Prior Authorization

Check prior authorization requirement

Checks whether a service appears to require prior authorization for the organization selected by the bearer API key, using payer, service, diagnosis, and optional provider/member/place-of-service context.

POSTNeeds publication reviewExternal or credentialedPrior AuthorizationoperationId: checkPriorAuthRequiredhttps://dev-api.quickintell.com/api/v1/prior-auth/requirements/check

Needs publication reviewExternal or credentialedPrior auth and clinical

Route status

Needs publication review

The endpoint contract is visible, but QuickRCM has not approved it yet for normal production API use.

Publication status

Needs publication review

Requires product, security/compliance, tenancy, side-effect, or module-owner approval before production public API use. Also requires E2 side-effect policy and E7 credential, webhook, and vendor trust policy before production recipes, SDK inclusion, or try-out access.

Authentication

Bearer API key declared

OpenAPI declares bearer API-key security for this operation.

Tenant context

API-key organization

API-key organization context is authoritative; request organizationId is not a public tenant selector.

Side-effect summary

External or credentialed

May touch credentials, webhooks, SFTP, EHRs, payers, portals, clearinghouses, or other external systems.

Source artifact

docs/openapi/openapi.json

OpenAPI 3.1.0; API 1.0.0.

When to use this endpoint

Use this page as an internal baseline for the prior auth and clinical contract generated for POST /api/v1/prior-auth/requirements/check. External use still depends on route classification, release evidence, and endpoint-specific side-effect approval.

What this does now

Shows the generated OpenAPI shape for POST /api/v1/prior-auth/requirements/check, but keeps the route out of ordinary production API positioning until review is complete.

What this does not do

Does not prove external GA readiness, SDK readiness, live production execution, or complete module behavior. Mutating behavior still needs side-effect and retry evidence.

Not public from this page

Do not publish this endpoint as an ordinary developer API until its unresolved decisions are closed.

Headers and tenancy

Current headers and tenant authority. Target headers stay labeled as future until OpenAPI and release evidence declare them.

Header	Required	Current status	Notes
Authorization	Yes	Current	Bearer <QUICKRCM_API_KEY>. OpenAPI security: bearerAuth.
Idempotency-Key	No	Target/future	Do not claim universal header support until E3 and OpenAPI metadata exist.
X-Request-Id	No	Target/future	Use for support correlation only after approved; not declared as a standard OpenAPI header today.

Required scopes

Unclassified until E6 route metadata exists; do not infer scopes from route names.

Wrong-org behavior

Tenant-safe 404, empty list, or 403 is endpoint-specific and remains an evidence gap until E1 is closed.

Actor and audit

No public actor, audit, or correlation contract is published from OpenAPI alone.

Idempotency and retries

Retry behavior is documented conservatively because universal idempotency headers are not declared.

Topic	Status	Guidance
Current idempotency	No idempotency mechanism is declared.	Do not retry blindly. Check resource, status, batch, or job state before repeating the request.
Universal header	Not declared	Do not document universal Idempotency-Key support until OpenAPI and E3 evidence declare it.
Conflict behavior	Unresolved	Same-key changed-payload, in-flight retry, fingerprint scope, and TTL behavior remain endpoint-specific evidence gaps.

Async jobs and polling

Queued work is accepted work, not proof of completed workflow execution.

Topic	Status	Guidance
Immediate response	No 202 response declared	OpenAPI does not declare HTTP 202 for this operation.
Polling and terminal states	Not indicated by OpenAPI	No generic polling contract is published from this page.
Later side effects	Not proven	Do not infer background execution beyond the documented response.

Files and artifacts

File-like routes need content-class, ownership, scanning, retention, and URL policy evidence before public recipes.

Topic	Status	Guidance
Content class	No file/artifact class inferred	OpenAPI text does not indicate file or artifact handling for this endpoint.
Ownership and storage keys	Not applicable unless a file field is present	Tenant ownership must be proven before retrieval or upload docs. Never expose storage keys as public identifiers.
URLs, scanning, and retention	Unresolved unless endpoint-specific evidence exists	Short-lived URLs, MIME limits, checksums, scanner status, retention, expiration, and legal hold behavior are not implied by OpenAPI examples.

