Coordination of Benefits

Create or update patient COB order

Creates or updates the local payer-order record for one organization-owned patient, including primary, secondary, optional tertiary insurance identifiers and the determination method.

PUTNeeds publication reviewExternal or credentialedCoordination of BenefitsoperationId: upsertCobOrderhttps://dev-api.quickintell.com/api/v1/cob/orders/{patientId}

Needs publication reviewExternal or credentialedClaims and remittances

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 remittances contract generated for PUT /api/v1/cob/orders/{patientId}. 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 PUT /api/v1/cob/orders/{patientId}, 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. Mutating behavior still needs side-effect and retry evidence.

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Do not publish this endpoint as an ordinary developer API until its unresolved decisions are closed.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	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

This endpoint needs explicit product, security/compliance, tenancy, or side-effect approval before publication.
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	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.

Coordination of Benefits public API.

Coordination of Benefits (COB) APIs expose organization-scoped workflows for maintaining a patient's payer order, finding secondary-claim opportunities from primary Electronic Remittance Advice (ERA, commonly X12 835) data, generating local secondary claim records, queueing secondary-claim submission workflow, checking local secondary status, posting local secondary payment state, and voiding non-paid secondary claims. The bearer API key selects the organization. Public callers should not send `organizationId` as a tenant selector. Medicare Secondary Payer (MSP) fields are local payer-order context unless an endpoint-specific response says otherwise. Read endpoints accept Coordination of Benefits read or write scope, while payer-order, detection, generation, submission, payment, and void endpoints require Coordination of Benefits write scope. Referenced patients, insurance identifiers, primary claims, remittances, secondary claims, payer identifiers, and generated records must resolve inside the authenticated organization. Use the secondary-claim lifecycle as local QuickRCM workflow state: generation creates or returns local `SC_GENERATED` records, submission accepts generated records and returns queue/submission metadata, status check reads submitted or acknowledged local status, payment posting can move eligible records to `SC_PAID` or `SC_DENIED`, and voiding marks eligible non-paid records `SC_VOID`. Crossover states (`SC_CROSSOVER_PENDING`, `SC_CROSSOVER_SENT`) are local lifecycle labels, not proof of payer completion by themselves. These endpoints coordinate QuickRCM local workflow state. They do not return raw X12 837P professional claim Electronic Data Interchange (EDI), raw X12 835 ERA, raw X12 276/277 claim-status EDI, payer portal, Amazon S3 object-storage, or Electronic Health Record (EHR) payloads; they do not prove payer acceptance, final adjudication, EHR writeback, patient accounts receivable balance transfer, cash posting, or external reversal by themselves. Use synthetic examples and keep notes/reasons free of unnecessary Protected Health Information (PHI), raw EDI, credentials, tokens, payer portal data, transcripts, and vendor payloads.

What this endpoint does

Use case

Use this when patient registration, eligibility review, or manual Coordination of Benefits review has established payer order and QuickRCM should store the local payer-order record before secondary opportunity detection or generation.

Before calling

Authenticate with `cob:write` scope. Resolve the patient and insurance identifiers from QuickRCM in the same organization. Supported insurance identifier inputs are organization-scoped payer configuration `id` or `payerId`, the selected patient's `PatientInsurance.id`, or that patient insurance row's linked organization-owned payer configuration `id`, `payerConfigId`, or `payerId`. Confirm the determination method is supported by the public enum.

Request and response behavior

Request guidance

`primaryInsuranceId`, `secondaryInsuranceId`, and `determinationMethod` are required. `tertiaryInsuranceId` is optional. Insurance identifiers are accepted only when they resolve through organization-scoped `PayerConfig.id`/`PayerConfig.payerId`, the selected patient's `PatientInsurance.id`, or that `PatientInsurance` row's linked organization-owned payer configuration identifiers. `notes` is capped at 2000 characters; keep it concise and avoid unnecessary Protected Health Information (PHI). `mspType` is capped at 255 characters when supplied.

Accepted insurance identifier sources are organization-scoped `PayerConfig.id`, organization-scoped `PayerConfig.payerId`, the selected patient's `PatientInsurance.id`, or that patient insurance row's linked organization-owned payer configuration identifiers.
`isMspApplicable` defaults false when not supplied by the handler path.
Use `COB_DET_MANUAL` only when the order was decided outside an automated rule.
Do not use payer names, member IDs, or raw eligibility responses as substitutes for these identifier fields.

