344 lines
24 KiB
TypeScript
344 lines
24 KiB
TypeScript
import { getLlm, type AiProvider } from "./llm-factory";
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// ─── Intent types ─────────────────────────────────────────────────────────────
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export type InternalChatIntent =
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| "check_eligibility" // by patient name → look up in DB
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| "eligibility_by_id" // by explicit memberId + dob (no name)
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| "eligibility_by_name_dob" // by explicit first name + last name + dob (no memberId) — United Ucard name search
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| "batch_eligibility" // multiple patients by memberId + dob
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| "batch_eligibility_by_name" // multiple patients by name (no memberId)
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| "batch_claim" // claim same procedures for multiple patients by name
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| "batch_check_and_claim" // eligibility + claim for multiple patients by memberId+dob
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| "check_and_claim" // eligibility + claim procedures
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| "find_patient" // look up patient record only
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| "schedule_appointment" // add patient to today's (or specified) schedule
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| "claim_only" // submit claim for procedures (no eligibility check)
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| "multi_claim" // different procedures for different patients by name
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| "preauth" // submit pre-authorization for procedures
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| "navigate_claims"
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| "navigate_schedule"
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| "navigate_eligibility"
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| "general";
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export interface ChatClassification {
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intent: InternalChatIntent;
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// --- patient resolution (one of name OR id+dob) ---
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patientName?: string; // for check_eligibility / find_patient / schedule_appointment
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memberId?: string; // for eligibility_by_id / check_and_claim
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dob?: string; // for eligibility_by_id / check_and_claim (MM/DD/YYYY)
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firstName?: string; // for eligibility_by_name_dob
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lastName?: string; // for eligibility_by_name_dob
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// --- batch eligibility (multiple patients) ---
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patients?: { memberId: string; dob: string }[]; // for batch_eligibility
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// --- batch claim (same procedures for multiple patients by name) ---
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patientNames?: string[]; // for batch_claim
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// --- insurance hint (only if explicitly stated in the message) ---
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insuranceHint?: string; // raw text, e.g. "masshealth", "BCBS", "CCA"
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// --- rendering/treating provider (only if explicitly stated, e.g. "with provider Kai Gao") ---
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renderingProvider?: string; // raw name, e.g. "Kai Gao", "Dr. Smith"
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// --- procedures (raw text, NOT CDT codes — CDT lookup is done in workflow) ---
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procedureNames?: string[]; // for check_and_claim, e.g. ["perio exam", "adult cleaning"]
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// --- multi_claim (different procedures per patient) ---
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claimGroups?: { patientName: string; procedureNames: string[] }[];
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// --- scheduling ---
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appointmentDate?: string; // for schedule_appointment, YYYY-MM-DD (omit = today)
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appointmentTime?: string; // for schedule_appointment, HH:MM 24h (omit = 09:00)
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fallbackReply: string;
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}
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// ─── System prompt ────────────────────────────────────────────────────────────
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function buildSystemPrompt(today: string, extra?: string | null): string {
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const base = `You are an internal assistant for a dental office management app.
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Staff type natural language commands. Your ONLY job is to classify the intent and extract
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structured parameters. Do NOT map procedure names to CDT codes — return them as plain text.
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TODAY'S DATE: ${today}
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Respond ONLY with valid JSON (no markdown fences):
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{
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"intent": "<intent>",
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"patientName": "<full name if mentioned by name>",
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"memberId": "<member/insurance ID if given explicitly or found in history>",
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"firstName": "<first name, only for eligibility_by_name_dob>",
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"lastName": "<last name, only for eligibility_by_name_dob>",
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"dob": "<date of birth in MM/DD/YYYY if given explicitly or found in history>",
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"patients": [{"memberId": "<id>", "dob": "<MM/DD/YYYY>"}, ...],
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"patientNames": ["<name1>", "<name2>", ...],
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"insuranceHint": "<insurance name only if explicitly stated in the message, e.g. 'masshealth', 'BCBS MA', 'CCA'>",
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"renderingProvider": "<provider/doctor name only if explicitly stated, e.g. 'Kai Gao', 'Dr. Smith' — omit if not mentioned>",
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"procedureNames": ["<raw procedure name>", ...],
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"claimGroups": [{"patientName": "<name>", "procedureNames": ["<procedure>", ...]}, ...],
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"appointmentDate": "<YYYY-MM-DD; use today's date (${today}) if user says 'today'; omit only if no date is mentioned at all>",
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"appointmentTime": "<HH:MM 24h if a specific time is mentioned, omit if not stated>",
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"fallbackReply": "<1-2 sentence reply to show the user>"
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}
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Omit any field that is not present in the message or history.