Publication warnings

This endpoint needs explicit product, security/compliance, tenancy, or side-effect approval before publication.
Universal Idempotency-Key header support is not declared; retry only after checking endpoint-specific state.
External or credentialed behavior needs vendor trust, credential, webhook, and callback evidence before publication.

Related platform rules

Workflow Guide Route Status Tenant Context Errors Rate Limits PHI and Security Publication Readiness Side-Effect Modes Idempotency

Evidence

Evidence	Status	Caveat
OpenAPI artifact	docs/openapi/openapi.json; OpenAPI 3.1.0; API 1.0.0.	Generated baseline contract only.
Route registry	Needs publication review from documentation classification overlay.	E6 route registry evidence is still required before external publication.
Example validation	Generated examples are internal baseline aids.	No external publication claim; examples must pass no-PHI/no-secret/no-raw-payload/no-storage-key checks.
Last reviewed	Implementation run 20260619T-docs-impl; source boardroom packet 20260619T064820Z.	Refresh this evidence for release workspaces.
Release evidence	E9 required.	No SDK readiness, production readiness, or expanded external docs claim from this endpoint page.

Prior Authorization public API.

Prior Authorization APIs expose organization-scoped requirement checks, case creation and maintenance, draft saves, status transitions, renewals, local appeal tracking, bulk workflow queueing, bulk-upload batch status, and supporting-document upload setup for the tenant selected by the bearer API key. The public reference should be explicit about side effects. Requirement checks return decision-support fields and do not create authorization cases. Case create/update/status/submit endpoints return sanitized QuickRCM prior authorization summaries, not payer approvals or denials. Renewal and appeal endpoints create or update local workflow records. Bulk authorization submissions and bulk-upload batches are queue-oriented public workflows. Document submission endpoints are public validation surfaces that require `dryRun: true`; the OpenAPI descriptions state vendor submission is skipped. The current draft-save OpenAPI request schema is an `allOf` body with the create-case request fields plus optional `priorAuthId`; documentation should not imply that draft save has an empty or undocumented body. If the final docs want partial-draft behavior, the public schema must be expanded or clarified first. These endpoints can carry PHI or sensitive operational data in patient names, dates of birth, MRNs, member IDs, clinical indications, medical-necessity letters, appeal letters, document metadata, presigned upload URLs, and storage object keys. Public examples should be synthetic, and docs should tell callers not to log raw request bodies, upload URLs, S3 keys, payer portal credentials, raw EDI, transcripts, tokens, or vendor payloads. For `createPriorAuth` and `savePriorAuthDraft`, the generated OpenAPI body shows `payerId` and `payerName` as individually optional, but the public contract enforces a cross-field rule: callers must provide at least one of them. The handler uses `payerName` when supplied, attempts to resolve known payer IDs, and can return 400 asking for an explicit `payerName` when a supplied `payerId` cannot be resolved.

What this endpoint does

Use case

Use this before creating a prior authorization case when an integration needs decision support for a planned service code and diagnosis code.

Before calling

Authenticate with a public API key that can access Prior Authorization. Prepare `payerId`, `serviceCode`, and `diagnosisCode`; include `providerNPI`, `memberId`, and place-of-service fields only when they are needed for the payer rule lookup.

Request and response behavior

Request guidance

`payerId`, `serviceCode`, and `diagnosisCode` are required strings. Optional `providerNPI`, `memberId`, `placeOfService`, and `placeOfServiceCode` are bounded strings. The API key selects the organization; do not send an `organizationId` selector.

Use a valid provider NPI only when payer logic requires provider identity.
`memberId` can identify a patient or subscriber and should not be logged raw.
`placeOfServiceCode` is limited to 10 characters by the public schema.

Response semantics

HTTP 200 returns `requiresAuth` plus optional `policyInfo`, `requirements`, `evidenceSufficiency`, and `alternatives`, with `meta.organizationId`. This is requirement decision support only; it does not create a case, reserve an authorization number, or prove payer approval.

