Insurance Discovery

Run insurance discovery search

Creates and runs a single insurance discovery search for a patient in the authenticated organization.

POSTPublic reference baselineLocal writeInsurance DiscoveryoperationId: runInsuranceDiscoverySearchhttps://dev-api.quickintell.com/api/v1/insurance-discovery/searches

Public reference baselineLocal writeEligibility and discovery

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 eligibility and discovery contract generated for POST /api/v1/insurance-discovery/searches. External use still depends on route classification, release evidence, and endpoint-specific side-effect approval.

What this does now

Documents the generated POST /api/v1/insurance-discovery/searches 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	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

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.

Insurance Discovery public API.

Insurance Discovery APIs expose organization-scoped workflows for finding possible hidden coverage for self-pay or uninsured patients, reviewing local discovery search records, starting simulated batch discovery, retrying failed searches in simulated mode, and verifying or dismissing discovered coverage. The bearer API key selects the organization. Public request bodies should not be documented as tenant selectors, and `organizationId` in responses is ownership/context metadata rather than a caller-controlled organization switch. Patient, search, and batch identifiers must resolve inside the authenticated organization. Search inputs can include patient demographics and optional sensitive matching fields. Treat names, dates of birth, addresses, ZIP codes, Social Security number (SSN) last four digits, payer member IDs, discovered group IDs, and match details as Protected Health Information (PHI) or sensitive insurance data where applicable. Examples must stay synthetic, and public docs should discourage logging search terms, raw vendor payloads, Electronic Health Record (EHR) responses, credentials, tokens, storage keys, and payer portal data. The public surface has mixed side-effect profiles. List and get endpoints read local QuickRCM Revenue Cycle Management (RCM) discovery records. `verifyDiscoveredCoverage` performs local database updates and is documented with `SAFE_WRITE_DB_ONLY` metadata. `startInsuranceDiscoveryBatch` and `retryInsuranceDiscoverySearch` require `simulateOnly: true` and return `SIMULATED_ONLY` metadata because those workflows can consume credits and call the simulated discovery vendor. Retry requests do not accept replacement demographics; current retry behavior reuses the failed search's stored first name, last name, date of birth, address, and ZIP code while not resubmitting stored SSN last-four. `runInsuranceDiscoverySearch` has no public `simulateOnly` flag; it can create a local PHI-bearing search record, consume discovery credits, and potentially transmit patient demographics to a discovery vendor, so document it with credit and privacy warnings. Verification should be described as a local QuickRCM coverage/account state update, not payer adjudication, eligibility verification, claim readiness, or EHR insurance write-back. Existing module docs state that direct EHR write-back is not wired from Insurance Discovery. Current public verification evidence supports creating a new local `PatientInsurance` record when discovered member data is available and storing that new identifier on the search; otherwise `patientInsuranceId` remains null. Downstream eligibility re-verification, claim use, payer configuration resolution, and optional EHR synchronization require separate workflows.

What this endpoint does

Use case

Use this when a patient is self-pay, uninsured, missing coverage, or otherwise requires hidden coverage discovery before downstream eligibility, claims, or patient-account workflows.

Before calling

Resolve `patientId` from the same QuickRCM tenant. Prepare required search names and trigger. Include date of birth, address, ZIP code, or SSN last four only when permitted and needed for matching. Confirm the organization has enough discovery credits.

Request and response behavior

Request guidance

`patientId`, `trigger`, `searchFirstName`, and `searchLastName` are required by the body schema. `patientId` must be a non-empty string. `trigger` must be one of the public trigger enum values. `searchFirstName` and `searchLastName` are trimmed, must be non-empty, and are capped at 100 characters each. `searchDob` is optional but, when supplied, must be a valid calendar date in `YYYY-MM-DD` format. `searchSsnLast4` is optional but must be exactly four digits. `searchAddress` is optional, trimmed, and capped at 500 characters. `searchZipCode` is optional and must be either five digits or ZIP+4 format. Do not include `organizationId` in the body.

`trigger` accepts `DISC_TRIG_REGISTRATION`, `DISC_TRIG_SELF_PAY_FLAG`, `DISC_TRIG_BATCH_RETROACTIVE`, `DISC_TRIG_MANUAL`, and `DISC_TRIG_SCHEDULING`.
The OpenAPI schema does not expose a public `simulateOnly` flag for this endpoint.
Optional demographic fields can improve matching but increase privacy sensitivity.
The request body should not include the patient's full SSN, raw EHR response, raw payer payload, or credentials.

