Specialty Billing

Create home-health episode

Creates a local home-health episode, a draft certification, and two initial open payment periods for the authenticated organization.

POSTNeeds publication reviewPayment or creditSpecialty BillingoperationId: createHomeHealthEpisodehttps://dev-api.quickintell.com/api/v1/specialty-billing/home-health/episodes

Needs publication reviewPayment or creditRevenue and specialty

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 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

Payment or credit

May affect payments, credits, refunds, voids, or financial posting. Requires explicit product approval before publication.

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 revenue and specialty contract generated for POST /api/v1/specialty-billing/home-health/episodes. 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/specialty-billing/home-health/episodes, 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Do not publish this endpoint as an ordinary developer API until its unresolved decisions are closed.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.

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.

Specialty Billing public API.

Specialty Billing APIs expose organization-scoped aggregate visibility across anesthesia, Ambulatory Surgical Center (ASC), Durable Medical Equipment (DME), laboratory, and behavioral-health billing records, plus safe public wrappers for home-health and hospice workflow state. The bearer API key selects the organization. Public callers should not send `organizationId`, `orgId`, or request signatures as tenant selectors in workflow request bodies; the API ignores those hints before authentication. The aggregate overview endpoint and the two local claim-status endpoints accept `specialty-billing:read` or `specialty-billing:write`. Workflow endpoints that create, update, validate, queue, acknowledge, or preview non-status records require `specialty-billing:write`. Linked patients, facilities, payer configs, patient insurance records, providers, episodes, payment periods, NOAs, referrals, authorizations, OASIS assessments, hospice elections, benefit periods, notices, census batches, claims, and denial cases must resolve inside the authenticated organization. This public surface is intentionally conservative. It can create or update local QuickRCM records such as home-health episodes, certifications, payment periods, referrals, authorizations, hospice elections, benefit periods, notices, acknowledgements, and queue/status markers. Submission endpoints return queued/local markers and do not call clearinghouse, payer, Electronic Health Record (EHR), Centers for Medicare & Medicaid Services (CMS), or Stedi/Availity adapters inline. Draft, Additional Documentation Request (ADR), appeal, and census preview endpoints validate or preview workflow state without creating Electronic Data Interchange (EDI) payloads, cross-module ADR cases, appeal packets, payer submissions, or EHR syncs unless a future contract explicitly says otherwise. Use synthetic examples. Endpoint examples are sanitized reference samples; when a response contains a local database object or submission-attempt snapshot, examples should either include the key returned object or explicitly say they are abbreviated. Do not include real Protected Health Information (PHI), raw EDI, transcripts, S3 keys, payer portal credentials, bearer tokens, clearinghouse payloads, EHR payloads, CMS payloads, or unnecessary patient-identifying notes in examples, metadata, payload, responsePayload, rows, message, or idempotency fields.

What this endpoint does

Use case

Use this when an integration needs to start home-health billing workflow state before generating an NOA, tracking authorizations, or previewing period-level claims.

Before calling

Authenticate with `specialty-billing:write`. Resolve required `patientId` and `facilityId` in QuickRCM for the same organization. Resolve optional payer, insurance, and provider identifiers before sending them.

Request and response behavior

Request guidance

`patientId`, `facilityId`, `startOfCareDate`, and `primaryDiagnosisCode` are required. `lupaThreshold` must be an integer from 1 through 30 when supplied. Diagnosis codes are normalized to uppercase by the API. Do not include tenant hints or PHI-heavy notes.

The API key selects the organization; body `organizationId`, `orgId`, and `signature` are not tenant selectors.
Optional patient insurance is checked against the same patient and organization.
`otherDiagnosisCodes` defaults to an empty array.

Response semantics

HTTP 201 returns a workflow response with `externalRiskMode: SAFE_WRITE_DB_ONLY`, the created `episode`, and summarized payment periods using `id`, `episodeId`, `periodNumber`, date, and status fields. This is a local database write; it does not submit an NOA or claim.

`SAFE_WRITE_DB_ONLY` means local QuickRCM records were written.
The payment-period response is summarized with `periodNumber`, `periodStartDate`, `periodEndDate`, and local status fields; it is not a full billing ledger.
The episode starts as local status `ACTIVE` in the public API.

Errors and retries

A 404 can mean the patient, facility, payer config, provider, or patient-insurance record did not resolve inside the authenticated organization. After a timeout, search or read local workflow state before creating another episode.

400 can indicate invalid dates or out-of-range `lupaThreshold`.
404 hides missing and wrong-organization linked records.
Avoid blind retries after ambiguous success because duplicate episode workflow state may be created.

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
patientId	body	Yes	string	Required QuickRCM patient identifier in the API-key organization.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
facilityId	body	Yes	string	Required facility identifier in the API-key organization.	Minimum length: 1.
payerConfigId	body	No	string	Optional payer configuration identifier in the same organization.	Minimum length: 1.
patientInsuranceId	body	No	string	Optional patient insurance identifier for the same patient and organization.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
startOfCareDate	body	Yes	string	Required ISO date or datetime for the home-health start of care.	Minimum length: 1.
primaryDiagnosisCode	body	Yes	string	Required primary diagnosis code; the API stores an uppercase normalized value.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
otherDiagnosisCodes	body	No	string[]	Optional additional diagnosis codes; defaults to an empty array and is uppercased.	Default: . Potential PHI; use synthetic examples and avoid logging raw values.
certifyingProviderId	body	No	string	Optional Provider identifier for the certifying clinician in the API-key organization.	Minimum length: 1.
orderingProviderId	body	No	string	Optional Provider identifier for the ordering clinician in the API-key organization.	Minimum length: 1.
lupaThreshold	body	No	integer	Optional Low Utilization Payment Adjustment visit threshold from 1 through 30.	Minimum value: 1. Maximum value: 30. Financial value; preserve decimal precision and avoid real account details.

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.

{
  "patientId": "00000000-0000-4000-8000-000000000001",
  "facilityId": "00000000-0000-4000-8000-000000000001",
  "startOfCareDate": "2026-06-08",
  "primaryDiagnosisCode": "example-primarydiagnosiscode",
  "payerConfigId": "00000000-0000-4000-8000-000000000001",
  "patientInsuranceId": "00000000-0000-4000-8000-000000000001",
  "otherDiagnosisCodes": [],
  "certifyingProviderId": "00000000-0000-4000-8000-000000000001",
  "orderingProviderId": "00000000-0000-4000-8000-000000000001",
  "lupaThreshold": 1
}

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.

201

Specialty billing workflow response.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {},
  "meta": {
    "organizationId": "00000000-0000-4000-8000-000000000001",
    "externalRiskMode": "SAFE_WRITE_DB_ONLY"
  }
}

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.