Revenue Integrity

Create an insurance contract

Creates an organization-owned insurance contract with optional facility scope and optional rate schedule rows after validating payer and facility references.

POSTNeeds publication reviewExternal or credentialedRevenue IntegrityoperationId: createRevenueIntegrityContracthttps://dev-api.quickintell.com/api/v1/revenue-integrity/contracts

Needs publication reviewExternal or credentialedRevenue integrity

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 revenue integrity contract generated for POST /api/v1/revenue-integrity/contracts. 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/revenue-integrity/contracts, 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Do not publish this endpoint as an ordinary developer API until its unresolved decisions are closed.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	Request body exposes an endpoint-specific idempotencyKey compatibility field.	Retry only with the documented key location and after checking endpoint state; 409 behavior and retention still need release evidence.
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.

Revenue Integrity public API.

Revenue Integrity APIs expose organization-scoped controls for dashboard metrics, underpayment recovery case lists, charge reconciliation, charge lag reporting, charge capture audits, operating room reconciliation, coding validation, contract rate validation, implant recovery tracking, underpayment appeal tracking, recovery recording, contract setup, and manual underpayment checks. The bearer API key selects the organization. Public callers should not send an `organizationId` selector in these requests. Read endpoints accept `revenue-integrity:read` or `revenue-integrity:write`; write endpoints require `revenue-integrity:write`. Referenced claims, patients, facilities, billing encounters, payer configurations, contracts, charge reconciliation sessions, charge reconciliation items, and underpayment cases must belong to the authenticated organization. This public surface is conservative. Some endpoints create or update local Revenue Integrity records. Other endpoints return `202 Accepted` for queued, validated, or dry-run local workflows. Those responses do not mean QuickRCM made a direct payer call, contacted a payer portal, submitted an appeal externally, changed an Electronic Health Record (EHR), posted cash, adjudicated a claim, or received a payer decision. Use synthetic examples and keep notes, descriptions, invoice identifiers, source record identifiers, and appeal references free of unnecessary Protected Health Information (PHI), raw Electronic Data Interchange (EDI), raw Electronic Remittance Advice (ERA), payer payloads, transcripts, credentials, tokens, S3 keys, and payer portal secrets. Queued workflow controls are consistent across the public Revenue Integrity endpoints that expose them: `validateOnly` validates ownership and request shape without creating a queued workflow; `dryRun` simulates the workflow when `validateOnly` is false; otherwise the API records a queued local workflow request. `queueOnly: false` by itself is not a request for direct payer, clearinghouse, or EHR execution.

What this endpoint does

Use case

Use this endpoint to load local payer contract terms that Revenue Integrity workflows can later use for rate validation and underpayment analysis.

Before calling

Authenticate with write scope. Resolve `payerConfigId` and optional `facilityId` in the same tenant. Prepare effective dates, base rate type, optional thresholds, terms, notes, and up to 1000 rate schedules.

Request and response behavior

Request guidance

`payerConfigId`, `contractName`, `effectiveDate`, and `baseRateType` are required. `contractName` is capped at 255 characters and `contractNumber` at 100. `notes` is capped at 5000 characters. `rateSchedules` defaults to an empty array and is capped at 1000. Rate schedule `codeType` is Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Diagnosis-Related Group (DRG), or revenue code (REV_CODE).

`baseRateType` and rate schedule `rateType` use the Revenue Integrity contract rate type enum.
Money fields accept numbers or decimal strings. Prefer decimal strings in examples to preserve cents.
`terms` is structured JSON for local contract terms; do not include credentials, raw payer payloads, or signed document URLs.

Response semantics

HTTP 201 returns the local contract id, status `ACTIVE`, mode `created`, and `meta.organizationId`. It creates local contract/rate schedule records only; it does not validate historical claims by itself.

Status is returned as ACTIVE on success.
Contract validation is a separate workflow.
The response does not include the created rate schedule rows.

Errors and retries

404 can indicate wrong-tenant payer or facility references. Check for an existing contract before retrying after a timeout because the public contract does not guarantee idempotent replay.

400 can indicate invalid enum, date-time, money, or string length values.
404 can indicate supplied payer or facility is not available to the tenant.

