feat: Preauth column for AI claims; searchable policy holder + ADA box 18; 2PA fix

- Schedule: last column is the Preauth column; "Claim for Column with AI" is now
  "Claim/Preauth for Column with AI" — that column's appointments go to PreAuth
  (MH, CCA, Tufts SCO, United/DentalHub; other insurances are skipped), the rest
  to Claim. Preauthorized appointments (hasPreauth) aren't resubmitted
- PreAuth payloads carry appointmentId; appointment X-rays/attachments are sent
  with MH/CCA/UnitedDH/Tufts preauths (shared appendAppointmentFiles helper)
- Patient form: policy holder is searchable from patients in the DB, plus
  "Relationship to Policy Holder/Subscriber" (Self, Spouse, Dependent Child,
  Other). New Patient columns policyHolderPatientId, policyHolderRelationship;
  browser-side schema updated so the fields aren't stripped on save
- ADA form: box 12-14 filled from the linked policy holder's record; box 18
  ticks the relationship (Self when the patient is the holder)
- AI notes: a bare "2PA" is an image count, not tooth #2 — restored before CDT
  lookup so it maps to D0220 #8 / D0230 #24

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>

apps/Backend/src/ai/internal-chat-graph.ts

@@ -206,6 +206,8 @@ Rules:
   e.g. "3 PA (#3, 14, 30)" → ["1 pa, #3", "2nd pa, #14", "2nd pa, #30"]
   e.g. "4 PA (#3, 14, 19, 30)" → ["1 pa, #3", "2nd pa, #14", "2nd pa, #19", "2nd pa, #30"]
   e.g. "2 pa #3 #14" → ["1 pa, #3", "2nd pa, #14"]
+- A number written right before PA with NO tooth numbers ("2PA", "4 PA") is the image count, never a tooth number — keep it exactly as written:
+  e.g. "perio exam, 2PA, 4BW" → ["perio exam", "2PA", "4BW"]   (NOT "1 pa, #2")
 - insuranceHint is only set when the user explicitly names an insurance in the message
 - renderingProvider is only set when the user explicitly names a treating/rendering provider or doctor
   e.g. "with provider Kai Gao", "provider Dr. Smith", "rendered by Kai Gao", "doctor Kai Gao"
@@ -239,6 +241,19 @@ Rules:
 // nothing else in it — e.g. "100232102531 4/27/1999" or "100232102531, 4/27/1999".
 // Bypasses the LLM entirely so this always resolves to eligibility_by_id, since some
 // providers hedge/refuse structured output on a bare digit string that looks like an SSN.
+// "2PA" / "4 PA" with no tooth numbers is an image count. The LLM sometimes rewrites it as
+// "1 pa, #2" (count read as a tooth), so put the original "NPA" back for the CDT lookup.
+function restoreBarePaCount(message: string, names: string[]): string[] {
+  const bare = [...message.matchAll(/\b(\d+)\s*pas?\b(?!\s*[(#])/gi)];
+  if (bare.length !== 1) return names;
+  const isPa = (n: string) => /^\s*(?:\d+(?:st|nd|rd|th)?\s*)?(?:pa|periapical)\b/i.test(n);
+  const first = names.findIndex(isPa);
+  if (first === -1) return names;
+  const kept = names.filter((n) => !isPa(n));
+  kept.splice(first, 0, `${bare[0]![1]}PA`);
+  return kept;
+}
+
 function parseBareIdDob(message: string): { memberId: string; dob: string } | null {
   const text = message.trim();
   const dobPattern = /(\d{1,2}[\/\-]\d{1,2}[\/\-]\d{4})/;
@@ -331,6 +346,7 @@ export async function classifyInternalChat(
     const jsonStr = raw.replace(/^```json\s*/i, "").replace(/```\s*$/, "").trim();
     const parsed = JSON.parse(jsonStr) as ChatClassification;
     if (!parsed.intent || !parsed.fallbackReply) return fallback;
+    if (parsed.procedureNames) parsed.procedureNames = restoreBarePaCount(message, parsed.procedureNames);
     return parsed;
   } catch (err) {
     const msg = err instanceof Error ? err.message : String(err);

apps/Backend/src/routes/appointments.ts

@@ -102,16 +102,18 @@ router.get("/day", async (req: Request, res: Response): Promise<any> => {
 
