@mindbill/react 0.23.2 → 0.25.0

package/dist/index.js

@@ -1294,6 +1294,79 @@ var BILL_SUBMISSION_DOCUMENT_TYPES = [
   "appeal",
   "other"
 ];
+var MED_LEGAL_REPORT_TYPE_CODE = "OZ:J4";
+var BILL_SUBMISSION_REPORT_TYPES = [
+  { code: "OZ:J1", label: "Doctor's First Report (DLSR 5021)" },
+  { code: "OZ:J2", label: "Supplemental Medical Report (BRs)" },
+  { code: "OZ:J3", label: "Medical Permanent Impairment Report" },
+  { code: MED_LEGAL_REPORT_TYPE_CODE, label: "Med-Legal Report" },
+  { code: "OZ:J5", label: "Vocational Report" },
+  { code: "OZ:J6", label: "Work Status Report" },
+  { code: "OZ:J7", label: "Consultation Report" },
+  { code: "OZ:J8", label: "Permanent Disability Report" },
+  { code: "OZ:J9", label: "Itemized Statement" },
+  { code: "03", label: "Justifying Treatment Beyond Utilization Guidelines" },
+  { code: "04", label: "Drugs Administered" },
+  { code: "05", label: "Treatment Diagnosis" },
+  { code: "06", label: "Initial Assessment" },
+  { code: "07", label: "Plan of Treatment" },
+  { code: "08", label: "Plan of Treatment" },
+  { code: "09", label: "PR2 (Progress Report)" },
+  { code: "10", label: "Continued Treatment" },
+  { code: "11", label: "Chemical Analysis" },
+  { code: "13", label: "Certified Test Report" },
+  { code: "15", label: "Justification for Admission" },
+  { code: "21", label: "Recovery Plan" },
+  { code: "A3", label: "Allergies/Sensitivities Document" },
+  { code: "A4", label: "Autopsy Report" },
+  { code: "AM", label: "Ambulance Certification" },
+  { code: "AS", label: "Admission Summary" },
+  { code: "B2", label: "Prescription" },
+  { code: "B3", label: "Physician Order" },
+  { code: "B4", label: "Referral Form" },
+  { code: "BR", label: "Benchmark Testing Results" },
+  { code: "BS", label: "Baseline" },
+  { code: "BT", label: "Blanket Test Results" },
+  { code: "CB", label: "Chiropractic Justification" },
+  { code: "CK", label: "Canceled Check" },
+  { code: "CT", label: "Certification" },
+  { code: "D2", label: "Drug Profile Document" },
+  { code: "DA", label: "Dental Models" },
+  { code: "DB", label: "Durable Medical Equipment RX" },
+  { code: "DG", label: "Diagnostic Report" },
+  { code: "DJ", label: "Discharge Monitoring Report" },
+  { code: "DS", label: "Discharge Summary" },
+  { code: "EB", label: "Explanation of Benefits" },
+  { code: "HC", label: "Health Clinic Records (HC)" },
+  { code: "HR", label: "Health Clinic Records (HR)" },
+  { code: "I5", label: "Immunization Record" },
+  { code: "IR", label: "State School Immunization Records" },
+  { code: "LA", label: "Laboratory Results" },
+  { code: "M1", label: "Medical Record Attachment" },
+  { code: "MT", label: "Nursing Notes" },
+  { code: "NN", label: "Minor Deviation Request" },
+  { code: "OB", label: "Operative Note" },
+  { code: "OC", label: "Oxygen Content Averaging Report" },
+  { code: "OD", label: "Orders and Treatments Document" },
+  { code: "OE", label: "Objective Physical Examination Doc" },
+  { code: "OX", label: "Oxygen Therapy Certification" },
+  { code: "OZ", label: "Support Data for Bill" },
+  { code: "P4", label: "Pathology Report" },
+  { code: "P5", label: "Patient Medical History Document" },
+  { code: "PE", label: "Periodontal Charts" },
+  { code: "PN", label: "Physical Therapy Notes" },
+  { code: "PO", label: "Prosthetics or Orthotic Certification" },
+  { code: "PQ", label: "Paramedical Results" },
+  { code: "PY", label: "Physician's Report" },
+  { code: "PZ", label: "Physical Therapy Certification" },
+  { code: "RB", label: "Radiology Films" },
+  { code: "RR", label: "Radiology Reports" },
+  { code: "RT", label: "Report of tests and Analysis Report" },
+  { code: "RX", label: "Renewable Oxygen Content Averaging Report" },
+  { code: "SG", label: "Symptoms Document" },
+  { code: "V5", label: "Death Notification" },
+  { code: "XP", label: "Photographs" }
+];
 var BILL_SUBMISSION_REQUIRED_FIELDS = [
   "patient.firstName",
   "patient.lastName",
@@ -1303,8 +1376,26 @@ var BILL_SUBMISSION_REQUIRED_FIELDS = [
   "patient.address.state",
   "patient.address.postalCode",
   "claim.claimNumber",
+  "claim.employer",
+  "claim.dateOfInjury",
   "claim.claimsAdministrator",
   "service.date",
+  "billingProvider.name",
+  "billingProvider.taxId",
+  "billingProvider.npi",
+  "billingProvider.phone",
+  "billingProvider.address.line1",
+  "billingProvider.address.city",
