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>

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

@@ -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)

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

@@ -113,6 +113,7 @@ interface StorageLike {
   }): Promise<any[] | null>;
   getPatientByInsuranceId(id: string): Promise<any | null>;
   getPatientByInsuranceIdAndDob(id: string, dob: Date): Promise<any | null>;
+  getPatientByInsuranceIdNoDob(id: string): Promise<any | null>;
   createAppointment(appointment: any): Promise<any>;
   getAppointmentsByDateForUser(dateStr: string, userId: number): Promise<any[]>;
   getOfficeHours(userId: number): Promise<any | null>;
@@ -172,7 +173,11 @@ async function findPatientByMemberId(
   if (dobDate && !isNaN(dobDate.getTime())) {
     const byCombo = await storage.getPatientByInsuranceIdAndDob(memberId, dobDate);
     if (byCombo) return byCombo;
-    // DOB provided but no record with that combo → this is a new family member not yet in DB
+    // No exact DOB match — check for an existing patient with this memberId but no DOB on
+    // file (e.g. imported from a PDF extraction that didn't capture birthdates) before
+    // concluding this is a brand-new family member not yet in DB.
+    const byIdNoDob = await storage.getPatientByInsuranceIdNoDob(memberId);
+    if (byIdNoDob) return byIdNoDob;
     return null;
   }
   return storage.getPatientByInsuranceId(memberId);
@@ -428,28 +433,12 @@ async function handleEligibilityById(
     };
   }
 
-  // Determine siteKey
+  // Determine siteKey (defaults to MassHealth when no payer is specified)
   const siteKey = resolveSiteKey(
     patient?.insuranceProvider ?? null,
     c.insuranceHint ?? null
   );
 
-  if (!siteKey) {
-    const name = patient
-      ? `${patient.firstName ?? ""} ${patient.lastName ?? ""}`.trim()
-      : `Member ID ${memberId}`;
-    return {
-      reply: `Found ${name} but couldn't determine the insurance type. Which insurance should I use?`,
-      action: "need_insurance_clarification",
-      actionData: {
-        memberId,
-        dob: resolvedDob,
-        patient,
-        options: ["MassHealth", "BCBS MA", "CCA", "Tufts SCO", "Delta Dental MA", "United SCO / Dental Hub"],
-      },
-    };
-  }
-
   const label = patient
     ? `${patient.firstName ?? ""} ${patient.lastName ?? ""}`.trim()
     : `Member ID ${memberId}`;
@@ -985,29 +974,12 @@ async function handleCheckAndClaim(
     };
   }
 
-  // 2. Determine siteKey
+  // 2. Determine siteKey (defaults to MassHealth when no payer is specified)
   const siteKey = resolveSiteKey(
     patient?.insuranceProvider ?? null,
     c.insuranceHint ?? null
   );
 
-  if (!siteKey) {
-    const label = patient
-      ? `${patient.firstName ?? ""} ${patient.lastName ?? ""}`.trim()
-      : `Member ID ${memberId}`;
-    return {
-      reply: `Found ${label} but couldn't determine the insurance type. Which insurance should I use?`,
-      action: "need_insurance_clarification",
-      actionData: {
-        memberId,
-        dob,
-        patient,
-        procedureNames: c.procedureNames ?? [],
-        options: ["MassHealth", "BCBS MA", "CCA", "Tufts SCO", "Delta Dental MA", "United SCO / Dental Hub"],
-      },
-    };
-  }
-
   // 3. Map procedure names → CDT codes (custom aliases take priority)
   const procedureNames = stripAttachmentRefs(c.procedureNames ?? []);
   const cdtResults: CdtResult[] = procedureNames.length > 0
@@ -1456,13 +1428,13 @@ export async function createAppointmentToday(
  * Determine siteKey from:
  *  1. Patient's stored insuranceProvider (most authoritative)
  *  2. Insurance hint from the chat message
- *  3. null → caller must ask for clarification
+ *  3. No payer specified → default to MassHealth ("MH")
  */
 function resolveSiteKey(
   storedProvider: string | null,
   hint: string | null
-): string | null {
+): string {
   if (storedProvider) return deriveSiteKey(storedProvider);
   if (hint) return deriveSiteKey(hint);
-  return null;
+  return "MH";
 }

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

@@ -11,6 +11,7 @@ export interface IStorage {
   getPatient(id: number): Promise<Patient | undefined>;
   getPatientByInsuranceId(insuranceId: string): Promise<Patient | null>;
   getPatientByInsuranceIdAndDob(insuranceId: string, dob: Date): Promise<Patient | null>;
+  getPatientByInsuranceIdNoDob(insuranceId: string): Promise<Patient | null>;
   getAllPatients(): Promise<Patient[]>;
   getRecentPatients(limit: number, offset: number): Promise<Patient[]>;
   getPatientsByIds(ids: number[]): Promise<Patient[]>;
@@ -74,6 +75,12 @@ export const patientsStorage: IStorage = {
     });
   },
 
+  async getPatientByInsuranceIdNoDob(insuranceId: string): Promise<Patient | null> {
+    return db.patient.findFirst({
+      where: { insuranceId, dateOfBirth: null },
+    });
+  },
+
   async getRecentPatients(limit: number, offset: number): Promise<Patient[]> {
     return db.patient.findMany({
       skip: offset,