     // Enrich each appointment with procedure / claim status flags
     const appointmentIds = appointments.map((a) => a.id).filter((id): id is number => id != null);
-    const [idsWithProcedures, idsWithClaimNumbers, procedureCodesByAppt] = await Promise.all([
+    const [idsWithProcedures, idsWithClaimNumbers, procedureCodesByAppt, idsWithPreauth] = await Promise.all([
       storage.getAppointmentIdsWithProcedures(appointmentIds),
       storage.getAppointmentIdsWithClaimNumbers(appointmentIds),
       storage.getProcedureCodesByAppointmentIds(appointmentIds),
+      storage.getAppointmentIdsWithPreauth(appointmentIds),
     ]);
 
     const enrichedAppointments = appointments.map((a) => ({
       ...a,
       hasProcedures: a.id != null && idsWithProcedures.has(a.id),
       hasClaimWithNumber: a.id != null && idsWithClaimNumbers.has(a.id),
+      hasPreauth: a.id != null && idsWithPreauth.has(a.id),
       procedureCodes: a.id != null ? (procedureCodesByAppt.get(a.id) ?? []) : [],
     }));
 

apps/Backend/src/routes/claims.ts

@@ -21,6 +21,7 @@ import { forwardToSeleniumClaimPreAuthAgent } from "../services/seleniumInsuranc
 import { formatDobForAgent } from "../utils/dateUtils";
 import { ADA_PAYERS, buildAdaClaimPdf } from "../services/adaClaimForm";
 import { backupScreenshots } from "../utils/screenshotBackup";
+import { appendAppointmentFiles } from "../utils/appointmentAttachments";
 
 const router = Router();
 
@@ -347,24 +348,11 @@ router.post(
         mimetype: f.mimetype,
       }));
 
-      // Include attachments already saved on the appointment (e.g. via "Select Procedures")
-      // that weren't re-uploaded in this request — read straight from disk by filePath.
+      // Include attachments already saved on the appointment.
       // Skipped for chatbot-driven submissions, which already send every intended file and
       // shouldn't have unrelated older appointment attachments silently tacked on.
-      if (claimData.appointmentId && !claimData.skipAppointmentAttachmentMerge) {
-        const seenNames = new Set(filesForQueue.map((f) => f.originalname));
-        const apptFiles = await storage.getAppointmentFiles(Number(claimData.appointmentId));
-        for (const f of apptFiles) {
-          if (!f.filePath || seenNames.has(f.filename)) continue;
-          const absPath = path.join(process.cwd(), f.filePath);
-          if (!fs.existsSync(absPath)) continue;
-          filesForQueue.push({
-            originalname: f.filename,
-            bufferBase64: fs.readFileSync(absPath).toString("base64"),
-            mimetype: f.mimeType ?? "application/octet-stream",
-          });
-          seenNames.add(f.filename);
-        }
+      if (!claimData.skipAppointmentAttachmentMerge) {
+        await appendAppointmentFiles(filesForQueue, claimData.appointmentId);
       }
 
       const job = await seleniumQueue.add("claim-submit", {
@@ -564,6 +552,9 @@ router.post(
         mimetype: f.mimetype,
       }));
 
+      // Include X-rays etc. already attached to the appointment
+      await appendAppointmentFiles(filesForQueue, claimData.appointmentId);
+
       const job = await seleniumQueue.add("claim-pre-auth", {
         jobType: "claim-pre-auth",
         userId: req.user.id,
@@ -1263,9 +1254,14 @@ async function buildAdaFormForRequest(req: Request): Promise<AdaFormResult> {
   const treatingProvider =
     claim.npiProvider ?? (await storage.getNpiProvidersByUser(req.user!.id))[0] ?? null;
 
+  const holderId = (claim.patient as any).policyHolderPatientId as number | null | undefined;
+  const policyHolderPatient =
+    holderId && holderId !== claim.patient.id ? ((await storage.getPatient(holderId)) ?? null) : null;
+
   const pdf = await buildAdaClaimPdf({
     claim,
     patient: claim.patient,
+    policyHolderPatient,
     office,
     treatingProvider,
     payer,

apps/Backend/src/routes/insuranceStatusCCAPreAuth.ts

@@ -2,6 +2,7 @@ import { Router, Request, Response } from "express";
 import { storage } from "../storage";
 import { enqueueSeleniumJob } from "../queue/jobRunner";
 import multer from "multer";
+import { appendAppointmentFiles } from "../utils/appointmentAttachments";
 
 const router = Router();
 const upload = multer({ storage: multer.memoryStorage() });
@@ -55,6 +56,8 @@ router.post(
         bufferBase64: f.buffer.toString("base64"),
         mimetype: f.mimetype,
       }));
+      // Include X-rays etc. already attached to the appointment
+      await appendAppointmentFiles(filesForQueue, claimData.appointmentId);
 
