kleine@gmail.com",
  "data_source": {
    "name": "Payer-posted CMS-0057-F prior authorization metrics (Humana, Aetna; CY2025)",
    "url": "https://www.cms.gov/prior-authorization-metrics-reporting-overview-template",
    "license": "Public payer postings required by federal rule; numbers served as published with source links",
    "refresh": "monthly SHA-256 check of the payer PDFs; rebuilt on change"
  },
  "tools": [
    {
      "name": "pametrics_list_payers",
      "title": "List payers with loaded prior authorization metrics",
      "description": "Lists the payer postings of CMS-0057-F prior authorization metrics that are loaded: one row per reporting unit (Medicare Advantage contract, Medicaid MCO state), with market, plan type, states, report year and the payer's own source URL. Filter by market, state, report_year or payer. Coverage is partial (CY2025: Humana MA + Medicaid, Aetna MA)."
    },
    {
      "name": "pametrics_get_payer",
      "title": "Get a payer's prior authorization metrics",
      "description": "Returns the prior authorization metrics a payer published for CY2025 under CMS-0057-F, exactly as posted: standard and expedited requests approved/denied (counts and % where the payer gave counts), approved after extension, approved after appeal, mean and median decision time (with the payer's unit, plus a normalized hours value), the payer's PA item list link and the source PDF. Give `unit` (an MA contract ID like H0028, or a state code for a Medicaid MCO) for one unit; omit it for all of the payer's units in the market, with a HealthMesh-computed total when the payer published counts."
    },
    {
      "name": "pametrics_compare_payers",
      "title": "Rank payer reporting units on one prior authorization metric",
      "description": "Ranks the loaded reporting units (MA contracts, Medicaid MCO states) on one published metric, optionally within a market, state and payer. Metrics: pct_approved_standard, pct_denied_standard, pct_approved_expedited, pct_denied_expedited, pct_approved_after_appeal, mean_days_standard, median_days_standard, mean_hours_expedited, median_hours_expedited, total_standard_requests. Units with the metric not reported (N/A) are listed separately, never ranked."
    },
    {
      "name": "pametrics_describe_dataset",
      "title": "Describe the payer prior authorization metrics data",
      "description": "Explains the CMS-0057-F public reporting requirement, which payer postings are loaded (with source URLs and SHA-256 of each PDF), the metrics and their units, how the PDFs were parsed, and coverage gaps."
    }
  ]
}