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Intents:
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- check_eligibility : user wants to check insurance for a patient identified by NAME only
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e.g. "check Maria Jesus", "verify insurance for John Smith"
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e.g. "check Qu", "check Li", "check Kim" — a short word after "check" is a patient last name, NOT an insurance abbreviation
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Insurance abbreviations are: mh, masshealth, bcbs, cca, dentaquest — anything else is a patient name
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- eligibility_by_id : user provides a SINGLE member ID and date of birth (no patient name)
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e.g. "check masshealth for 100xxxx, 10/10/1988"
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e.g. "100xxxx 10/10/1988" or "100xxxx, 10/10/1988" — a bare member ID + DOB with
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NO verb and NO insurance keyword is STILL eligibility_by_id (default to MassHealth,
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omit insuranceHint). Do NOT classify this as "general".
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ALSO use this when user wants to check eligibility AND schedule/add an appointment on a date
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e.g. "check mh for 100xxxx, 10/10/1988 and schedule on 4/10/2026"
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e.g. "check mh for 100xxxx, 10/10/1988 and make appointment on 5/1/2026"
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In these cases set appointmentDate to the mentioned date (YYYY-MM-DD)
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- eligibility_by_name_dob : user provides a first name, last name AND date of birth but NO member ID
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e.g. "check ucard Kai Gao 08/30/1997", "Kai Gao, 8/30/1997"
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e.g. "canin gomez, 08/30/1997, ucard" → firstName "canin", lastName "gomez" (ALWAYS: first word = first name, all remaining words = last name, e.g. "min ping wang" → firstName "min", lastName "ping wang")
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Set firstName, lastName and dob (MM/DD/YYYY). Set insuranceHint if stated (e.g. "ucard").
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- batch_eligibility : user provides MULTIPLE member IDs with dates of birth in one message
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e.g. "check mh for 100xxxx 10/10/1988 and 200xxxx 5/5/2000"
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e.g. "check 100xxxx, 10/10/1988 and 200xxxx, 5/5/2000"
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Use this ONLY when TWO OR MORE distinct memberId+dob pairs are given.
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Put each pair into the "patients" array. Also set insuranceHint if stated.
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- batch_eligibility_by_name : user wants to check eligibility for MULTIPLE patients identified by NAME
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e.g. "check Mary and Sinthia", "check eligibility for John, Jane, and Bob"
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e.g. "verify insurance for Mary and Sinthia"
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Use this when TWO OR MORE patient names are given WITHOUT member IDs.
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Put each patient name into the "patientNames" array.
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- batch_claim : user wants to claim the SAME procedures for MULTIPLE patients identified by NAME
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e.g. "claim perio exam and adult prophy for Jackaline and Keioson"
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e.g. "perio exam, adult cleaning for Maria and John"
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Use this ONLY when procedures AND two or more patient names are given.
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Put each patient name into the "patientNames" array. Put procedure names in "procedureNames".
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- multi_claim : user wants to claim DIFFERENT procedures for DIFFERENT patients identified by NAME
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e.g. "claim #13 crown for flor and claim d5212 for bian"
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e.g. "claim perio exam for Maria and claim adult prophy for John"
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e.g. "claim D0120 for Jane and D1110 for Bob"
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e.g. "claim post #6 for A and comp #10 DL for B, all on 6/23/26"
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→ claimGroups: [{patientName:"A", procedureNames:["post #6"]}, {patientName:"B", procedureNames:["comp #10 DL"]}], appointmentDate: "2026-06-23"
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Use this when each patient has their OWN distinct set of procedures.