       const enrichedPayload = {
         claim: {

apps/Backend/src/services/adaClaimForm.ts

@@ -62,7 +62,19 @@ export type AdaClaimInput = {
     insuranceId?: string | null;
     groupNumber?: string | null;
     policyHolder?: string | null;
+    policyHolderRelationship?: string | null;
   };
+  /** Policy holder's own patient record (Patient.policyHolderPatientId), when not self */
+  policyHolderPatient?: {
+    firstName: string;
+    lastName: string;
+    dateOfBirth?: Date | string | null;
+    gender?: string | null;
+    address?: string | null;
+    city?: string | null;
+    state?: string | null;
+    zipCode?: string | null;
+  } | null;
   office: {
     legalName?: string | null;
     officeName?: string | null;
@@ -257,10 +269,12 @@ async function fillOnePage(
   const genderBox = { M: "Check Box1", F: "Check Box2", U: "Check Box3" }[gender];
 
   const holder = (patient.policyHolder ?? "").trim();
-  const isSelf =
-    !holder ||
-    holder.toLowerCase() === "self" ||
-    normName(holder) === normName(`${patient.firstName} ${patient.lastName}`);
+  const relationship = (patient.policyHolderRelationship ?? "").trim().toUpperCase();
+  const isSelf = relationship
+    ? relationship === "SELF"
+    : !holder ||
+      holder.toLowerCase() === "self" ||
+      normName(holder) === normName(`${patient.firstName} ${patient.lastName}`);
 
   if (isSelf) {
     setText(form, "12 PolicyholderSubscriber Name Last First Middle Initial Suffix", patientName);
@@ -268,11 +282,28 @@ async function fillOnePage(
     setText(form, "12 City, State, Zip", patientCsz);
     setText(form, "13 Date of Birth MMDDCCYY", dob);
     check(form, `14 ${genderBox}`);
-    check(form, "18 Check Box1");
+  } else if (input.policyHolderPatient) {
+    // Subscriber is another patient in the system: fill 12-14 from their record
+    const h = input.policyHolderPatient;
+    setText(form, "12 PolicyholderSubscriber Name Last First Middle Initial Suffix", `${h.lastName}, ${h.firstName}`);
+    setText(form, "12 Address 1", h.address);
+    setText(
+      form,
+      "12 City, State, Zip",
+      cityStateZip(h.city, h.state || (h.address || h.city ? officeState : ""), h.zipCode),
+    );
+    setText(form, "13 Date of Birth MMDDCCYY", fmtDate(h.dateOfBirth));
+    const hGenderBox = { M: "Check Box1", F: "Check Box2", U: "Check Box3" }[genderCode(h.gender)];
+    check(form, `14 ${hGenderBox}`);
   } else {
-    // Subscriber is someone else: name only; DOB, gender and relationship are completed by hand.
+    // Subscriber typed by name only: DOB, gender and address are completed by hand.
     setText(form, "12 PolicyholderSubscriber Name Last First Middle Initial Suffix", holder);
   }
+  // 18. Relationship to policyholder: Self, Spouse, Dependent Child, Other (left to right)
+  const relationshipBox = isSelf
+    ? "Check Box1"
+    : { SPOUSE: "Check Box2", DEPENDENT: "Check Box3", OTHER: "Check Box4" }[relationship];
+  if (relationshipBox) check(form, `18 ${relationshipBox}`);
   setText(form, "15 Policyho derSubscriber ID Assigned by Plan", claim.memberId || patient.insuranceId);
   setText(form, "16 PlanGroup Number", patient.groupNumber);
 

apps/Backend/src/storage/claims-storage.ts

@@ -24,6 +24,7 @@ export interface IStorage {
   updateClaimStatus(id: number, status: ClaimStatus): Promise<Claim>;
   deleteClaim(id: number): Promise<void>;
   getAppointmentIdsWithClaimNumbers(ids: number[]): Promise<Set<number>>;
+  getAppointmentIdsWithPreauth(ids: number[]): Promise<Set<number>>;
 }
 
 export const claimsStorage: IStorage = {
@@ -137,4 +138,19 @@ export const claimsStorage: IStorage = {
     });
     return new Set(rows.map((r: { appointmentId: number | null }) => r.appointmentId));
   },
+
+  async getAppointmentIdsWithPreauth(ids: number[]): Promise<Set<number>> {
+    if (!ids.length) return new Set();
+    const rows = await db.claim.findMany({
+      // PREAUTH records are created before the Selenium run, so only count ones that got a number back
+      where: {
+        appointmentId: { in: ids },
+        status: "PREAUTH" as ClaimStatus,
+        OR: [{ preAuthNumber: { not: null } }, { claimNumber: { not: null } }],
+      },
+      select: { appointmentId: true },
+      distinct: ["appointmentId"],
+    });
+    return new Set(rows.map((r: { appointmentId: number | null }) => r.appointmentId));
+  },
 };

