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
parent 8c65c3d625
commit b30bed8903
5 changed files with 47 additions and 41 deletions

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@@ -1,4 +1,4 @@
{ {
"is_task_list_visible": true, "is_task_list_visible": true,
"active_task": "backend#dev" "active_task": "frontend#dev"
} }

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@@ -79,6 +79,9 @@ Intents:
Insurance abbreviations are: mh, masshealth, bcbs, cca, dentaquest — anything else is a patient name 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) - 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. "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 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 schedule on 4/10/2026"
e.g. "check mh for 100xxxx, 10/10/1988 and make appointment on 5/1/2026" e.g. "check mh for 100xxxx, 10/10/1988 and make appointment on 5/1/2026"
@@ -219,6 +222,20 @@ Rules:
// ─── Classifier ─────────────────────────────────────────────────────────────── // ─── 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( export async function classifyInternalChat(
message: string, message: string,
apiKey: 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.", "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; if (!apiKey) return fallback;
// Prefer the client's local date (avoids UTC midnight rollover for US timezones) // Prefer the client's local date (avoids UTC midnight rollover for US timezones)

View File

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

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

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