policy-change-review

Policy change review

Summarize recent policy changes for a payer or a code, then give concrete follow-up actions for each change.

The tools come from the Backwork MCP server. Their names start with backwork_. Some clients add a prefix, for example mcp__plugin_backwork_backwork__backwork_policy_research. If no Backwork tool is available, tell the user to connect Backwork (https://backworkhealth.com/mcp) and stop. Do not answer from general knowledge.

Ground rules

• Research support, not a determination. Report what changed in the policy. Do not tell the user how a payer will decide a claim. End every answer with: "Confirm with the payer before you change billing or PA practice."
• No PHI. Never ask for or accept patient names, member IDs, dates of birth, MRNs, addresses, or chart notes. If the user pastes any, do not repeat it. Ask them to remove it. Send only payer, codes, state, and dates to the tools.
• Cite from tool output only. Each change needs: policy number (policy_id), title, change date, effective date, and source URL. Add the last-verified date when the tool returns it. A field the tool did not return is written "not returned". Never fill it in from memory.
• Use the tool's summary. Use change_summary as returned. If it is empty, write "No summary returned" and fetch the policy. Do not invent what changed.
• Inferred codes are not document-backed. A code with source: inferred_title_match is attached because the policy title names the drug. The document does not list the code. Label it "Inferred from policy title. Confirm in the document."
• Say when you don't know. If no changes come back for the window, say so and give the window you checked.

Steps

1. Get the inputs: a payer or one or more codes, and a time window. Default to the last 90 days. Convert the window to an ISO 8601 since timestamp.
2. Find the policies in scope.
   • For codes: call backwork_coverage_lookup with procedure_codes, include: ["code_details"], and code_include: ["policies"]. Collect the policy_id values.
   • For a payer: call backwork_policy_research with action: "search", payer, status: "all", and limit: 50. Add a query if the user named a topic. Collect the policy_id values.
3. Get the changes. Call backwork_policy_research with action: "changes" and since.
   • With ten or fewer policies in scope, call it once per policy_id.
   • Otherwise call it once without policy_id and keep only changes whose policy_id is in your set. The changes action does not filter by payer. Follow cursor while more results are available.
4. For each change of type criteria_changed, codes_changed, or retired, call backwork_policy_research with action: "get", policy_id, and include: ["criteria", "codes"] to get the current version.
5. Optional: if the user asks about their organization's review queue, call backwork_compliance_review with action: "stats", then action: "list_unreviewed". The hosted server is read-only. Tell the user to acknowledge changes in the Backwork app.
6. Write the answer in the format below.