apps/Backend/src/utils/appointmentAttachments.ts

@@ -0,0 +1,27 @@
+import path from "path";
+import fs from "fs";
+import { storage } from "../storage";
+
+type QueuedFile = { originalname: string; bufferBase64: string; mimetype: string };
+
+// Include attachments already saved on the appointment (e.g. X-rays added via "Select Procedures")
+// that weren't re-uploaded in this request — read straight from disk by filePath.
+export async function appendAppointmentFiles(
+  filesForQueue: QueuedFile[],
+  appointmentId: number | string | null | undefined,
+): Promise<void> {
+  if (!appointmentId) return;
+  const seenNames = new Set(filesForQueue.map((f) => f.originalname));
+  const apptFiles = await storage.getAppointmentFiles(Number(appointmentId));
+  for (const f of apptFiles) {
+    if (!f.filePath || seenNames.has(f.filename)) continue;
+    const absPath = path.join(process.cwd(), f.filePath);
+    if (!fs.existsSync(absPath)) continue;
+    filesForQueue.push({
+      originalname: f.filename,
+      bufferBase64: fs.readFileSync(absPath).toString("base64"),
+      mimetype: f.mimeType ?? "application/octet-stream",
+    });
+    seenNames.add(f.filename);
+  }
+}

apps/Frontend/src/components/claims/claim-form.tsx

@@ -638,7 +638,8 @@ export function ClaimForm({
           insuranceSiteKey,
         });
       });
-      setPrefillDone(true);
+      // With an appointment, 2b (procedures + X-ray attachments) marks prefill done
+      if (!appointmentId) setPrefillDone(true);
     } catch {}
   }, []);
 
@@ -1118,6 +1119,7 @@ export function ClaimForm({
       patientId: patientId,
       insuranceProvider: "Mass Health",
       insuranceSiteKey: "MH",
+      appointmentId: appointmentId ?? 0,
     });
 
     // 5. Close form
@@ -1607,6 +1609,7 @@ export function ClaimForm({
       patientId,
       insuranceProvider: "CCA",
       insuranceSiteKey: "CCA",
+      appointmentId: appointmentId ?? 0,
     });
 
     onClose();
@@ -1650,7 +1653,8 @@ export function ClaimForm({
       patientId,
       insuranceProvider: "United/DentalHub",
       insuranceSiteKey: "UNITED_SCO",
-      claimFiles: udPreAuthFilesMeta,
+      appointmentId: appointmentId ?? 0,
+      claimFiles: mergeWithExistingAttachments(udPreAuthFilesMeta),
     });
 
     onClose();
@@ -1694,7 +1698,8 @@ export function ClaimForm({
       patientId,
       insuranceProvider: "Tufts SCO",
       insuranceSiteKey: "TUFTS_SCO",
-      claimFiles: preAuthFilesMeta,
+      appointmentId: appointmentId ?? 0,
+      claimFiles: mergeWithExistingAttachments(preAuthFilesMeta),
     });
 
     onClose();

apps/Frontend/src/components/patients/patient-form.tsx

@@ -32,6 +32,15 @@ import {
 } from "@repo/db/types";
 import { z } from "zod";
 import { DateInputField } from "@/components/ui/dateInputField";
+import { PolicyHolderSearch } from "@/components/patients/policy-holder-search";
+
+// ADA claim form box 18 — relationship to policyholder/subscriber
+const POLICY_HOLDER_RELATIONSHIPS = [
+  { value: "SELF", label: "Self" },
+  { value: "SPOUSE", label: "Spouse" },
+  { value: "DEPENDENT", label: "Dependent Child" },
+  { value: "OTHER", label: "Other" },
+];
 
 // New England first (most patients), then the remaining states alphabetically
 const US_STATES = [
@@ -53,6 +62,11 @@ interface PatientFormProps {
   onSubmit: (data: InsertPatient | UpdatePatient) => void;
 }
 
+// Patients saved before the relationship field existed: no policy holder means the
+// patient is the holder, so show Self (matches how the ADA form treats them).
+const defaultRelationship = (p: Patient): string =>
+  p.policyHolderRelationship || (!(p.policyHolder ?? "").trim() ? "SELF" : "");
+
 export type PatientFormRef = {
   submit: () => void;
 };
@@ -100,6 +114,7 @@ export const PatientForm = forwardRef<PatientFormRef, PatientFormProps>(
             ? formatLocalDate(new Date(patient.dateOfBirth))
             : null,
           insuranceProvider: normalizeInsuranceProvider(patient.insuranceProvider),
+          policyHolderRelationship: defaultRelationship(patient),
         };
       }
       return {
@@ -117,6 +132,8 @@ export const PatientForm = forwardRef<PatientFormRef, PatientFormProps>(
         insuranceId: extractedInfo?.insuranceId || "",
         groupNumber: "",
         policyHolder: "",
+        policyHolderPatientId: null,
+        policyHolderRelationship: "SELF",
         allergies: "",
         medicalConditions: "",
         preferredLanguage: "English",
@@ -156,6 +173,7 @@ export const PatientForm = forwardRef<PatientFormRef, PatientFormProps>(
             ? formatLocalDate(new Date(patient.dateOfBirth))
             : null,
           insuranceProvider: normalized,
+          policyHolderRelationship: defaultRelationship(patient),
         };
         form.reset(resetValues);
         // Explicit setValue ensures the controlled Select re-renders with the new value
@@ -532,6 +550,41 @@ export const PatientForm = forwardRef<PatientFormRef, PatientFormProps>(
                 )}
               />
 
