Denial Management

List denial cases

Lists denial cases owned by the organization selected by the bearer API key, with optional filters for local status, denial category, severity, payer, claim, patient, queue, owner user, and pagination.

GETNeeds publication reviewExternal or credentialedDenial ManagementoperationId: listDenialCaseshttps://dev-api.quickintell.com/api/v1/denial-management/cases

Needs publication reviewExternal or credentialedClaims and denials

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 claims and denials contract generated for GET /api/v1/denial-management/cases. 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 GET /api/v1/denial-management/cases, 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.

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Do not publish this endpoint as an ordinary developer API until its unresolved decisions are closed.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	Read request; no mutation idempotency contract needed.	Use ordinary safe-read retry behavior with rate-limit backoff.
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	Endpoint-specific	Use only operation-specific status endpoints visible in OpenAPI; generic job behavior, cancellation, retries, and retention are unresolved.
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.
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

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.

Denial Management public API.

Denial Management APIs expose organization-scoped denial case read models, local denial workflow writes, remittance association, draft appeal creation, denial queue routing configuration, explicit case rerouting, and safe document-extraction validation. The bearer API key selects the organization. Public requests should not send `organizationId` as a tenant selector. Read endpoints accept Denial Management read or write scope; mutation endpoints require Denial Management write scope. Referenced denial cases, queues, queue rules, remittances, draft appeals, users, and optional case links must resolve inside the authenticated organization. These endpoints operate on QuickRCM local workflow state. They do not submit appeals to payers, run OCR or LLM extraction, upload files, parse ERA payloads, post payments, adjudicate claims, call clearinghouses, or guarantee denial recovery. Use synthetic examples and keep notes, rule metadata, letter HTML, filenames, and search/filter values free of real PHI, raw EDI, payer portal credentials, tokens, S3 keys, transcripts, and vendor payloads. Iteration 2 adds complete queue-rule action and condition field semantics, common response-field glossary coverage, and PHI-safe synthetic request/response examples for all 10 Denial Management operations.

What this endpoint does

Use case

Use this endpoint to build denial worklists, queue dashboards, aging reviews, appeal-prep picklists, or integration reconciliation screens that need a bounded set of local denial cases.

Before calling

Authenticate with an API key that has `denial-management:read` or `denial-management:write`. Decide which operational filters should narrow the list and use skip/take pagination on every production call.

Request and response behavior

Request guidance

`skip` defaults to 0 and is capped at 10000. `take` defaults to 25 and is capped at 100. The API key selects the tenant; do not send `organizationId`. Treat patient, payer, claim, queue, and owner identifiers as QuickRCM-local selectors that still remain organization-scoped.

Use `status`, `category`, `severity`, `payerId`, `claimId`, `patientId`, `queueId`, or `ownerUserId` to avoid broad denial exports.
The endpoint orders cases by `updatedAt` descending in the current handler.
Filter values can reveal patient or denial workflow context, so avoid logging raw query strings.

Response semantics

The response contains local QuickRCM denial case summaries, total count, and the effective pagination values. Each case includes monetary strings, status, root-cause fields, Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) summaries, SLA and appeal deadline timestamps, limited claim/patient/facility/queue/payer summaries, and related-count totals. It is not payer adjudication evidence and does not include raw payer payloads or full patient demographics.

`data.denialCases` is local denial workflow state, not a payer response or appeal outcome.
Nested `patient` is a limited display summary; raw demographics such as MRN are not part of the public response.
`counts` reports related local appeals, activities, files, and lines for workflow navigation.

Errors and retries

Treat 400 as invalid filters or pagination bounds, 401 as missing or invalid bearer credentials, 403 as missing Denial Management scope or organization access, and 429 as a backoff signal. Retry only transient 5xx or rate-limit responses with bounded backoff.

400 can indicate an unsupported enum value or out-of-range pagination.
403 means the API key lacks Denial Management access even if it has other module scopes.
429 should be retried with backoff rather than tight polling.