Response semantics

HTTP 201 returns the created or completed local search record and `meta.organizationId`. A result with found coverage still needs review and may need eligibility re-verification before billing workflows rely on it. This endpoint is not marked `SIMULATED_ONLY` in the public response schema.

`status` describes local discovery workflow state, not eligibility verification.
`source` is nullable and, when present, identifies the discovery source enum.
`foundCoverage.memberId` and related coverage fields are local discovery output and should be handled as sensitive insurance data.
`meta.organizationId` is tenant context metadata returned by the service.

Errors and retries

402 means the organization lacks enough discovery credits. 404 can indicate the patient was not found in the authenticated organization. 409 means a recent discovery search already exists for the patient, reflecting the 30-day dedupe behavior described by the implementation and module docs. Avoid blind retries after timeouts because the workflow can create a local record and consume credits.

400 can indicate missing required fields, invalid trigger, invalid date, overlong name/address values, invalid SSN last four, or invalid ZIP code.
402 is credit exhaustion.
409 is recent-search conflict/deduplication.
Do not retry unchanged 400 validation failures.

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
patientId	body	Yes	string	Required non-empty QuickRCM patient identifier. The patient must belong to the API key organization.	Minimum length: 1. Sensitive credential or storage-adjacent value; use placeholders only.
trigger	body	Yes	DISC_TRIG_REGISTRATION \| DISC_TRIG_SELF_PAY_FLAG \| DISC_TRIG_BATCH_RETROACTIVE \| DISC_TRIG_MANUAL \| DISC_TRIG_SCHEDULING	Required reason for the discovery search. Must be one of the public trigger enum values.	Enum values are declared in the Type column.
searchFirstName	body	Yes	string	Required first name used for discovery matching. Trimmed, non-empty, max 100 characters. Keep examples synthetic.	Minimum length: 1. Maximum length: 100.
searchLastName	body	Yes	string	Required last name used for discovery matching. Trimmed, non-empty, max 100 characters. Keep examples synthetic.	Minimum length: 1. Maximum length: 100.
searchDob	body	No	string	Optional date of birth used for matching. Must be a valid `YYYY-MM-DD` calendar date when supplied.	Pattern constraint declared in OpenAPI. Potential PHI; use synthetic examples and avoid logging raw values.
searchSsnLast4	body	No	string	Optional last four digits of the Social Security number (SSN) used for matching. Must be exactly four digits and must not be logged.	Pattern constraint declared in OpenAPI.
searchAddress	body	No	string	Optional address text used for matching. Trimmed, max 500 characters, and treated as patient demographic data.	Minimum length: 1. Maximum length: 500. Potential PHI; use synthetic examples and avoid logging raw values.
searchZipCode	body	No	string	Optional five-digit or ZIP+4 postal code used for matching.	Pattern constraint declared in OpenAPI.

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.

{
  "patientId": "00000000-0000-4000-8000-000000000001",
  "trigger": "DISC_TRIG_REGISTRATION",
  "searchFirstName": "Example insurance_discovery_search",
  "searchLastName": "Example insurance_discovery_search",
  "searchDob": "1984-03-22",
  "searchSsnLast4": "example-searchssnlast4",
  "searchAddress": "example-searchaddress",
  "searchZipCode": "example-searchzipcode"
}

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

Discovery search completed or queued.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "id": "00000000-0000-4000-8000-000000000001",
    "organizationId": "00000000-0000-4000-8000-000000000001",
    "patientId": "00000000-0000-4000-8000-000000000001",
    "batchId": "00000000-0000-4000-8000-000000000001",
    "status": "DISC_PENDING",
    "source": "DISC_SRC_EXPERIAN",
    "trigger": "DISC_TRIG_REGISTRATION",
    "foundCoverage": {
      "payerName": "Example insurance_discovery_search",
      "memberId": "W123456789",
      "groupId": "00000000-0000-4000-8000-000000000001",
      "planType": "example-plantype",
      "coverageStart": "2026-06-08T10:15:30Z",
      "coverageEnd": "2026-06-08T10:15:30Z",
      "matchScore": "example-matchscore"
    },
    "eligibilityCheckId": "00000000-0000-4000-8000-000000000001",
    "patientInsuranceId": "00000000-0000-4000-8000-000000000001",
    "verifiedAt": "2026-06-08T10:15:30Z",
    "dismissedAt": "2026-06-08T10:15:30Z",
    "dismissReason": "example-dismissreason",
    "searchStartedAt": "2026-06-08T10:15:30Z",
    "searchCompletedAt": "2026-06-08T10:15:30Z",
    "createdAt": "2026-06-08T10:15:30Z",
    "updatedAt": "2026-06-08T10:15:30Z"
  },
  "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.