+              <FormField
+                control={form.control}
+                name="policyHolderRelationship"
+                render={({ field }) => (
+                  <FormItem>
+                    <FormLabel>Relationship to Policy Holder/Subscriber</FormLabel>
+                    <Select
+                      value={field.value || ""}
+                      onValueChange={(v) => {
+                        field.onChange(v);
+                        // Self: the patient is the policy holder, so drop any other holder
+                        if (v === "SELF") {
+                          form.setValue("policyHolder", "", { shouldDirty: true });
+                          form.setValue("policyHolderPatientId" as any, null, { shouldDirty: true });
+                        }
+                      }}
+                    >
+                      <FormControl>
+                        <SelectTrigger>
+                          <SelectValue placeholder="Select relationship" />
+                        </SelectTrigger>
+                      </FormControl>
+                      <SelectContent>
+                        {POLICY_HOLDER_RELATIONSHIPS.map((r) => (
+                          <SelectItem key={r.value} value={r.value}>
+                            {r.label}
+                          </SelectItem>
+                        ))}
+                      </SelectContent>
+                    </Select>
+                    <FormMessage />
+                  </FormItem>
+                )}
+              />
+
               <FormField
                 control={form.control}
                 name="policyHolder"
@@ -539,7 +592,19 @@ export const PatientForm = forwardRef<PatientFormRef, PatientFormProps>(
                   <FormItem>
                     <FormLabel>Policy Holder (if not self)</FormLabel>
                     <FormControl>
-                      <Input {...field} value={field.value || ""} />
+                      <PolicyHolderSearch
+                        value={field.value || ""}
+                        holderPatientId={(form.watch("policyHolderPatientId" as any) as number | null) ?? null}
+                        excludePatientId={patient?.id}
+                        onChange={(name, holderPatientId) => {
+                          field.onChange(name);
+                          form.setValue("policyHolderPatientId" as any, holderPatientId, { shouldDirty: true });
+                          // Picking someone else means the patient isn't the holder
+                          if (name.trim() && form.getValues("policyHolderRelationship" as any) === "SELF") {
+                            form.setValue("policyHolderRelationship" as any, "", { shouldDirty: true });
+                          }
+                        }}
+                      />
                     </FormControl>
                     <FormMessage />
                   </FormItem>

apps/Frontend/src/components/patients/patient-table.tsx

@@ -1320,6 +1320,14 @@ export function PatientTable({
                       <span className="text-gray-500">Policy Holder:</span>{" "}
                       {currentPatient.policyHolder || "Self"}
                     </p>
+                    {currentPatient.policyHolderRelationship && (
+                      <p>
+                        <span className="text-gray-500">Relationship:</span>{" "}
+                        {({ SELF: "Self", SPOUSE: "Spouse", DEPENDENT: "Dependent Child", OTHER: "Other" } as Record<string, string>)[
+                          currentPatient.policyHolderRelationship
+                        ] ?? currentPatient.policyHolderRelationship}
+                      </p>
+                    )}
                   </div>
                 </div>
 

