Revenue Integrity

Validate coding data

Creates a local coding validation result from structured diagnosis and procedure code inputs, with optional claim, billing encounter, patient, Diagnosis-Related Group, encounter-type, Present on Admission, and length-of-stay request context.

POSTNeeds publication reviewValidate or simulateRevenue IntegrityoperationId: validateRevenueIntegrityCodinghttps://dev-api.quickintell.com/api/v1/revenue-integrity/coding-validations

Needs publication reviewValidate or simulateRevenue 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 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

Validate or simulate

Produces validation, preview, dry-run, or simulation output. Treat results as local compatibility behavior.

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 POST /api/v1/revenue-integrity/coding-validations. 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 POST /api/v1/revenue-integrity/coding-validations, 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Do not publish this endpoint as an ordinary developer API until its unresolved decisions are closed.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	Request body exposes an endpoint-specific idempotencyKey compatibility field.	Retry only with the documented key location and after checking endpoint state; 409 behavior and retention still need release evidence.
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.
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	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 after a coding system or integration has assembled structured codes that need Revenue Integrity review for modifiers, medical necessity, Present on Admission indicators, or Diagnosis-Related Group concerns.

Before calling

Authenticate with write scope. Resolve optional `claimId`, `billingEncounterId`, or `patientId` from the same tenant when those references are known.

Request and response behavior

Request guidance

`dateOfService`, at least one diagnosis code, and at least one procedure code are required. Diagnosis and procedure arrays are each capped at 250. Procedure `codeType` defaults to Current Procedural Terminology (CPT); diagnosis `isPrincipal` defaults to false. `encounterType` is INPATIENT, OUTPATIENT, EMERGENCY, or OBSERVATION when supplied.

`dateOfService` must be an ISO datetime.
`poaIndicators` require diagnosisCode, poaIndicator, and sequenceNumber for each supplied item.
Do not send raw chart transcripts, complete clinical notes, or payer payloads in code descriptions.

Response semantics

HTTP 201 returns a local validation result id, status `NEEDS_REVIEW`, mode `created`, and `meta.organizationId`. The immediate response is mutation metadata and does not include detailed validation findings, a final coding decision, or a claim coding update.

`status` is `NEEDS_REVIEW` on success.
The response does not include detailed validation findings.
This endpoint does not update claim coding directly.

Errors and retries

A 404 can indicate a referenced claim, billing encounter, or patient is unavailable in the tenant context. Correct schema validation errors before retrying. Check existing validation results before retrying after a timeout because the public contract does not guarantee duplicate suppression.

400 can indicate missing diagnosisCodes or procedureCodes, invalid codeType, or invalid encounterType.
404 can indicate wrong-tenant optional references.

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
claimId	body	No	string	Optional QuickRCM claim identifier scoped to the API-key organization.	Minimum length: 1.
billingEncounterId	body	No	string	Optional QuickRCM billing encounter identifier scoped to the same organization.	Minimum length: 1.
patientId	body	No	string	Optional QuickRCM patient identifier scoped to the same organization.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
dateOfService	body	Yes	string (date-time)	Required ISO datetime for the service date represented by the coded data.	Format: date-time.
encounterType	body	No	INPATIENT \| OUTPATIENT \| EMERGENCY \| OBSERVATION	Optional encounter classification: INPATIENT, OUTPATIENT, EMERGENCY, or OBSERVATION.	Enum values are declared in the Type column. Potential PHI; use synthetic examples and avoid logging raw values.
assignedDrg	body	No	string	Optional Diagnosis-Related Group code supplied as request context. Do not treat the create response as DRG validation output.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
diagnosisCodes	body	Yes	object[]	Required array of diagnosis code objects, capped at 250.	Potential PHI; use synthetic examples and avoid logging raw values.
diagnosisCodes[].code	body	Yes	string	Procedure, revenue, Diagnosis-Related Group (DRG), or other local code on a contract rate schedule row.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
diagnosisCodes[].description	body	No	string	Human-readable description of the queue, workflow, or record. Avoid secrets and unnecessary PHI.	Sensitive credential or storage-adjacent value; use placeholders only.
diagnosisCodes[].sequenceNumber	body	No	integer	OpenAPI description is missing; publication gap.	Minimum value: 1. Potential PHI; use synthetic examples and avoid logging raw values.
diagnosisCodes[].isPrincipal	body	No	boolean	OpenAPI description is missing; publication gap.	Default: false. Potential PHI; use synthetic examples and avoid logging raw values.
diagnosisCodes[].poaIndicator	body	No	string	OpenAPI description is missing; publication gap.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
procedureCodes	body	Yes	object[]	Required array of procedure code objects, capped at 250.	OpenAPI does not declare additional validation metadata.
procedureCodes[].code	body	Yes	string	Procedure, revenue, Diagnosis-Related Group (DRG), or other local code on a contract rate schedule row.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
procedureCodes[].description	body	No	string	Human-readable description of the queue, workflow, or record. Avoid secrets and unnecessary PHI.	Sensitive credential or storage-adjacent value; use placeholders only.
procedureCodes[].codeType	body	No	CPT \| HCPCS \| ICD10_PCS	Code set or classification used for a denial, appeal, collection, or claim workflow reason.	Enum values are declared in the Type column. Default: CPT.
procedureCodes[].modifiers	body	No	string[]	Array of procedure modifiers on a claim line.	Default: .
poaIndicators	body	No	object[]	Optional Present on Admission indicator entries keyed by diagnosis code and sequence number.	Potential PHI; use synthetic examples and avoid logging raw values.
poaIndicators[].diagnosisCode	body	Yes	string	Diagnosis code supporting the requested service, capped at 40 characters in create and update requests.	Minimum length: 1. Potential PHI; use synthetic examples and avoid logging raw values.
poaIndicators[].poaIndicator	body	Yes	string	OpenAPI description is missing; publication gap.	Minimum length: 1.
poaIndicators[].sequenceNumber	body	Yes	integer	OpenAPI description is missing; publication gap.	Minimum value: 1.
los	body	No	integer	Optional length of stay as a non-negative integer supplied as request context.	Minimum value: 0.
idempotencyKey	body	No	string	Optional caller retry marker capped at 200 characters.	Minimum length: 1. Maximum length: 200. Endpoint-specific compatibility key; universal Idempotency-Key header support is not declared.

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.

{
  "dateOfService": "2026-06-08T10:15:30Z",
  "diagnosisCodes": [
    {
      "code": "ERROR",
      "description": "Example revenue_integrity_coding note",
      "sequenceNumber": 1,
      "isPrincipal": false,
      "poaIndicator": "example-poaindicator"
    }
  ],
  "procedureCodes": [
    {
      "code": "ERROR",
      "description": "Example revenue_integrity_coding note",
      "codeType": "CPT",
      "modifiers": []
    }
  ],
  "claimId": "00000000-0000-4000-8000-000000000001",
  "billingEncounterId": "00000000-0000-4000-8000-000000000001",
  "patientId": "00000000-0000-4000-8000-000000000001",
  "encounterType": "INPATIENT",
  "assignedDrg": "example-assigneddrg",
  "poaIndicators": [
    {
      "diagnosisCode": "example-diagnosiscode",
      "poaIndicator": "example-poaindicator",
      "sequenceNumber": 1
    }
  ],
  "los": 1,
  "idempotencyKey": "example-idempotencykey"
}

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

Coding validation result created.

Generated from the OpenAPI response schema.

{
  "success": true,
  "data": {
    "id": "00000000-0000-4000-8000-000000000001",
    "status": "active",
    "mode": "created"
  },
  "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.