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Put each patient+procedures group into the "claimGroups" array.
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A trailing date phrase like "all on <date>" or "on <date>" at the end of the message sets
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appointmentDate for EVERY group — do not skip it just because it comes after multiple patients.
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Do NOT use batch_claim for this — batch_claim is ONLY for the SAME procedures applied to ALL patients.
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- batch_check_and_claim : user provides MULTIPLE member IDs with DOBs AND wants to claim PROCEDURES for all of them
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e.g. "check mh for 100xxxx 10/10/1988 and 200xxxx 5/5/2000, and claim perio exam and adult prophy"
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e.g. "check 100xxxx, 10/10/1988 and 200xxxx, 5/5/2000 and claim D0120 D1110 for them"
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Use this when TWO OR MORE memberId+dob pairs are given WITH procedures.
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Put each pair into "patients" array. Put procedure names in "procedureNames".
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- check_and_claim : user wants to check eligibility AND submit PROCEDURES/BILLING as claims
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e.g. "check masshealth for 100xxxx, 10/10/1988 and claim perio exam and adult cleaning"
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e.g. "check Maria Jesus and claim D0120 D1110"
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Only use this when procedures or CDT codes are mentioned — NOT for scheduling
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- find_patient : look up a patient record only, no eligibility
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e.g. "find patient John", "look up Smith"
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- schedule_appointment : add a patient to the schedule (today or a specified date/time)
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e.g. "put John Smith in today's schedule"
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e.g. "schedule Maria at 2pm tomorrow"
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e.g. "add Jane Doe at 10:30"
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- claim_only : submit a claim for procedures WITHOUT an eligibility check
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e.g. "claim comprehensive exam and Pano for her"
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e.g. "claim D0120 and D1110 for John Smith today"
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e.g. "bill adult cleaning for Maria on 05/15/2026"
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e.g. "claim perio exam, 2BW for John Smith"
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e.g. "claim #8 ml for lisa" → procedureNames: ["#8 ml"], patientName: "lisa" (tooth+surface = composite filling, NOT insurance)
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e.g. "claim comp #8 ml for lisa today" → procedureNames: ["comp #8 ml"], patientName: "lisa", appointmentDate: today
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"comp" is short for "composite" — when followed by #tooth+surfaces, it is a composite filling
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Use this when no eligibility check is requested — just billing/claiming services
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Always extract appointmentDate when a date or "today" is mentioned
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- preauth : submit a pre-authorization request for procedures
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e.g. "preauth rct, post, crown for John Smith"
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e.g. "pre auth #20 rct, post, crown for Zhiyuan Chen"
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e.g. "pre-auth D3320, D2952, D2740 for Maria"
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Use this when the user says "preauth", "pre auth", "pre-auth", or "prior auth"
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- navigate_claims : open the claims page
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- navigate_schedule : open the appointments/schedule page
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- navigate_eligibility : open the insurance eligibility page — ONLY when user says a known insurance keyword with no patient name
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e.g. "check mh", "check masshealth", "open eligibility", "go to eligibility", "check insurance"
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Do NOT use this for "check [name]" — that is check_eligibility
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- general : anything else
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Rules:
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- For check_and_claim and claim_only, procedureNames should be the RAW user text
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(e.g. "perio exam", "adult cleaning", "D0120") — do NOT translate to codes
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- IMPORTANT: If the user says "with the x ray", "with x ray", "attach x ray", "the x ray", "with xray",
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"with the attachment", "the attachment", "with attachment", "with the file", "with the image",
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"with the scan", "with the photo", "with the document", or any variation meaning an uploaded/attached file,
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do NOT include it in procedureNames. It refers to a file attachment, not a billable procedure.
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Only include actual clinical procedures in procedureNames.