apps/Frontend/src/components/patients/policy-holder-search.tsx

@@ -0,0 +1,116 @@
+import { useEffect, useRef, useState } from "react";
+import { useQuery } from "@tanstack/react-query";
+import { useDebounce } from "use-debounce";
+import { X } from "lucide-react";
+import { Input } from "@/components/ui/input";
+import { apiRequest } from "@/lib/queryClient";
+import { formatLocalDate } from "@/utils/dateUtils";
+import type { Patient } from "@repo/db/types";
+
+interface PolicyHolderSearchProps {
+  /** Policy holder name as stored on the patient (free text) */
+  value: string;
+  /** Linked patient record of the policy holder, if one was picked */
+  holderPatientId: number | null;
+  /** Patient being edited — hidden from the results */
+  excludePatientId?: number;
+  onChange: (name: string, holderPatientId: number | null) => void;
+}
+
+// Type to search patients in the DB and pick the policy holder; free text is still allowed
+// for holders who aren't patients here (then holderPatientId is null).
+export function PolicyHolderSearch({ value, holderPatientId, excludePatientId, onChange }: PolicyHolderSearchProps) {
+  const [open, setOpen] = useState(false);
+  const [debounced] = useDebounce(value.trim(), 300);
+  const wrapperRef = useRef<HTMLDivElement>(null);
+
+  // The search API matches one name field at a time, so query by the first word
+  // and narrow by the remaining words here ("john smith" → name=john, then must contain "smith").
+  const tokens = debounced.toLowerCase().split(/[\s,]+/).filter(Boolean);
+  const { data: results = [], isFetching } = useQuery<Patient[]>({
+    queryKey: ["policy-holder-search", tokens[0] ?? ""],
+    queryFn: async () => {
+      const res = await apiRequest(
+        "GET",
+        `/api/patients/search?name=${encodeURIComponent(tokens[0]!)}&limit=50&offset=0`,
+      );
+      if (!res.ok) return [];
+      const payload = await res.json();
+      return Array.isArray(payload) ? payload : (payload.patients ?? []);
+    },
+    enabled: open && tokens.length > 0 && holderPatientId == null,
+  });
+
+  const matches = results
+    .filter((p) => p.id !== excludePatientId)
+    .filter((p) => {
+      const full = `${p.firstName} ${p.lastName}`.toLowerCase();
+      return tokens.every((t) => full.includes(t));
+    })
+    .slice(0, 10);
+
+  useEffect(() => {
+    const onDown = (e: MouseEvent) => {
+      if (wrapperRef.current && !wrapperRef.current.contains(e.target as Node)) setOpen(false);
+    };
+    document.addEventListener("mousedown", onDown);
+    return () => document.removeEventListener("mousedown", onDown);
+  }, []);
+
+  return (
+    <div ref={wrapperRef} className="relative">
+      <Input
+        value={value}
+        placeholder="Search patient by name…"
+        autoComplete="off"
+        onFocus={() => setOpen(true)}
+        onChange={(e) => {
+          // Editing the text unlinks any previously selected patient
+          onChange(e.target.value, null);
+          setOpen(true);
+        }}
+        className={holderPatientId != null ? "pr-8 border-blue-400 bg-blue-50" : "pr-8"}
+      />
+      {value && (
+        <button
+          type="button"
+          className="absolute right-2 top-1/2 -translate-y-1/2 text-gray-400 hover:text-gray-600"
+          onClick={() => onChange("", null)}
+          title="Clear"
+        >
+          <X className="h-4 w-4" />
+        </button>
+      )}
+      {holderPatientId != null && (
+        <p className="mt-1 text-xs text-blue-600">Linked to patient record #{holderPatientId}</p>
+      )}
+      {open && holderPatientId == null && tokens.length > 0 && (
+        <div className="absolute z-50 mt-1 w-full max-h-60 overflow-y-auto rounded-md border bg-white shadow-md">
+          {isFetching && matches.length === 0 ? (
+            <div className="px-3 py-2 text-xs text-gray-500">Searching…</div>
+          ) : matches.length === 0 ? (
+            <div className="px-3 py-2 text-xs text-gray-500">No matching patients — the name will be saved as typed.</div>
+          ) : (
+            matches.map((p) => (
+              <button
+                key={p.id}
+                type="button"
+                className="block w-full px-3 py-2 text-left text-sm hover:bg-gray-100"
+                onClick={() => {
+                  onChange(`${p.firstName} ${p.lastName}`.trim(), Number(p.id));
+                  setOpen(false);
+                }}
+              >
+                <span className="font-medium">{p.firstName} {p.lastName}</span>
+                <span className="ml-2 text-xs text-gray-500">
+                  {p.dateOfBirth ? `DOB ${formatLocalDate(new Date(p.dateOfBirth))}` : ""}
+                  {p.insuranceId ? ` · ID ${p.insuranceId}` : ""}
+                </span>
+              </button>
+            ))
+          )}
+        </div>
+      )}
+    </div>
+  );
+}

apps/Frontend/src/pages/appointments-page.tsx

@@ -100,6 +100,7 @@ interface ScheduledAppointment {
   patientInsuranceProvider: string | null;
   hasProcedures: boolean;
   hasClaimWithNumber: boolean;
+  hasPreauth: boolean;
   movedByAi?: boolean;
   staffId: number;
   date: string | Date;
@@ -111,6 +112,17 @@ interface ScheduledAppointment {
   procedureCodes?: string[];
 }
 
