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);
+  }
+}