Risk Adjustment

Review risk adjustment HCC code

Records a human review decision for one HCC code on a tenant-scoped risk adjustment job without returning raw evidence text or review notes.

PUTPublic reference baselineLocal writeRisk AdjustmentoperationId: reviewRiskAdjustmentHccCodehttps://dev-api.quickintell.com/api/v1/risk-adjustment/jobs/{jobId}/hcc-codes/{codeId}/review

Public reference baselineLocal writePrior auth and clinical

Route status

Public reference baseline

Generated endpoint contract may be shown with caveats, but external publication still needs route registry and release evidence.

Publication status

Baseline reference only

Requires E6 route registry and E9 release evidence before external publication. 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

Local write

May mutate QuickRCM records. It does not prove live payer, EHR, clearinghouse, payment, or communication execution.

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 prior auth and clinical contract generated for PUT /api/v1/risk-adjustment/jobs/{jobId}/hcc-codes/{codeId}/review. External use still depends on route classification, release evidence, and endpoint-specific side-effect approval.

What this does now

Documents the generated PUT /api/v1/risk-adjustment/jobs/{jobId}/hcc-codes/{codeId}/review contract as a local write baseline endpoint.

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

Live external side effects, file contents, credentials, webhooks, SDK promises, and production recipes are still gated.

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	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

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	Public reference baseline 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.

Risk Adjustment public API.

Risk Adjustment APIs expose organization-scoped job workflow controls for patient-document risk adjustment processing and human review of Hierarchical Condition Category (HCC) code results. HCC outputs contribute to Risk Adjustment Factor (RAF) score fields, but the bearer API key selects the organization; public callers should not send an `organizationId` selector in these requests. All referenced jobs, patients, files, appointments, and HCC code review targets must belong to the authenticated organization. The public surface is job-oriented and asynchronous. Create, bulk-create, and reprocess endpoints validate local QuickRCM references and either return validation output or queue local work; the OpenAPI descriptions state that public callers do not directly invoke optical character recognition (OCR) or artificial intelligence (AI) processing. Read endpoints return sanitized job summaries, HCC result summaries, and a limited patient-summary object. They do not expose raw document chunks, raw evidence text, clinical note text, transcripts, raw electronic health record (EHR) payloads, raw payer payloads, signed storage URLs, review notes, protected health information (PHI) beyond the minimum documented identifiers, or raw electronic data interchange (EDI) payloads. These endpoints do not submit diagnoses to the Centers for Medicare & Medicaid Services (CMS), send Risk Adjustment Processing System (RAPS) files, send Encounter Data Processing System (EDPS) files, adjudicate claims, update a payer portal, write back to an EHR, or certify final RAF/HCC accuracy. Use `reviewRiskAdjustmentHccCode` only to record a human decision for one HCC code. Treat `finalizedRafScore` and review fields as downstream workflow inputs only when the job state actually includes them and required review has completed. Diagnosis code fields use International Classification of Diseases, 10th Revision (ICD-10) code values where the response schema names them.

What this endpoint does

Use case

Use this endpoint when a reviewer has approved, rejected, or modified an individual HCC result after inspecting the appropriate clinical evidence in QuickRCM or another approved workflow.

Before calling

Authenticate with `risk-adjustment:write`. Read the job detail, choose the HCC code `id` to review, and ensure the reviewer has enough audited clinical evidence outside the public response to support the decision. If the decision is `modified`, prepare a sanitized replacement `modifiedCode`.

Request and response behavior

Request guidance

`decision` is required and must be `approved`, `rejected`, or `modified`. `modifiedCode` is conditionally required when `decision` is `modified`; it is optional for `approved` and `rejected`. `modifiedCode` is trimmed and capped at 32 characters. `notes` is optional, trimmed, and capped at 2000 characters; keep it minimal, clinically necessary, and free of raw excerpts, transcripts, payer payloads, credentials, tokens, S3 keys, and vendor responses.

`decision` is always required.
`modifiedCode` is required only when `decision` is `modified`; it is optional for `approved` and `rejected`.
`notes` can contain sensitive clinical rationale and should be sanitized in public examples.

Response semantics

HTTP 200 returns the updated sanitized `hccCode` summary with ICD-10/HCC metadata, RAF weight, confidence, source, active/review flags, `reviewedAt`, and `reviewDecision`, plus `meta.organizationId`. The response does not return raw evidence text or review notes. A `modified` decision updates the returned `icd10Code` to the supplied `modifiedCode`.

The updated `hccCode` summary omits raw evidence and review notes.
`humanReviewed`, `reviewedAt`, and `reviewDecision` reflect review state for the individual HCC code.
A code-level review response does not itself document job-level finalization or downstream submission.

Errors and retries

Treat 400 as invalid decision, missing `modifiedCode` for `decision: "modified"`, invalid code shape, or invalid notes shape. Treat 404 as job or HCC code not found in the authenticated organization. 402 and 409 are declared common responses, but this handler should not be documented as a normal credit-consuming or workflow-conflict path. After a timeout, retrieve the job or HCC code summary before repeating the review write.

400 can indicate an unsupported decision enum, missing `modifiedCode` for modified decisions, or overlong notes.
404 can indicate either the job or HCC code is absent from the authenticated tenant.
Do not describe this endpoint as recalculating final RAF or finalizing the whole job unless a future contract adds that behavior.

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

Name	Location	Required	Type	Description	Validation and safety notes
jobId	path	Yes	string	Optional internal or background job identifier associated with a conversion record. It is metadata only in public responses.	Minimum length: 1.
codeId	path	Yes	string	QuickRCM risk adjustment HCC code identifier from a job detail response.	Minimum length: 1.

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
decision	body	Yes	approved \| rejected \| modified	Required human review decision. Valid values are `approved`, `rejected`, and `modified`.	Enum values are declared in the Type column.
modifiedCode	body	No	string	Conditionally required replacement code when `decision` is `modified`; capped at 32 characters.	Minimum length: 1. Maximum length: 32.
notes	body	No	string	Optional human review note capped at 2000 characters. Keep it sanitized and clinically necessary.	Minimum length: 1. Maximum length: 2000. Potential PHI; use synthetic examples and avoid logging raw values.

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.

{
  "decision": "approved",
  "modifiedCode": "example-modifiedcode",
  "notes": "Example review_risk_adjustment_hcc_code note"
}

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

Risk adjustment HCC code review recorded.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "hccCode": {
      "id": "00000000-0000-4000-8000-000000000001",
      "icd10Code": "example-icd10code",
      "icd10Description": "Example review_risk_adjustment_hcc_code note",
      "hccCategory": 1,
      "hccVersion": "example-hccversion",
      "hccLabel": "example-hcclabel",
      "rafWeight": 1.25,
      "demographicModel": "example-demographicmodel",
      "confidence": 1.25,
      "source": "example-source",
      "isActive": true,
      "conditionInteractions": [
        "example-conditioninteractions"
      ],
      "needsHumanReview": true,
      "humanReviewed": true,
      "reviewedAt": "2026-06-08T10:15:30Z",
      "reviewDecision": "example-reviewdecision"
    }
  },
  "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.