Appeals

Create or update appeal compliance rule

Creates or updates an organization-scoped appeal compliance rule using payer type, jurisdiction state, and appeal level.

POSTPublic reference baselineExternal or credentialedAppealsoperationId: upsertAppealComplianceRulehttps://dev-api.quickintell.com/api/v1/appeals/compliance-rules

Public reference baselineExternal or credentialedClaims and denials

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 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 POST /api/v1/appeals/compliance-rules. 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/appeals/compliance-rules contract as a external or credentialed 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.
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

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.

Appeals public API.

Appeals APIs manage QuickRCM denial appeal records, supporting document workflows, peer-to-peer reviews, deadlines, reminders, analytics, and compliance tracking. All endpoints are scoped to the organization selected by the bearer API key; callers do not provide a public organization selector. Use these endpoints after a denial case, claim, supporting document, reminder, peer-to-peer review, compliance event, or compliance rule already exists in QuickRCM. Read endpoints accept `appeals:read` or `appeals:write`; write endpoints require `appeals:write`. The public API exposes local workflow state and sanitized metadata. It intentionally avoids returning raw payer payloads, PHI-heavy activity metadata, S3 object keys, raw EDI, transcripts, or vendor credentials. Electronic portal appeal submission is validate-only through the public API and returns a simulated validation response rather than transmitting a payer payload.

What this endpoint does

Use case

Use this when an organization needs to define or revise its own appeal compliance timing rule.

Before calling

Confirm the rule values match the organization's policy and have been reviewed by qualified staff; do not present these public API docs as legal advice.

Request and response behavior

Request guidance

Send the complete rule body: required `payerType`, `appealLevel`, `providerFilingDays`, `payerResponseDays`, and `regulatoryReference`; optional `jurisdictionState`, `expeditedFilingHours`, `expeditedResponseHours`, `description`, `penaltyForViolation`, and `isActive`.

`regulatoryReference` is required.
Set `isActive` false rather than deleting historical rule context when applicable.

Response semantics

The response returns the created or updated organization-scoped rule. POST can return 201 for create or 200 when an existing matching rule is updated.

Returned rule is scoped to the authenticated organization.
Global rules are not modified by this endpoint.

Errors and retries

After a timeout, list rules using the same payer type, jurisdiction state, and appeal level before retrying.

400 means rule validation failed.
401/403 require credential or scope correction.

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
payerType	body	Yes	string	Required payer category for the compliance rule, such as a configured payer class or payer type string.	Minimum length: 1. Maximum length: 100.
jurisdictionState	body	No	string	Optional nullable two-letter state code for state-specific rules; null or omitted means not state-specific.	Minimum length: 2. Maximum length: 2.
appealLevel	body	Yes	LEVEL_1_RECONSIDERATION \| LEVEL_2_FORMAL_APPEAL \| LEVEL_3_EXTERNAL_REVIEW \| LEVEL_4_ALJ_HEARING \| LEVEL_5_COUNCIL_REVIEW \| LEVEL_6_FEDERAL_COURT \| STATE_FAIR_HEARING \| INDEPENDENT_REVIEW_ORG \| STATE_INSURANCE_DEPT	Required appeal level enum value the rule applies to.	Enum values are declared in the Type column.
providerFilingDays	body	Yes	integer	Required provider filing window in whole days; the schema permits 0 through 3650.	Minimum value: 0. Maximum value: 3650.
expeditedFilingHours	body	No	integer	Optional nullable expedited filing window in hours; the schema permits 0 through 8760.	Minimum value: 0. Maximum value: 8760. File, artifact, or raw-payload adjacent; keep examples metadata-only.
payerResponseDays	body	Yes	integer	Required payer response window in whole days; the schema permits 0 through 3650.	Minimum value: 0. Maximum value: 3650.
expeditedResponseHours	body	No	integer	Optional nullable expedited payer response window in hours; the schema permits 0 through 8760.	Minimum value: 0. Maximum value: 8760. File, artifact, or raw-payload adjacent; keep examples metadata-only.
regulatoryReference	body	Yes	string	Required reference text for the policy, contract, or regulation supporting the rule; max length is 500.	Minimum length: 1. Maximum length: 500.
description	body	No	string	Optional nullable rule description; max length is 2000. This is operational documentation, not legal advice.	Minimum length: 1. Maximum length: 2000. File, artifact, or raw-payload adjacent; keep examples metadata-only.
penaltyForViolation	body	No	string	Optional nullable description of consequence or policy for violating the rule; max length is 2000.	Minimum length: 1. Maximum length: 2000.
isActive	body	No	boolean	Optional boolean controlling whether the rule is active.	OpenAPI does not declare additional validation metadata.