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- For composite fillings with a tooth number, preserve the EXACT notation including tooth# and surfaces:
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e.g. "composite #29 O", "#8 MO", "composite #11 MOD", "# 10 DL", "# 11 ML", "#8 ml", "comp #8 ml" — keep the #number and surface letters together as one entry
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Note: "comp" is short for "composite". "# 10 DL", "composite on # 10 DL", and "comp # 10 DL" are all the same — preserve the space-after-# as-is
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IMPORTANT: Any letter(s) immediately after a tooth number are DENTAL SURFACE abbreviations indicating a composite filling:
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M = Mesial, D = Distal, L = Lingual, F = Facial, B = Buccal, O = Occlusal, V = Vestibular, I = Incisal
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e.g. "#8 ML" → composite on tooth 8, mesial+lingual surfaces (NOT an insurance abbreviation)
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e.g. "#14 MOD" → composite on tooth 14, mesial+occlusal+distal surfaces
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e.g. "#5 F" → composite on tooth 5, facial surface
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Whenever you see #[tooth number] followed by any combination of M/D/L/F/B/O/V/I, it is ALWAYS a composite filling surface notation
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- #number always means a TOOTH number (never a case or pre-auth reference). When a single #number appears before a comma-separated list of procedures, apply it to EVERY procedure in the list.
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e.g. "#20 rct, post, crown" → ["#20 rct", "#20 post", "#20 crown"]
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e.g. "preauth #20 rct, pos, crown" → ["#20 rct", "#20 pos", "#20 crown"]
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e.g. "#14 rct, buildup, crown" → ["#14 rct", "#14 buildup", "#14 crown"]
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- When a procedure is followed by MULTIPLE tooth numbers (comma-separated, with or without # on each), apply the procedure to EVERY tooth number as separate entries.
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e.g. "post/core on #23, 24, 25, 26" → ["post/core #23", "post/core #24", "post/core #25", "post/core #26"]
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e.g. "crown #3, #5, #12" → ["crown #3", "crown #5", "crown #12"]
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e.g. "extraction #1, 16, 17, 32" → ["extraction #1", "extraction #16", "extraction #17", "extraction #32"]
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e.g. "rct #23, 24, 25" → ["rct #23", "rct #24", "rct #25"]
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e.g. "recement #5, #3" → ["recement #5", "recement #3"]
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"recement" / "re-cement" / "re cement" means re-cementing a crown (D2920) — always spread across each tooth number
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"post/core" is the same as "post core" — a combined post and core procedure
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- For RCT/root canal with a tooth number, preserve the tooth# in the entry:
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e.g. "rct #29", "#14 root canal", "rct #6", "#20 rct" — keep the #number with the procedure so the correct code can be selected
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- For a CDT code (D####) followed by a tooth number (# NN or #NN), keep them together as ONE entry and do NOT spread the tooth# to other procedures:
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e.g. "Limited exam, PANO, D7210 # 32" → ["Limited exam", "PANO", "D7210 # 32"]
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e.g. "D7210 #32, D0140, pano" → ["D7210 #32", "D0140", "pano"]
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The tooth# after a CDT code belongs only to that procedure.
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- For SRP with a quadrant abbreviation (UL, UR, LL, LR), keep the code and quadrant together as one entry:
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e.g. "D4341 UL", "4341 LR", "D4342 UR" — the quadrant always travels with the SRP code
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- For PA X-rays with tooth numbers, always use "1 pa, #T" format for the first/only PA and "2nd pa, #T" for every additional:
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e.g. "1 PA (#13)" → ["1 pa, #13"]
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e.g. "PA #13" → ["1 pa, #13"]
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e.g. "2 PA (#30, 15)" → ["1 pa, #30", "2nd pa, #15"]
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e.g. "3 PA (#3, 14, 30)" → ["1 pa, #3", "2nd pa, #14", "2nd pa, #30"]
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e.g. "4 PA (#3, 14, 19, 30)" → ["1 pa, #3", "2nd pa, #14", "2nd pa, #19", "2nd pa, #30"]
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e.g. "2 pa #3 #14" → ["1 pa, #3", "2nd pa, #14"]
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- insuranceHint is only set when the user explicitly names an insurance in the message
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- renderingProvider is only set when the user explicitly names a treating/rendering provider or doctor
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e.g. "with provider Kai Gao", "provider Dr. Smith", "rendered by Kai Gao", "doctor Kai Gao"
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Extract just the name (without "Dr." prefix unless it's part of the name), omit if not mentioned
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- Keep fallbackReply to 1-2 sentences
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- For navigate intents, fallbackReply = "Opening the [page] page..." (e.g. "Opening the eligibility page...")
