Coordination of Benefits

Detect COB secondary claim opportunities

Scans organization-scoped primary remittance data for claims that may need secondary billing and returns sanitized opportunity summaries without patient names, raw X12 835 Electronic Remittance Advice (ERA), or payer payloads.

POSTNeeds publication reviewFile or artifactCoordination of BenefitsoperationId: detectCobSecondaryClaimOpportunitieshttps://dev-api.quickintell.com/api/v1/cob/secondary-claim-opportunities/detect

Needs publication reviewFile or artifactClaims and remittances

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, E4 file and artifact governance, 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

File or artifact

Touches documents, reports, transcripts, PDFs, EDI, or generated artifacts. Metadata is safer than raw content.

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 claims and remittances contract generated for POST /api/v1/cob/secondary-claim-opportunities/detect. 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/cob/secondary-claim-opportunities/detect, 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

Raw file contents, storage keys, signed URLs, and generated artifacts are not public from this page.

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	Potential file or artifact	Documents, PDFs, reports, transcripts, EDI, OCR, or generated artifacts need E4 classification before public examples.
Ownership and storage keys	Evidence required	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.
File and artifact examples must stay metadata-only until scanning, retention, ownership, and URL policy are approved.
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 Files and Artifacts

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.

Coordination of Benefits public API.

Coordination of Benefits (COB) APIs expose organization-scoped workflows for maintaining a patient's payer order, finding secondary-claim opportunities from primary Electronic Remittance Advice (ERA, commonly X12 835) data, generating local secondary claim records, queueing secondary-claim submission workflow, checking local secondary status, posting local secondary payment state, and voiding non-paid secondary claims. The bearer API key selects the organization. Public callers should not send `organizationId` as a tenant selector. Medicare Secondary Payer (MSP) fields are local payer-order context unless an endpoint-specific response says otherwise. Read endpoints accept Coordination of Benefits read or write scope, while payer-order, detection, generation, submission, payment, and void endpoints require Coordination of Benefits write scope. Referenced patients, insurance identifiers, primary claims, remittances, secondary claims, payer identifiers, and generated records must resolve inside the authenticated organization. Use the secondary-claim lifecycle as local QuickRCM workflow state: generation creates or returns local `SC_GENERATED` records, submission accepts generated records and returns queue/submission metadata, status check reads submitted or acknowledged local status, payment posting can move eligible records to `SC_PAID` or `SC_DENIED`, and voiding marks eligible non-paid records `SC_VOID`. Crossover states (`SC_CROSSOVER_PENDING`, `SC_CROSSOVER_SENT`) are local lifecycle labels, not proof of payer completion by themselves. These endpoints coordinate QuickRCM local workflow state. They do not return raw X12 837P professional claim Electronic Data Interchange (EDI), raw X12 835 ERA, raw X12 276/277 claim-status EDI, payer portal, Amazon S3 object-storage, or Electronic Health Record (EHR) payloads; they do not prove payer acceptance, final adjudication, EHR writeback, patient accounts receivable balance transfer, cash posting, or external reversal by themselves. Use synthetic examples and keep notes/reasons free of unnecessary Protected Health Information (PHI), raw EDI, credentials, tokens, payer portal data, transcripts, and vendor payloads.

What this endpoint does

Use case

Use this after primary remittances have been imported and COB orders exist for patients with secondary coverage, before generating individual or batch secondary claims.

Before calling

Authenticate with `cob:write` scope. Ensure Payment Posting/remittance data and COB payer-order records exist for the same organization. Use date and pagination bounds to keep scans small.

Request and response behavior

Request guidance

`page` defaults to 1. `pageSize` defaults to 25 and is capped at 100. `limit` optionally caps returned opportunities and is capped at 100. `dateFrom` and `dateTo` filter remittance check dates and must be `YYYY-MM-DD` or timezone-qualified ISO datetimes. Pagination is over fetched remittances and their remittance-claim rows, not a stable total-opportunity cursor.

The scan is side-effect-sensitive enough to require `cob:write` scope.
`dateFrom` and `dateTo` are remittance check-date filters, not generated secondary claim dates.
The endpoint has a per-organization scan cooldown in addition to API-key rate limiting.