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
payerConfigId	body	Yes	string	Required organization-scoped payer configuration identifier.	Minimum length: 1.
facilityId	body	No	string	Optional facility scope for the contract. If omitted, the contract is not tied to one public facility id.	Minimum length: 1.
contractName	body	Yes	string	Required human-readable contract name capped at 255 characters.	Minimum length: 1. Maximum length: 255.
contractNumber	body	No	string	Optional sanitized contract number capped at 100 characters.	Minimum length: 1. Maximum length: 100.
effectiveDate	body	Yes	string (date-time)	Required ISO datetime when the contract terms start.	Format: date-time.
terminationDate	body	No	string (date-time)	Optional ISO datetime when the contract terms end.	Format: date-time.
baseRateType	body	Yes	FEE_SCHEDULE \| PER_DIEM \| DRG_BASED \| CASE_RATE \| PERCENT_OF_CHARGE \| MEDICARE_PERCENT \| CAPITATED \| STOP_LOSS \| OUTLIER \| CARVE_OUT	Required contract base rate type: FEE_SCHEDULE, PER_DIEM, DRG_BASED, CASE_RATE, PERCENT_OF_CHARGE, MEDICARE_PERCENT, CAPITATED, STOP_LOSS, OUTLIER, or CARVE_OUT.	Enum values are declared in the Type column. File, artifact, or raw-payload adjacent; keep examples metadata-only.
baseRate	body	No	number \| string	Optional base monetary or percentage value, depending on `baseRateType`. Use a number or decimal string.	OpenAPI does not declare additional validation metadata.
medicarePercent	body	No	number \| string	Optional Medicare percentage value used when Medicare-percent contract terms apply.	File, artifact, or raw-payload adjacent; keep examples metadata-only.
stopLossThreshold	body	No	number \| string	Optional charge or cost threshold where stop-loss terms begin.	Financial value; preserve decimal precision and avoid real account details.
stopLossPercent	body	No	number \| string	Optional percentage applied to stop-loss calculations.	OpenAPI does not declare additional validation metadata.
stopLossMinCharges	body	No	number \| string	Optional minimum charges required before stop-loss terms apply.	Financial value; preserve decimal precision and avoid real account details.
outlierThreshold	body	No	number \| string	Optional threshold used for outlier payment terms.	Financial value; preserve decimal precision and avoid real account details.
outlierPercent	body	No	number \| string	Optional percentage applied to outlier calculations.	OpenAPI does not declare additional validation metadata.
implantCarveOut	body	No	boolean	Boolean flag indicating whether implant carve-out terms are configured locally.	Default: false.
implantMarkupPercent	body	No	number \| string	Optional percentage markup for implant carve-out terms.	OpenAPI does not declare additional validation metadata.
implantMinCost	body	No	number \| string	Optional minimum implant cost threshold for implant carve-out terms.	OpenAPI does not declare additional validation metadata.
terms	body	No	object	Optional structured JSON for local contract terms. Keep it free of secrets and raw payer documents.	Sensitive credential or storage-adjacent value; use placeholders only.
notes	body	No	string	Optional local contract notes capped at 5000 characters. Avoid credentials, raw payer payloads, and unnecessary PHI.	Maximum length: 5000. Sensitive credential or storage-adjacent value; use placeholders only.
rateSchedules	body	No	object[]	Optional array of local rate schedule rows, capped at 1000.	Default: .
rateSchedules[].rateType	body	Yes	FEE_SCHEDULE \| PER_DIEM \| DRG_BASED \| CASE_RATE \| PERCENT_OF_CHARGE \| MEDICARE_PERCENT \| CAPITATED \| STOP_LOSS \| OUTLIER \| CARVE_OUT	OpenAPI description is missing; publication gap.	Enum values are declared in the Type column.
rateSchedules[].code	body	Yes	string	Procedure, revenue, Diagnosis-Related Group (DRG), or other local code on a contract rate schedule row.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
rateSchedules[].codeType	body	Yes	CPT \| HCPCS \| DRG \| REV_CODE	Code set or classification used for a denial, appeal, collection, or claim workflow reason.	Enum values are declared in the Type column.
rateSchedules[].description	body	No	string	Human-readable description of the queue, workflow, or record. Avoid secrets and unnecessary PHI.	Sensitive credential or storage-adjacent value; use placeholders only.
rateSchedules[].rate	body	Yes	number \| string	Primary decimal rate amount for a contract rate schedule row, returned as a string.	Financial value; preserve decimal precision and avoid real account details.
rateSchedules[].ratePercent	body	No	number \| string	Optional percentage-style decimal rate for a contract rate schedule row.	OpenAPI does not declare additional validation metadata.
rateSchedules[].perDiemRate	body	No	number \| string	Optional daily decimal rate for a per-diem contract rate schedule row.	OpenAPI does not declare additional validation metadata.
rateSchedules[].caseRate	body	No	number \| string	Optional case-level decimal rate for a contract rate schedule row.	OpenAPI does not declare additional validation metadata.
rateSchedules[].minRate	body	No	number \| string	Optional minimum decimal amount for a bounded contract rate schedule row.	Financial value; preserve decimal precision and avoid real account details.
rateSchedules[].maxRate	body	No	number \| string	Optional maximum decimal amount for a bounded contract rate schedule row.	Financial value; preserve decimal precision and avoid real account details.
rateSchedules[].effectiveDate	body	No	string (date-time)	Required ISO datetime when the contract terms start.	Format: date-time.
rateSchedules[].terminationDate	body	No	string (date-time)	Optional ISO datetime when the contract terms end.	Format: date-time.
idempotencyKey	body	No	string	Optional caller retry marker capped at 200 characters.	Minimum length: 1. Maximum length: 200. Endpoint-specific compatibility key; universal Idempotency-Key header support is not declared.

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.

{
  "payerConfigId": "00000000-0000-4000-8000-000000000001",
  "contractName": "Example revenue_integrity_contract",
  "effectiveDate": "2026-06-08T10:15:30Z",
  "baseRateType": "FEE_SCHEDULE",
  "facilityId": "00000000-0000-4000-8000-000000000001",
  "contractNumber": "example-contractnumber",
  "terminationDate": "2026-06-08T10:15:30Z",
  "baseRate": 1.25,
  "medicarePercent": 1.25,
  "stopLossThreshold": 1.25,
  "stopLossPercent": 1.25,
  "stopLossMinCharges": 125.5
}

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

Insurance contract created.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "id": "00000000-0000-4000-8000-000000000001",
    "status": "active",
    "mode": "created"
  },
  "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 parameters.