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.

{
  "payerType": "example-payertype",
  "appealLevel": "LEVEL_1_RECONSIDERATION",
  "providerFilingDays": 1,
  "payerResponseDays": 1,
  "regulatoryReference": "example-regulatoryreference",
  "jurisdictionState": "example-jurisdictionstate",
  "expeditedFilingHours": 1,
  "expeditedResponseHours": 1,
  "description": "Example upsert_appeal_compliance_rule note",
  "penaltyForViolation": "example-penaltyforviolation",
  "isActive": true
}

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

Compliance rule updated

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "complianceRule": {
      "id": "00000000-0000-4000-8000-000000000001",
      "organizationId": "00000000-0000-4000-8000-000000000001",
      "payerType": "example-payertype",
      "jurisdictionState": "example-jurisdictionstate",
      "appealLevel": "LEVEL_1_RECONSIDERATION",
      "providerFilingDays": 1,
      "expeditedFilingHours": 1,
      "payerResponseDays": 1,
      "expeditedResponseHours": 1,
      "regulatoryReference": "example-regulatoryreference",
      "description": "Example upsert_appeal_compliance_rule note",
      "penaltyForViolation": "example-penaltyforviolation",
      "isActive": true,
      "createdAt": "2026-06-08T10:15:30Z",
      "updatedAt": "2026-06-08T10:15:30Z"
    }
  }
}

201

Compliance rule created

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "complianceRule": {
      "id": "00000000-0000-4000-8000-000000000001",
      "organizationId": "00000000-0000-4000-8000-000000000001",
      "payerType": "example-payertype",
      "jurisdictionState": "example-jurisdictionstate",
      "appealLevel": "LEVEL_1_RECONSIDERATION",
      "providerFilingDays": 1,
      "expeditedFilingHours": 1,
      "payerResponseDays": 1,
      "expeditedResponseHours": 1,
      "regulatoryReference": "example-regulatoryreference",
      "description": "Example upsert_appeal_compliance_rule note",
      "penaltyForViolation": "example-penaltyforviolation",
      "isActive": true,
      "createdAt": "2026-06-08T10:15:30Z",
      "updatedAt": "2026-06-08T10:15:30Z"
    }
  }
}

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

Handle this response as normal integration control flow.

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

401

Authentication required

Handle this response as normal integration control flow.

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

403

Organization access denied

Handle this response as normal integration control flow.

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

Adjacent endpoints

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

POSTPublic reference baselineLocal write

Acknowledge appeal reminder

/api/v1/appeals/reminders/{reminderId}/acknowledge

POSTPublic reference baselineFile or artifact

Add appeal supporting document

/api/v1/appeals/{appealId}/documents

PUTPublic reference baselineLocal write

Cancel peer-to-peer review

/api/v1/appeals/peer-to-peer/{p2pReviewId}/cancel

POSTPublic reference baselineLocal write

Compile appeal packet

/api/v1/appeals/{appealId}/packet/compile

POSTPublic reference baselineLocal write

Create appeal

/api/v1/appeals

POSTPublic reference baselineFile or artifact

Create appeal document download URL

/api/v1/appeals/documents/{documentId}/download-url

All endpoint pages Open Scalar reference