+  "billingProvider.address.state",
+  "billingProvider.address.postalCode",
+  "renderingProvider.name",
+  "renderingProvider.npi",
+  "renderingProvider.taxonomy",
+  "serviceLocation.placeOfServiceCode",
+  "serviceLocation.address.line1",
+  "serviceLocation.address.city",
+  "serviceLocation.address.state",
+  "serviceLocation.address.postalCode",
   "diagnoses[]",
   "serviceLines[].code",
   "serviceLines[].units"
@@ -1344,6 +1435,8 @@ async function prepareBillSubmissionDocuments({
   attachments,
   selectedIds,
   uploads,
+  reportTypeCodeByAttachmentId = {},
+  defaultReportTypeCode,
   fetch: fetchOverride
 }) {
   const fetcher = fetchOverride ?? globalThis.fetch;
@@ -1357,12 +1450,14 @@ async function prepareBillSubmissionDocuments({
       externalId: attachment.id,
       filename: attachment.fileName,
       documentType: attachment.documentType,
+      ...reportTypeCodeByAttachmentId[attachment.id] || attachment.reportTypeCode || defaultReportTypeCode ? { reportTypeCode: reportTypeCodeByAttachmentId[attachment.id] || attachment.reportTypeCode || defaultReportTypeCode } : {},
       ...attachment.description ? { description: attachment.description } : {}
     });
   }));
-  const uploadedDocuments = await Promise.all(uploads.map(({ file, documentType, description }) => pdfDocument(file, {
+  const uploadedDocuments = await Promise.all(uploads.map(({ file, documentType, description, reportTypeCode }) => pdfDocument(file, {
     filename: file.name,
     documentType,
+    ...reportTypeCode || defaultReportTypeCode ? { reportTypeCode: reportTypeCode || defaultReportTypeCode } : {},
     ...description ? { description } : {}
   })));
   return [...sourceDocuments, ...uploadedDocuments];
@@ -1460,8 +1555,26 @@ function validateBillSubmission(bill) {
   required("patient.address.state", bill.patient.address.state, "Enter the patient's 2-letter state code.");
   required("patient.address.postalCode", bill.patient.address.postalCode, "Enter the patient's ZIP code.");
   required("claim.claimNumber", bill.claim.claimNumber, "Enter the claim number.");
+  required("claim.employer", bill.claim.employer, "Enter the employer name.");
+  required("claim.dateOfInjury", bill.claim.dateOfInjury, "Enter the date of injury.");
   required("claim.claimsAdministrator", bill.claim.claimsAdministrator?.name, "Select a claims administrator so MindBill can route this bill.");
   required("service.date", bill.service.date, "Enter the date of service.");
+  required("billingProvider.name", bill.billingProvider?.name, "Enter the billing provider name.");
+  required("billingProvider.taxId", bill.billingProvider?.taxId, "Enter the billing provider Tax ID (EIN or SSN).");
+  required("billingProvider.npi", bill.billingProvider?.npi, "Enter the billing provider NPI.");
+  required("billingProvider.phone", bill.billingProvider?.phone, "Enter the billing provider phone number.");
+  required("billingProvider.address.line1", bill.billingProvider?.address?.line1, "Enter the billing provider street address.");
+  required("billingProvider.address.city", bill.billingProvider?.address?.city, "Enter the billing provider city.");
+  required("billingProvider.address.state", bill.billingProvider?.address?.state, "Enter the billing provider 2-letter state code.");
+  required("billingProvider.address.postalCode", bill.billingProvider?.address?.postalCode, "Enter the billing provider ZIP code.");
+  required("renderingProvider.name", bill.renderingProvider?.name, "Enter the rendering provider name.");
+  required("renderingProvider.npi", bill.renderingProvider?.npi, "Enter the rendering provider NPI.");
+  required("renderingProvider.taxonomy", bill.renderingProvider?.taxonomy, "Enter the rendering provider taxonomy code.");
+  required("serviceLocation.placeOfServiceCode", bill.serviceLocation?.placeOfServiceCode, "Enter the 2-digit place of service code.");
+  required("serviceLocation.address.line1", bill.serviceLocation?.address?.line1, "Enter the service facility street address.");
+  required("serviceLocation.address.city", bill.serviceLocation?.address?.city, "Enter the service facility city.");
+  required("serviceLocation.address.state", bill.serviceLocation?.address?.state, "Enter the service facility 2-letter state code.");
+  required("serviceLocation.address.postalCode", bill.serviceLocation?.address?.postalCode, "Enter the service facility ZIP code.");