+// Insurances with an online PreAuth flow on the claims page (others can't be preauthorized there).
+// Maps either site-key spelling (AI "TUFTS_SCO" / local "TuftsSCO") to the key the claim form expects.
+const PREAUTH_SITE_KEYS: Record<string, string> = {
+  MH: "MH",
+  CCA: "CCA",
+  TUFTSSCO: "TUFTS_SCO",
+  UNITEDSCO: "UNITED_SCO",
+};
+const toPreauthSiteKey = (siteKey: string): string | undefined =>
+  PREAUTH_SITE_KEYS[siteKey.replace(/_/g, "").toUpperCase()];
+
 function deriveInsuranceSiteKey(provider: string | null | undefined): string {
   const p = (provider || "").toLowerCase().trim();
   if (!p) return "";
@@ -384,6 +396,10 @@ export default function AppointmentsPage() {
     color: colors[index % colors.length] || "bg-gray-400",
   }));
 
+  // The last schedule column is the Preauth column: "Claim/Preauth for Column with AI"
+  // sends its appointments to PreAuth instead of Claim.
+  const preauthStaffId = staffMembers.length ? Number(staffMembers[staffMembers.length - 1]!.id) : null;
+
   // Initialize column labels from localStorage; default A, B, C… for new staff
   useEffect(() => {
     if (!staffMembersRaw.length) return;
@@ -703,6 +719,7 @@ export default function AppointmentsPage() {
       patientInsuranceProvider,
       hasProcedures: !!(apt as any).hasProcedures,
       hasClaimWithNumber: !!(apt as any).hasClaimWithNumber,
+      hasPreauth: !!(apt as any).hasPreauth,
       notes: (apt as any).notes ?? null,
       procedureCodes: (apt as any).procedureCodes ?? [],
       movedByAi: !!(apt as any).movedByAi,
@@ -1654,10 +1671,12 @@ export default function AppointmentsPage() {
   const handleClaimForColumnWithAi = async () => {
     if (selectedClaimAiColumns.size === 0) return;
     const unclaimed = processedAppointments.filter(
-      (apt) => selectedClaimAiColumns.has(apt.staffId) && !apt.hasClaimWithNumber
+      (apt) =>
+        selectedClaimAiColumns.has(apt.staffId) &&
+        (apt.staffId === preauthStaffId ? !apt.hasPreauth : !apt.hasClaimWithNumber)
     );
     if (!unclaimed.length) {
-      toast({ title: "No unclaimed appointments", description: "All appointments in the selected columns are already claimed." });
+      toast({ title: "Nothing to submit", description: "All appointments in the selected columns are already claimed / preauthorized." });
       return;
     }
     const autoRun = autoConfirmEnabled || autoClaimEnabled;
@@ -1677,6 +1696,17 @@ export default function AppointmentsPage() {
   const handleAiClaimConfirm = () => {
     if (!aiClaimCurrentData) return;
     const { matchedCodes, siteKey, serviceDate, appointmentId } = aiClaimCurrentData;
+    const isPreauth = aiClaimQueue[aiClaimCurrentIndex]?.staffId === preauthStaffId;
+    const preauthSiteKey = toPreauthSiteKey(siteKey);
+    if (isPreauth && !preauthSiteKey) {
+      toast({
+        title: "PreAuth not supported",
+        description: `${aiClaimCurrentData.patientName}: online PreAuth isn't available for ${siteKey || "this insurance"} — skipped.`,
+        variant: "destructive",
+      });
+      handleAiClaimSkip();
+      return;
+    }
     // Include current patient in queue; claims-page advances it only on successful submit.
     const fromCurrent = aiClaimQueue.slice(aiClaimCurrentIndex);
     if (fromCurrent.length > 0) {
@@ -1689,14 +1719,24 @@ export default function AppointmentsPage() {
     } else {
       sessionStorage.removeItem("ai_claim_queue");
     }
-    sessionStorage.setItem("chatbot_claim_prefill", JSON.stringify({
-      codes: matchedCodes,
-      siteKey,
-      serviceDate,
-      autoSubmit: true,
-    }));
+    if (isPreauth) {
+      sessionStorage.removeItem("chatbot_claim_prefill");
+      sessionStorage.setItem("chatbot_preauth_prefill", JSON.stringify({
+        codes: matchedCodes,
+        siteKey: preauthSiteKey,
+        serviceDate,
+      }));
+    } else {
+      sessionStorage.removeItem("chatbot_preauth_prefill");
+      sessionStorage.setItem("chatbot_claim_prefill", JSON.stringify({
+        codes: matchedCodes,
+        siteKey,
+        serviceDate,
+        autoSubmit: true,
+      }));
+    }
     // BCBS is a paper form filled and saved in the background — come straight back here
-    if (/^bcbs/i.test(siteKey)) sessionStorage.setItem("ai_claim_return_to_schedule", "1");
+    if (!isPreauth && /^bcbs/i.test(siteKey)) sessionStorage.setItem("ai_claim_return_to_schedule", "1");
     else sessionStorage.removeItem("ai_claim_return_to_schedule");
     setAiClaimModalOpen(false);
     setLocation(`/claims?appointmentId=${appointmentId}`);
@@ -1924,7 +1964,7 @@ export default function AppointmentsPage() {
                 ) : (
                   <>
                     <Bot className="h-4 w-4 mr-1" />
-                    Claim for Column with AI
+                    Claim/Preauth for Column with AI
                   </>
                 )}
               </Button>
@@ -2375,8 +2415,14 @@ export default function AppointmentsPage() {
                               {columnLabels[String(staff.id)] ?? String.fromCharCode(65 + index)}
                             </div>
                           )}
-                          <div className="text-xs text-gray-500">{staff.name}</div>
-                          <div className="text-xs text-gray-400">{staff.role}</div>
+                          {Number(staff.id) === preauthStaffId ? (
+                            <div className="text-xs font-semibold text-blue-600">Preauth</div>
+                          ) : (
+                            <>
+                              <div className="text-xs text-gray-500">{staff.name}</div>
+                              <div className="text-xs text-gray-400">{staff.role}</div>
+                            </>
+                          )}
                         </th>
                       ))}
                     </tr>
@@ -2516,7 +2562,7 @@ export default function AppointmentsPage() {
             <div className="p-4 border-b flex items-center justify-between">
               <h3 className="font-semibold text-base flex items-center gap-2">
                 <Bot className="h-4 w-4 text-teal-600" />
-                AI Claim Queue
+                AI Claim/Preauth Queue
               </h3>
               <span className="text-xs text-gray-500 font-medium">
                 {aiClaimAutoRun && (
@@ -2626,7 +2672,7 @@ export default function AppointmentsPage() {
                         onClick={handleAiClaimConfirm}
                       >
                         <FileCheck className="h-3.5 w-3.5" />
-                        Confirm &amp; Claim
+                        {aiClaimQueue[aiClaimCurrentIndex]?.staffId === preauthStaffId ? "Confirm & PreAuth" : "Confirm & Claim"}
                       </button>
                     )}
                     <button