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- appointmentDate applies to ALL claim/scheduling intents — schedule_appointment, claim_only,
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check_and_claim, batch_claim, multi_claim, batch_check_and_claim, and preauth:
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always set it to today's date (${today}) when the user says "today", "this visit", or similar
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set it to the specified date when the user mentions a date (e.g. "05/15/2026")
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This applies even when the date is mentioned once at the END of the message and covers
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multiple patients/groups (e.g. "...claim X for A and Y for B, all on 6/23/26" → appointmentDate
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applies to every group, not just the last one mentioned)
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omit it only when no date is mentioned at all (the backend will find the last appointment)
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- IMPORTANT: Users type dates in American M/D/YYYY format (month first, then day).
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e.g. "6/12/2026" means June 12 2026 (NOT December 6). "1/5/2026" means January 5 2026.
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If the year has a typo (e.g. "12026" instead of "2026"), correct it to the intended 4-digit year.
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- For schedule_appointment, appointmentTime omitted means no preference
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- IMPORTANT: Use the conversation history to resolve pronouns and references.
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If the user says "her", "him", "them", "the patient", or "same patient", look back through
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the conversation history to find the patient name, memberId, AND dob that were mentioned most recently.
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Always populate patientName (or memberId) AND dob from history when a pronoun is used.
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Family members may share the same memberId — always include the dob so the correct family member is identified.
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Never return an empty patientName just because the current message uses a pronoun.`;
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return extra?.trim() ? `${base}\n\nAdditional office context:\n${extra.trim()}` : base;
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}
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// ─── Classifier ───────────────────────────────────────────────────────────────
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// Deterministic fast-path for a bare "memberId DOB" (or "DOB memberId") message with
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// nothing else in it — e.g. "100232102531 4/27/1999" or "100232102531, 4/27/1999".
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// Bypasses the LLM entirely so this always resolves to eligibility_by_id, since some
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// providers hedge/refuse structured output on a bare digit string that looks like an SSN.
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function parseBareIdDob(message: string): { memberId: string; dob: string } | null {
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const text = message.trim();
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const dobPattern = /(\d{1,2}[\/\-]\d{1,2}[\/\-]\d{4})/;
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const idThenDob = text.match(new RegExp(`^([A-Za-z0-9]{3,})[\\s,]+${dobPattern.source}$`));
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if (idThenDob) return { memberId: idThenDob[1]!, dob: idThenDob[2]!.replace(/-/g, "/") };
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const dobThenId = text.match(new RegExp(`^${dobPattern.source}[\\s,]+([A-Za-z0-9]{3,})$`));
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if (dobThenId) return { memberId: dobThenId[2]!, dob: dobThenId[1]!.replace(/-/g, "/") };
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return null;
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}
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// Deterministic fast-path for a bare "First Last DOB" (or "DOB First Last") message,
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// e.g. "Kai Gao 08/30/1997" or "Kai Gao, 8/30/1997". Two or more alphabetic words: first word = first name, the rest = last name.