`requiresAuth` is the primary result field.
`requirements` and `alternatives` are structured guidance, not authorization determinations.
The response has no priorAuthId because no case is created.

Errors and retries

Treat 400 as invalid or incomplete request fields, 401 as missing or invalid credentials, 403 as a tenant or permission failure, 429 as a backoff signal, and 500 as transient only when retry limits allow.

400 can indicate missing required payer, service, or diagnosis context.
429 should be retried with scheduled or exponential backoff.
401 and 403 require credential, scope, or tenant-context correction before retrying.

Template boundary before examples

The route class, authentication state, tenancy rule, side-effect mode, idempotency status, async behavior, file policy, warnings, links, and evidence above are part of the endpoint contract. Treat generated examples below as internal baseline aids until release evidence closes.

Path parameters

This endpoint does not define path parameters.

Query parameters

This endpoint does not define query parameters.

OpenAPI-declared header parameters

Standard platform header guidance appears in the governance panel. This table only lists operation-specific headers declared in OpenAPI.

This endpoint does not define operation-specific header parameters.

Request body

JSON fields from the generated OpenAPI schema with pilot enrichment applied where available. Nested object fields are shown with dotted paths.

Name	Location	Required	Type	Description	Validation and safety notes
payerId	body	Yes	string	Required payer identifier used for prior authorization requirement lookup. Treat payer/member combinations as sensitive workflow context.	Minimum length: 1. Maximum length: 120. Potential PHI; use synthetic examples and avoid logging raw values.
providerNPI	body	No	string	Optional National Provider Identifier for the ordering or rendering provider when payer rules need provider context.	Minimum length: 1. Maximum length: 20.
serviceCode	body	Yes	string	Required service or procedure code being checked for prior authorization requirements.	Minimum length: 1. Maximum length: 40.
diagnosisCode	body	Yes	string	Required diagnosis code used with the service code to evaluate authorization requirements.	Minimum length: 1. Maximum length: 40. Potential PHI; use synthetic examples and avoid logging raw values.
memberId	body	No	string	Optional payer member or subscriber identifier. Treat as PHI-adjacent and avoid logging raw values.	Minimum length: 1. Maximum length: 120. Potential PHI; use synthetic examples and avoid logging raw values.
placeOfService	body	No	string	Optional human-readable place-of-service context.	Minimum length: 1. Maximum length: 120.
placeOfServiceCode	body	No	string	Optional place-of-service code, capped at 10 characters.	Minimum length: 1. Maximum length: 10.

Generated request example

Generated examples are baseline contract aids only. They are not external publication evidence and must not include real PHI, credentials, raw vendor payloads, raw EDI, transcripts, storage keys, or signed URLs.

{
  "payerId": "87726",
  "serviceCode": "example-servicecode",
  "diagnosisCode": "example-diagnosiscode",
  "providerNPI": "1234567893",
  "memberId": "W123456789",
  "placeOfService": "example-placeofservice",
  "placeOfServiceCode": "example-placeofservicecode"
}

Successful responses

Generated response examples show the baseline OpenAPI contract. Tenant identifier echo, PHI redaction, pagination, money, date/time, and enum semantics remain endpoint-specific publication checks.

200

Prior authorization requirement result.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "requiresAuth": true,
    "policyInfo": {
      "name": "Example prior_auth_required",
      "description": "Example prior_auth_required note"
    },
    "requirements": [
      {
        "name": "Example prior_auth_required",
        "description": "Example prior_auth_required note"
      }
    ],
    "evidenceSufficiency": {},
    "alternatives": [
      {
        "code": "ERROR",
        "description": "Example prior_auth_required note"
      }
    ]
  },
  "meta": {
    "organizationId": "00000000-0000-4000-8000-000000000001"
  }
}

Error responses

Errors must remain sanitized. Do not include raw payer, EHR, SFTP, SMTP, Stripe, LLM/OCR, browser automation, file, transcript, EDI, worker, or vendor payloads.

400

Invalid request.