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

Name	Location	Required	Type	Description	Validation and safety notes
status	query	No	NEW \| IN_PROGRESS \| ON_HOLD \| RESUBMITTED \| APPEALED \| CLOSED_PAID \| CLOSED_PARTIAL \| CLOSED_WRITE_OFF \| CLOSED_DROPPED	Optional local denial case status filter. The public enum includes NEW, IN_PROGRESS, ON_HOLD, RESUBMITTED, APPEALED, CLOSED_PAID, CLOSED_PARTIAL, CLOSED_WRITE_OFF, and CLOSED_DROPPED.	Enum values are declared in the Type column.
category	query	No	ELIGIBILITY \| AUTHORIZATION \| CODING \| MEDICAL_NECESSITY \| TIMELY_FILING \| COB \| BENEFIT_EXHAUSTED \| DUPLICATE \| BUNDLING \| OTHER	Optional denial category filter such as ELIGIBILITY, AUTHORIZATION, CODING, MEDICAL_NECESSITY, TIMELY_FILING, COB, BENEFIT_EXHAUSTED, DUPLICATE, BUNDLING, or OTHER.	Enum values are declared in the Type column. File, artifact, or raw-payload adjacent; keep examples metadata-only.
severity	query	No	LOW \| MEDIUM \| HIGH \| CRITICAL	Optional denial severity filter. Valid values are LOW, MEDIUM, HIGH, and CRITICAL.	Enum values are declared in the Type column. File, artifact, or raw-payload adjacent; keep examples metadata-only.
payerId	query	No	string	Optional payer identifier filter stored on the denial case. It must be interpreted within the authenticated organization context.	Minimum length: 1. Maximum length: 128.
claimId	query	No	string	Optional QuickRCM claim identifier filter. The claim relationship remains organization-scoped.	Minimum length: 1. Maximum length: 128.
patientId	query	No	string	Optional QuickRCM patient identifier filter. Avoid logging raw values.	Minimum length: 1. Maximum length: 128. Potential PHI; use synthetic examples and avoid logging raw values.
queueId	query	No	string	Optional Denial Management queue identifier filter for the authenticated organization.	Minimum length: 1. Maximum length: 128.
ownerUserId	query	No	string	Optional QuickRCM user identifier filter for the case owner inside the authenticated organization.	Minimum length: 1. Maximum length: 128.
skip	query	No	integer	Zero-based number of denial cases to skip. Defaults to 0 and cannot exceed 10000.	Minimum value: 0. Maximum value: 10000. Default: 0.
take	query	No	integer	Maximum denial cases to return. Defaults to 25 and cannot exceed 100.	Minimum value: 1. Maximum value: 100. Default: 25.

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.

This endpoint does not define a JSON request body.

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.

No request example is declared.

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

Denial case list

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "denialCases": [
      {
        "id": "00000000-0000-4000-8000-000000000001",
        "organizationId": "00000000-0000-4000-8000-000000000001",
        "facilityId": "00000000-0000-4000-8000-000000000001",
        "appointmentId": "00000000-0000-4000-8000-000000000001",
        "claimId": "00000000-0000-4000-8000-000000000001",
        "patientId": "00000000-0000-4000-8000-000000000001",
        "payerId": "87726",
        "category": "ELIGIBILITY",
        "rootCauseCode": "example-rootcausecode",
        "rootCauseLabel": "example-rootcauselabel",
        "severity": "LOW",
        "deniedAmount": "example-deniedamount",
        "expectedAmount": "example-expectedamount",
        "paidAmount": "example-paidamount",
        "billedAmount": "example-billedamount",
        "status": "NEW",
        "openedAt": "2026-06-08T10:15:30Z",
        "closedAt": "2026-06-08T10:15:30Z",
        "appealDeadline": "2026-06-08T10:15:30Z",
        "slaDueAt": "2026-06-08T10:15:30Z",
        "slaDeadline": "2026-06-08T10:15:30Z",
        "slaStatus": "example-slastatus",
        "ownerUserId": "00000000-0000-4000-8000-000000000001",
        "queueId": "00000000-0000-4000-8000-000000000001",
        "isPreventable": true,
        "deniedCodes": [
          "example-deniedcodes"
        ],
        "primaryCarcCode": "example-primarycarccode",
        "primaryRarcCode": "example-primaryrarccode",
        "allCarcCodes": [
          "example-allcarccodes"
        ],
        "allRarcCodes": [
          "example-allrarccodes"
        ],
        "adjustmentGroupCode": "example-adjustmentgroupcode",
        "denialType": "example-denialtype",
        "autoCreatedFromEra": true,
        "createdAt": "2026-06-08T10:15:30Z",
        "updatedAt": "2026-06-08T10:15:30Z",
        "claim": {
          "id": "00000000-0000-4000-8000-000000000001",
          "claimControlNumber": "example-claimcontrolnumber",
          "status": "active"
        },
        "patient": {
          "id": "00000000-0000-4000-8000-000000000001",
          "displayName": "Example denial_case"
        },
        "facility": {
          "id": "00000000-0000-4000-8000-000000000001",
          "name": "Example denial_case"
        },
        "queue": {
          "id": "00000000-0000-4000-8000-000000000001",
          "name": "Example denial_case"
        },
        "payer": {
          "id": "00000000-0000-4000-8000-000000000001",
          "payerId": "87726",
          "name": "Example denial_case"
        },
        "counts": {
          "appeals": 1,
          "activities": 1,
          "files": 1,
          "lines": 1
        }
      }
    ],
    "total": 1,
    "skip": 1,
    "take": 1
  }
}

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