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>
2026-10-11 21:09:51 -04:00
parent c3efdc7f8e
commit 44a1a41efa
261 changed files with 2159 additions and 195 deletions
@@ -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();
@@ -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>
@@ -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>

@@ -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>
+  );
+}
@@ -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
@@ -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);