apps/Frontend/src/pages/claims-page.tsx

@@ -325,6 +325,15 @@ export default function ClaimsPage() {
               }
             }
           } catch {}
+          // Preauth column of "Claim/Preauth for Column with AI": open the PreAuth tab and auto-submit
+          try {
+            const preauthRaw = sessionStorage.getItem("chatbot_preauth_prefill");
+            if (preauthRaw) {
+              setChatbotInitialTab("preauth");
+              const parsed = JSON.parse(preauthRaw);
+              if (parsed?.siteKey) setChatbotAutoSubmitPreauthSiteKey(parsed.siteKey);
+            }
+          } catch {}
           handleNewClaim(patientId, appointmentId);
           clearUrlParams(["appointmentId"]);
         }
@@ -761,6 +770,7 @@ export default function ClaimsPage() {
 
   // United/DentalHub pre-auth selenium handler
   const handleUnitedDHPreAuthSubmitSelenium = async (data: any) => {
+    advanceAiClaimQueue();
     try {
       dispatch(setTaskStatus({ key: "claimSubmit", status: "pending", message: "Submitting United/DentalHub pre-authorization..." }));
       const response = await apiRequest("POST", "/api/claims/uniteddh-preauth", {
@@ -826,6 +836,7 @@ export default function ClaimsPage() {
 
   // Tufts SCO pre-auth selenium handler
   const handleTuftsSCOPreAuthSubmitSelenium = async (data: any) => {
+    advanceAiClaimQueue();
     try {
       dispatch(setTaskStatus({ key: "claimSubmit", status: "pending", message: "Submitting Tufts SCO pre-authorization..." }));
       const response = await apiRequest("POST", "/api/claims/tuftssco-preauth", {
@@ -1044,6 +1055,7 @@ export default function ClaimsPage() {
 
   // CCA pre-auth selenium handler
   const handleCCAPreAuthSubmitSelenium = async (data: any) => {
+    advanceAiClaimQueue();
     const formData = new FormData();
     formData.append("data", JSON.stringify(data));
     if (socketId) formData.append("socketId", socketId);
@@ -1203,6 +1215,7 @@ export default function ClaimsPage() {
 
   // Pre Auth section
   const handleMHClaimPreAuthSubmitSelenium = async (data: any) => {
+    advanceAiClaimQueue();
     const formData = new FormData();
     formData.append("data", JSON.stringify(data));
     if (socketId) formData.append("socketId", socketId);