Revenue Integrity

List underpayment cases

Lists organization-owned underpayment recovery cases with optional filters for status, underpayment type, payer configuration, assignee, and page-based pagination.

GETNeeds publication reviewExternal or credentialedRevenue IntegrityoperationId: listRevenueIntegrityUnderpaymentCaseshttps://dev-api.quickintell.com/api/v1/revenue-integrity/underpayment-cases

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 GET /api/v1/revenue-integrity/underpayment-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/revenue-integrity/underpayment-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Do not publish this endpoint as an ordinary developer API until its unresolved decisions are closed.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.

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 build underpayment worklists, appeal queues, recovery dashboards, or reconciliation views before updating appeal or recovery state.

Before calling

Authenticate with Revenue Integrity read access. If filtering by `payerConfigId` or `assignedToId`, use identifiers from the same API-key organization.

Request and response behavior

Request guidance

`page` defaults to 1. `pageSize` defaults to 25 and is capped at 100. `status` and `underpaymentType` must match the public Revenue Integrity enums. Do not send Protected Health Information or free-text search terms; no search parameter is exposed.

`status` values include IDENTIFIED, UNDER_REVIEW, CONFIRMED, APPEAL_DRAFTED, APPEAL_SUBMITTED, RECOVERED, CLOSED_NO_RECOVERY, CLOSED_WRITE_OFF, and BATCHED.
`underpaymentType` values include CONTRACT_VARIANCE, STOP_LOSS, OUTLIER, IMPLANT_COST, CARVE_OUT, SEQUESTRATION, INTEREST, and OTHER.
There is no public `claimId` or free-text search filter in this endpoint.

Response semantics

HTTP 200 returns `data.underpaymentCases`, total count, current page, page size, total pages, and `meta.organizationId`. Rows include local financial strings, appeal metadata, nested claim/payer/contract/assignee references, and activity count.

Amounts such as `billedAmount`, `expectedAmount`, `paidAmount`, `varianceAmount`, `recoveredAmount`, and `interestAmount` are decimal strings.
`claim`, `payer`, `contract`, and `assignedTo` are limited references and can be null.
The list is local QuickRCM recovery state, not a payer remittance, Electronic Remittance Advice feed, or appeal decision feed.

Errors and retries

Correct invalid enum or pagination values before retrying. Treat 401/403 as credential or scope issues and 429 as a backoff signal.

400 can indicate invalid page, pageSize, status, or underpaymentType.
A valid but empty filtered result returns an empty array rather than an error.

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
page	query	No	integer	One-based page number. Defaults to 1.	Minimum value: 1. Default: 1.
pageSize	query	No	integer	Number of underpayment cases per page. Defaults to 25 and cannot exceed 100.	Minimum value: 1. Maximum value: 100. Default: 25. Financial value; preserve decimal precision and avoid real account details.
status	query	No	IDENTIFIED \| UNDER_REVIEW \| CONFIRMED \| APPEAL_DRAFTED \| APPEAL_SUBMITTED \| RECOVERED \| CLOSED_NO_RECOVERY \| CLOSED_WRITE_OFF \| BATCHED	Workflow status filter or target status. Valid values depend on the endpoint schema and module state machine.	Enum values are declared in the Type column.
underpaymentType	query	No	CONTRACT_VARIANCE \| STOP_LOSS \| OUTLIER \| IMPLANT_COST \| CARVE_OUT \| SEQUESTRATION \| INTEREST \| OTHER	Local underpayment case classification. Public detection-created cases use CONTRACT_VARIANCE in the current handler.	Enum values are declared in the Type column. Financial value; preserve decimal precision and avoid real account details.
payerConfigId	query	No	string	Optional organization-scoped payer configuration filter.	Minimum length: 1.
assignedToId	query	No	string	Optional QuickRCM user identifier used to filter assigned underpayment cases.	Minimum length: 1. Financial value; preserve decimal precision and avoid real account details.

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

Underpayment recovery cases for the authenticated organization.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "underpaymentCases": [
      {
        "id": "00000000-0000-4000-8000-000000000001",
        "organizationId": "00000000-0000-4000-8000-000000000001",
        "claimId": "00000000-0000-4000-8000-000000000001",
        "remittanceClaimId": "00000000-0000-4000-8000-000000000001",
        "paymentId": "00000000-0000-4000-8000-000000000001",
        "contractId": "00000000-0000-4000-8000-000000000001",
        "payerConfigId": "00000000-0000-4000-8000-000000000001",
        "caseNumber": "example-casenumber",
        "underpaymentType": "CONTRACT_VARIANCE",
        "status": "IDENTIFIED",
        "billedAmount": "example-billedamount",
        "expectedAmount": "example-expectedamount",
        "paidAmount": "example-paidamount",
        "varianceAmount": "example-varianceamount",
        "recoveredAmount": "example-recoveredamount",
        "interestAmount": "example-interestamount",
        "priorityScore": 1.25,
        "appealDeadline": "2026-06-08T10:15:30Z",
        "appealSubmittedAt": "2026-06-08T10:15:30Z",
        "appealReference": "example-appealreference",
        "appealLevel": "example-appeallevel",
        "identifiedAt": "2026-06-08T10:15:30Z",
        "resolvedAt": "2026-06-08T10:15:30Z",
        "autoDetected": true,
        "createdAt": "2026-06-08T10:15:30Z",
        "updatedAt": "2026-06-08T10:15:30Z",
        "claim": {
          "id": "00000000-0000-4000-8000-000000000001",
          "claimControlNumber": "example-claimcontrolnumber"
        },
        "payer": {
          "id": "00000000-0000-4000-8000-000000000001",
          "payerName": "Example revenue_integrity_underpayment_case"
        },
        "contract": {
          "id": "00000000-0000-4000-8000-000000000001",
          "contractName": "Example revenue_integrity_underpayment_case"
        },
        "assignedTo": {
          "id": "00000000-0000-4000-8000-000000000001",
          "name": "Example revenue_integrity_underpayment_case"
        },
        "activityCount": 1
      }
    ],
    "total": 1,
    "page": 1,
    "pageSize": 1,
    "totalPages": 1
  },
  "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.