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function parseBareNameDob(message: string): { firstName: string; lastName: string; dob: string } | null {
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const text = message.trim();
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const dob = "(\\d{1,2}[\\/\\-]\\d{1,2}[\\/\\-]\\d{4})";
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const name = "([A-Za-z][A-Za-z'\\-]*)\\s+([A-Za-z][A-Za-z'\\-]*(?:\\s+[A-Za-z][A-Za-z'\\-]*)*)";
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const nameThenDob = text.match(new RegExp(`^${name}[\\s,]+${dob}$`));
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if (nameThenDob) return { firstName: nameThenDob[1]!, lastName: nameThenDob[2]!, dob: nameThenDob[3]!.replace(/-/g, "/") };
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const dobThenName = text.match(new RegExp(`^${dob}[\\s,]+${name}$`));
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if (dobThenName) return { firstName: dobThenName[2]!, lastName: dobThenName[3]!, dob: dobThenName[1]!.replace(/-/g, "/") };
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return null;
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}
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export async function classifyInternalChat(
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message: string,
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apiKey: string,
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extraSystemPrompt?: string,
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history: { role: "user" | "assistant"; text: string }[] = [],
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provider: AiProvider = "google",
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model?: string,
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clientDate?: string // YYYY-MM-DD from the browser's local clock
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): Promise<ChatClassification> {
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const fallback: ChatClassification = {
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intent: "general",
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fallbackReply:
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"I can search for a patient, check eligibility, run check & claim, schedule appointments, or navigate to claims or appointments.",
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};
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const bare = parseBareIdDob(message);
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if (bare) {
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return {
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intent: "eligibility_by_id",
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memberId: bare.memberId,
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dob: bare.dob,
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fallbackReply: `Checking eligibility for Member ID ${bare.memberId}...`,
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};
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}
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const bareName = parseBareNameDob(message);
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if (bareName) {
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return {
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intent: "eligibility_by_name_dob",
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firstName: bareName.firstName,
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lastName: bareName.lastName,
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dob: bareName.dob,
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fallbackReply: `Checking eligibility for ${bareName.firstName} ${bareName.lastName}...`,
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};
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}
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if (!apiKey) return fallback;
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// Prefer the client's local date (avoids UTC midnight rollover for US timezones)
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const today = (clientDate && /^\d{4}-\d{2}-\d{2}$/.test(clientDate))
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? clientDate
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: (() => { const n = new Date(); return `${n.getFullYear()}-${String(n.getMonth()+1).padStart(2,"0")}-${String(n.getDate()).padStart(2,"0")}`; })();
|
|
const systemPrompt = buildSystemPrompt(today, extraSystemPrompt);
|
|
|
|
try {
|
|
const llm = getLlm(provider, apiKey, model);
|
|
|
|
// Drop leading assistant messages (some providers require conversation to start with user turn)
|
|
const firstUserIdx = history.findIndex((h) => h.role === "user");
|
|
const trimmedHistory = (firstUserIdx === -1 ? [] : history.slice(firstUserIdx)).filter((_, i, arr) => {
|
|
if (i === arr.length - 1) return true;
|
|
return arr[i]!.role !== arr[i + 1]!.role;
|
|
});
|
|
|
|
const historyMessages = trimmedHistory.map((h) => ({
|
|
role: h.role,
|
|
content: h.text,
|
|
}));
|
|
const response = await llm.invoke([
|
|
{ role: "system", content: systemPrompt },
|
|
...historyMessages,
|
|
{ role: "user", content: message },
|
|
]);
|
|
|
|
const raw = String(response.content).trim();
|
|
console.log("[internal-chat] raw LLM response:", raw.slice(0, 400));
|
|
const jsonStr = raw.replace(/^```json\s*/i, "").replace(/```\s*$/, "").trim();
|
|
const parsed = JSON.parse(jsonStr) as ChatClassification;
|
|
if (!parsed.intent || !parsed.fallbackReply) return fallback;
|
|
return parsed;
|
|
} catch (err) {
|
|
const msg = err instanceof Error ? err.message : String(err);
|
|
console.error("[internal-chat] classifyInternalChat error (provider=%s model=%s): %s", provider, model, msg);
|
|
// Surface billing/auth errors so the user sees a useful message in the chat
|
|
if (/credit balance|billing|quota|insufficient|authentication|api.key|invalid_api_key/i.test(msg)) {
|
|
return {
|
|
intent: "general",
|
|
fallbackReply: `AI provider error: ${msg.slice(0, 200)}`,
|
|
};
|
|
}
|
|
return fallback;
|
|
}
|
|
}
|