fix: match PDF-imported patients by member ID when DOB is missing on record

MassHealth eligibility lookups via the AI chatbot only matched existing
patients on memberId+DOB, so patients imported from PDF extraction (which
have a member ID but no stored birthday) were treated as new/unknown even
though they already exist in the system.

Co-Authored-By: Claude Sonnet 5 <noreply@anthropic.com>
This commit is contained in:
2026-07-20 11:11:47 -04:00
co-authored by Claude Sonnet 5
parent 8c65c3d625
commit b30bed8903
5 changed files with 47 additions and 41 deletions
@@ -79,6 +79,9 @@ Intents:
Insurance abbreviations are: mh, masshealth, bcbs, cca, dentaquest — anything else is a patient name
- eligibility_by_id : user provides a SINGLE member ID and date of birth (no patient name)
e.g. "check masshealth for 100xxxx, 10/10/1988"
e.g. "100xxxx 10/10/1988" or "100xxxx, 10/10/1988" — a bare member ID + DOB with
NO verb and NO insurance keyword is STILL eligibility_by_id (default to MassHealth,
omit insuranceHint). Do NOT classify this as "general".
ALSO use this when user wants to check eligibility AND schedule/add an appointment on a date
e.g. "check mh for 100xxxx, 10/10/1988 and schedule on 4/10/2026"
e.g. "check mh for 100xxxx, 10/10/1988 and make appointment on 5/1/2026"
@@ -219,6 +222,20 @@ Rules:
// ─── Classifier ───────────────────────────────────────────────────────────────
// Deterministic fast-path for a bare "memberId DOB" (or "DOB memberId") message with
// 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.
function parseBareIdDob(message: string): { memberId: string; dob: string } | null {
const text = message.trim();
const dobPattern = /(\d{1,2}[\/\-]\d{1,2}[\/\-]\d{4})/;
const idThenDob = text.match(new RegExp(`^([A-Za-z0-9]{3,})[\\s,]+${dobPattern.source}$`));
if (idThenDob) return { memberId: idThenDob[1]!, dob: idThenDob[2]!.replace(/-/g, "/") };
const dobThenId = text.match(new RegExp(`^${dobPattern.source}[\\s,]+([A-Za-z0-9]{3,})$`));
if (dobThenId) return { memberId: dobThenId[2]!, dob: dobThenId[1]!.replace(/-/g, "/") };
return null;
}
export async function classifyInternalChat(
message: string,
apiKey: string,
@@ -234,6 +251,16 @@ export async function classifyInternalChat(
"I can search for a patient, check eligibility, run check & claim, schedule appointments, or navigate to claims or appointments.",
};
const bare = parseBareIdDob(message);
if (bare) {
return {
intent: "eligibility_by_id",
memberId: bare.memberId,
dob: bare.dob,
fallbackReply: `Checking eligibility for Member ID ${bare.memberId}...`,
};
}
if (!apiKey) return fallback;
// Prefer the client's local date (avoids UTC midnight rollover for US timezones)