Response semantics

HTTP 200 returns `opportunities`, `totalFound`, `scannedRemittances`, and `pagination`. Opportunities include primary claim, remittance, patient id, primary paid/allowed amounts, patient balance, and secondary payer identifiers. `totalFound` is the number of opportunity rows returned from the current scan page after filters and optional `limit`; it is not a guaranteed count of every possible opportunity across all pages. `scannedRemittances` counts remittance-claim rows considered on the current page, and `pagination.hasMore` indicates that another remittance page may exist because the current remittance page reached `pageSize`.

`patientBalance` is the candidate secondary-billing balance derived from primary allowed minus primary paid in current implementation evidence.
`scannedRemittances` counts remittance-claim rows considered by the scan path for the current page.
`totalFound` is the returned opportunity count for this scan page after filters and optional `limit`; it is not an all-pages total.
`pagination.hasMore` is true when the fetched remittance page reached `pageSize`, so callers should request the next page to continue scanning.
Returned opportunities still need generation before they become local secondary-claim records.

Errors and retries

The operation has API-key rate limits and an organization-level scan cooldown. Back off on 429. Correct invalid body values before retrying 400 responses.

429 can mean API-key rate limit or scan cooldown.
400 can indicate an invalid date filter, page, pageSize, or limit.
403 means missing write scope or tenant authorization failure.

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
dateFrom	body	No	string	Optional lower remittance check-date bound as `YYYY-MM-DD` or ISO datetime with timezone.	Minimum length: 1.
dateTo	body	No	string	Optional upper remittance check-date bound as `YYYY-MM-DD` or ISO datetime with timezone.	Minimum length: 1.
page	body	No	integer	One-based COB pagination page number.	Minimum value: 1. Default: 1.
pageSize	body	No	integer	COB pagination page size. Defaults to 25 and is capped at 100 where exposed.	Minimum value: 1. Maximum value: 100. Default: 25.
limit	body	No	integer	Optional cap on returned opportunities. Minimum 1 and maximum 100.	Minimum value: 1. Maximum value: 100.

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.

{
  "dateFrom": "2026-06-08",
  "dateTo": "2026-06-08",
  "page": 1,
  "pageSize": 25,
  "limit": 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.

200

Detected secondary claim opportunities for the authenticated organization.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "opportunities": [
      {
        "remittanceId": "00000000-0000-4000-8000-000000000001",
        "primaryClaimId": "00000000-0000-4000-8000-000000000001",
        "patientId": "00000000-0000-4000-8000-000000000001",
        "primaryPaid": "00000000-0000-4000-8000-000000000001",
        "primaryAllowed": "example-primaryallowed",
        "patientBalance": "example-patientbalance",
        "secondaryPayerId": "00000000-0000-4000-8000-000000000001",
        "secondaryPayerName": "Example detect_cob_secondary_claim_opportunitie"
      }
    ],
    "totalFound": 1,
    "scannedRemittances": 1,
    "pagination": {
      "page": 1,
      "pageSize": 1,
      "hasMore": true
    }
  },
  "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 body.

Handle this response as normal integration control flow.

{
  "error": "Request validation failed",
  "statusCode": 400
}

401

Authentication failed.

Handle this response as normal integration control flow.

{
  "error": "Authentication required",
  "statusCode": 401
}

403

The requested organization does not match the authenticated caller.

Handle this response as normal integration control flow.

{
  "error": "Forbidden",
  "statusCode": 403
}

429

API key or scan rate limit exceeded.

Handle this response as normal integration control flow.

{
  "error": "Rate limit exceeded",
  "statusCode": 429
}

Adjacent endpoints

Nearby generated endpoints in the same OpenAPI tag. Route class and side-effect labels still apply per endpoint.

POSTNeeds publication reviewLocal write

Batch generate COB secondary claims

/api/v1/cob/secondary-claims/batch-generate

POSTNeeds publication reviewExternal or credentialed

Check COB secondary claim status

/api/v1/cob/secondary-claims/{secondaryClaimId}/status/check

PUTNeeds publication reviewExternal or credentialed

Create or update patient COB order

/api/v1/cob/orders/{patientId}

POSTNeeds publication reviewExternal or credentialed

Generate COB secondary claim

/api/v1/cob/secondary-claims/generate

GETNeeds publication reviewRead-only

Get COB secondary claim

/api/v1/cob/secondary-claims/{secondaryClaimId}

GETNeeds publication reviewExternal or credentialed

List COB secondary claims

/api/v1/cob/secondary-claims

All endpoint pages Open Scalar reference