naftiko: 1.0.0-alpha2
info:
  label: UnitedHealthcare Provider Operations
  description: Workflow capability for healthcare providers using UnitedHealthcare APIs to verify member eligibility, manage
    claims, check prior authorizations, and access the provider directory. Supports revenue cycle management, point-of-care
    eligibility, and clinical workflow automation for practices, hospitals, and health IT systems.
  tags:
  - UnitedHealthcare
  - Healthcare Provider
  - Eligibility
  - Claims Management
  - Prior Authorization
  - Revenue Cycle
  created: '2026-05-03'
  modified: '2026-05-06'
binds:
- namespace: env
  keys:
    UHC_BEARER_TOKEN: UHC_BEARER_TOKEN
capability:
  consumes:
  - type: http
    namespace: uhc-provider
    baseUri: https://api.uhcprovider.com
    description: UnitedHealthcare Provider API.
    authentication:
      type: bearer
      token: '{{UHC_BEARER_TOKEN}}'
    resources:
    - name: eligibility
      path: /eligibility/v1/real-time
      description: Real-time eligibility verification.
      operations:
      - name: check-eligibility
        method: POST
        description: Verify member eligibility and benefits in real time.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        body:
          type: json
          data:
            memberId: '{{tools.memberId}}'
            dateOfBirth: '{{tools.dateOfBirth}}'
            serviceType: '{{tools.serviceType}}'
            dateOfService: '{{tools.dateOfService}}'
            npi: '{{tools.npi}}'
    - name: benefit-check
      path: /eligibility/v1/patient-benefit-check
      description: Patient-specific benefit check.
      operations:
      - name: check-patient-benefit
        method: POST
        description: Check patient benefit and cost-sharing details for a service.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        body:
          type: json
          data:
            memberId: '{{tools.memberId}}'
            serviceCode: '{{tools.serviceCode}}'
            dateOfService: '{{tools.dateOfService}}'
            npi: '{{tools.npi}}'
    - name: claims
      path: /claims/v1/inquiry
      description: Claim status inquiry.
      operations:
      - name: inquire-claim
        method: POST
        description: Check claim status and payment details.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        body:
          type: json
          data:
            claimNumber: '{{tools.claimNumber}}'
            npi: '{{tools.npi}}'
            memberId: '{{tools.memberId}}'
    - name: prior-auth
      path: /prior-auth/v1/check
      description: Prior authorization requirement check.
      operations:
      - name: check-prior-auth
        method: POST
        description: Check if prior authorization is required for a procedure.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
        body:
          type: json
          data:
            memberId: '{{tools.memberId}}'
            npi: '{{tools.npi}}'
            serviceCode: '{{tools.serviceCode}}'
    - name: providers
      path: /providers/v1/demographics
      description: Provider demographics and directory.
      operations:
      - name: get-provider-demographics
        method: GET
        description: Get provider demographic and credentialing information.
        inputParameters:
        - name: npi
          in: query
          type: string
          required: true
          description: Provider NPI.
        - name: state
          in: query
          type: string
          required: false
          description: State filter.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
  exposes:
  - type: rest
    port: 8080
    namespace: provider-operations-api
    description: Unified REST API for UnitedHealthcare provider operations.
    resources:
    - path: /v1/eligibility
      name: eligibility
      description: Member eligibility verification.
      operations:
      - method: POST
        name: check-eligibility
        description: Check member eligibility.
        call: uhc-provider.check-eligibility
        outputParameters:
        - type: object
          mapping: $.
      - method: POST
        name: check-benefit
        description: Check patient benefit details.
        call: uhc-provider.check-patient-benefit
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/claims
      name: claims
      description: Claims management.
      operations:
      - method: POST
        name: inquire-claim
        description: Inquire claim status.
        call: uhc-provider.inquire-claim
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/prior-auth
      name: prior-auth
      description: Prior authorization management.
      operations:
      - method: POST
        name: check-prior-auth
        description: Check prior auth requirements.
        call: uhc-provider.check-prior-auth
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/providers
      name: providers
      description: Provider directory.
      operations:
      - method: GET
        name: get-provider
        description: Get provider demographics.
        call: uhc-provider.get-provider-demographics
        with:
          npi: rest.npi
        outputParameters:
        - type: object
          mapping: $.
  - type: mcp
    port: 9090
    namespace: provider-operations-mcp
    transport: http
    description: MCP server for AI-assisted UnitedHealthcare provider operations.
    tools:
    - name: verify-member-eligibility
      description: Verify UnitedHealthcare member eligibility and coverage details at point of care including deductible,
        copay, and network status.
      hints:
        readOnly: false
        destructive: false
        idempotent: true
      call: uhc-provider.check-eligibility
      outputParameters:
      - type: object
        mapping: $.
    - name: check-patient-benefit
      description: Check patient-specific benefit details for a service code including whether authorization is required and
        estimated cost-sharing.
      hints:
        readOnly: false
        destructive: false
        idempotent: true
      call: uhc-provider.check-patient-benefit
      outputParameters:
      - type: object
        mapping: $.
    - name: get-claim-status
      description: Look up UnitedHealthcare claim status, payment details, and denial reasons by claim number or member ID.
      hints:
        readOnly: false
        destructive: false
        idempotent: true
      call: uhc-provider.inquire-claim
      outputParameters:
      - type: object
        mapping: $.
    - name: check-prior-authorization
      description: Determine if prior authorization is required for a procedure and check current authorization status to
        prevent avoidable denials.
      hints:
        readOnly: false
        destructive: false
        idempotent: true
      call: uhc-provider.check-prior-auth
      outputParameters:
      - type: object
        mapping: $.
    - name: find-provider
      description: Search UnitedHealthcare provider directory for in-network physicians and organizations by NPI or state.
      hints:
        readOnly: true
        openWorld: true
      call: uhc-provider.get-provider-demographics
      with:
        npi: tools.npi
        state: tools.state
      outputParameters:
      - type: object
        mapping: $.