Response semantics

HTTP 200 returns the stored `cobOrder` summary, including payer-order identifiers, determination method/date, Medicare Secondary Payer (MSP) flags, and timestamps. It is a local QuickRCM payer-order record and does not update Electronic Health Record (EHR) insurance slots or submit any claim by itself.

`notes` is accepted but not returned in the public response schema.
`determinationDate` is set when the record is updated and may be null on create depending on stored data.
The response confirms local Coordination of Benefits order storage only.

Errors and retries

Fix 400 payer-reference or validation failures before retrying. Treat 404 as missing or wrong-tenant patient context. Retry 429 with backoff.

400 can mean a primary, secondary, or tertiary insurance identifier does not resolve for the patient or organization.
404 means the patient was not found in the authenticated organization.
403 can mean missing COB write scope or tenant mismatch.

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
patientId	path	Yes	string	QuickRCM patient identifier in the path. The patient must belong to the API key organization.	Minimum length: 1. Sensitive credential or storage-adjacent value; use placeholders only.

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
primaryInsuranceId	body	Yes	string	Required identifier for the payer/insurance selected as primary. Accepted inputs are an organization-scoped payer configuration `id`/`payerId`, the selected patient's `PatientInsurance.id`, or that row's linked organization-owned payer configuration identifier.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
secondaryInsuranceId	body	Yes	string	Required identifier for the payer/insurance selected as secondary. It follows the same accepted identifier-source rules as `primaryInsuranceId`.	Minimum length: 1.
tertiaryInsuranceId	body	No	string	Optional identifier for tertiary coverage tracking. It follows the same accepted identifier-source rules as `primaryInsuranceId`.	Minimum length: 1.
determinationMethod	body	Yes	COB_DET_SUBSCRIBER_EMPLOYER \| COB_DET_BIRTHDAY_RULE \| COB_DET_GENDER_RULE \| COB_DET_ACTIVE_INACTIVE \| COB_DET_MSP_QUESTIONNAIRE \| COB_DET_MANUAL \| COB_DET_DEFAULT_ORDER	Method used to decide payer order: subscriber/employer, Birthday Rule, gender rule, active/inactive, Medicare Secondary Payer (MSP) questionnaire, manual, or default order.	Enum values are declared in the Type column. Potential PHI; use synthetic examples and avoid logging raw values.
isMspApplicable	body	No	boolean	Optional flag indicating Medicare Secondary Payer (MSP) logic was applicable to the determination.	File, artifact, or raw-payload adjacent; keep examples metadata-only.
mspType	body	No	string	Optional Medicare Secondary Payer (MSP) type/context label, capped at 255 characters.	Minimum length: 1. Maximum length: 255. File, artifact, or raw-payload adjacent; keep examples metadata-only.
notes	body	No	string	Optional local determination note, capped at 2000 characters. Avoid unnecessary Protected Health Information (PHI), raw payer text, or credentials.	Maximum length: 2000. Sensitive credential or storage-adjacent value; use placeholders only.

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.

{
  "primaryInsuranceId": "00000000-0000-4000-8000-000000000001",
  "secondaryInsuranceId": "00000000-0000-4000-8000-000000000001",
  "determinationMethod": "COB_DET_SUBSCRIBER_EMPLOYER",
  "tertiaryInsuranceId": "00000000-0000-4000-8000-000000000001",
  "isMspApplicable": true,
  "mspType": "example-msptype",
  "notes": "Example upsert_cob_order 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

COB order created or updated for the authenticated organization.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "cobOrder": {
      "id": "00000000-0000-4000-8000-000000000001",
      "organizationId": "00000000-0000-4000-8000-000000000001",
      "patientId": "00000000-0000-4000-8000-000000000001",
      "primaryInsuranceId": "00000000-0000-4000-8000-000000000001",
      "secondaryInsuranceId": "00000000-0000-4000-8000-000000000001",
      "tertiaryInsuranceId": "00000000-0000-4000-8000-000000000001",
      "determinationMethod": "COB_DET_SUBSCRIBER_EMPLOYER",
      "determinationDate": "2026-06-08T10:15:30Z",
      "isMspApplicable": true,
      "mspType": "example-msptype",
      "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 body or payer references.