   if (!(bill.diagnoses ?? []).some((code) => code.trim())) {
     errors.diagnoses = "Select at least one ICD-10 diagnosis code.";
   }
@@ -1469,7 +1582,16 @@ function validateBillSubmission(bill) {
     errors["claim.claimsAdministrator"] = "Select a claims administrator from the payer directory.";
   }
   if (bill.patient.dateOfBirth && !parseBillSubmissionDate(bill.patient.dateOfBirth)) errors["patient.dateOfBirth"] = "Use MM/DD/YYYY";
+  if (bill.claim.dateOfInjury && !parseBillSubmissionDate(bill.claim.dateOfInjury)) errors["claim.dateOfInjury"] = "Use MM/DD/YYYY";
   if (bill.patient.address.state.trim().length !== 2) errors["patient.address.state"] = "Use a 2-letter state code";
+  if (bill.billingProvider?.address?.state && bill.billingProvider.address.state.trim().length !== 2) errors["billingProvider.address.state"] = "Use a 2-letter state code.";
+  if (bill.serviceLocation?.address?.state && bill.serviceLocation.address.state.trim().length !== 2) errors["serviceLocation.address.state"] = "Use a 2-letter state code.";
+  const digits = (value) => value?.replace(/\D/g, "") ?? "";
+  if (bill.billingProvider?.taxId && digits(bill.billingProvider.taxId).length !== 9) errors["billingProvider.taxId"] = "Enter a valid 9-digit EIN or SSN.";
+  if (bill.billingProvider?.npi && !/^\d{10}$/.test(digits(bill.billingProvider.npi))) errors["billingProvider.npi"] = "Enter a valid 10-digit NPI.";
+  if (bill.renderingProvider?.npi && !/^\d{10}$/.test(digits(bill.renderingProvider.npi))) errors["renderingProvider.npi"] = "Enter a valid 10-digit NPI.";
+  if (bill.renderingProvider?.taxonomy && !/^[A-Za-z0-9]{10}$/.test(bill.renderingProvider.taxonomy.trim())) errors["renderingProvider.taxonomy"] = "Enter a valid 10-character taxonomy code.";
+  if (bill.serviceLocation?.placeOfServiceCode && !/^\d{2}$/.test(bill.serviceLocation.placeOfServiceCode.trim())) errors["serviceLocation.placeOfServiceCode"] = "Enter a valid 2-digit place of service code.";
   const lines = submittedLines(bill.serviceLines);
   if (!lines.length) errors.serviceLines = "Add at least one service line";
   lines.forEach((line, index) => {
@@ -1482,13 +1604,14 @@ function validateBillSubmission(bill) {
 var css = `
 .mbsf{display:grid;gap:20px;color:var(--mb-text);font-family:var(--mb-font);font-size:15px}.mbsf *{box-sizing:border-box}
 .mbsf-head,.mbsf-section-head,.mbsf-attach-row,.mbsf-actions{display:flex;align-items:center;justify-content:space-between;gap:16px}.mbsf-title{margin:0;font-size:24px}.mbsf-copy,.mbsf-help{color:var(--mb-muted);margin:5px 0 0}.mbsf-required{font-size:13px;color:var(--mb-muted);white-space:nowrap}.mbsf-star,.mbsf-error{color:var(--mb-danger)}
-.mbsf-card{min-width:0;margin:0;padding:24px;border:1px solid var(--mb-border);border-radius:var(--mb-radius);background:var(--mb-surface);box-shadow:var(--mb-shadow)}.mbsf-legend{padding:0 10px;font-size:18px;font-weight:760}.mbsf-grid{display:grid;grid-template-columns:repeat(2,minmax(0,1fr));gap:18px 24px}.mbsf-span{grid-column:1/-1}.mbsf-field{display:grid;align-content:start;gap:7px;min-width:0}.mbsf-label{font-weight:680}.mbsf-input,.mbsf-select{width:100%;min-height:46px;padding:10px 12px;border:1px solid var(--mb-border);border-radius:var(--mb-control-radius);background:var(--mb-input);color:var(--mb-text);font:inherit}.mbsf-input:focus,.mbsf-select:focus{outline:3px solid color-mix(in srgb,var(--mb-accent) 22%,transparent);border-color:var(--mb-accent)}.mbsf-field[data-invalid=true] .mbsf-input,.mbsf-field[data-invalid=true] .mbsf-select,.mbsf-invalid-control .mbsf-input{border-color:var(--mb-danger);background:color-mix(in srgb,var(--mb-danger) 4%,var(--mb-input))}.mbsf-field[data-invalid=true] .mbsf-input:focus,.mbsf-field[data-invalid=true] .mbsf-select:focus{outline-color:color-mix(in srgb,var(--mb-danger) 24%,transparent)}
+.mbsf-card{min-width:0;margin:0;padding:24px;border:1px solid var(--mb-border);border-radius:var(--mb-radius);background:var(--mb-surface);box-shadow:var(--mb-shadow)}.mbsf-card[data-invalid=true]{border-color:var(--mb-danger)}.mbsf-legend{padding:0 10px;font-size:18px;font-weight:760}.mbsf-grid{display:grid;grid-template-columns:repeat(2,minmax(0,1fr));gap:18px 24px}.mbsf-subhead{grid-column:1/-1;margin:6px 0 -2px;padding-top:14px;border-top:1px solid var(--mb-border);font-size:15px;font-weight:780;letter-spacing:.01em}.mbsf-subhead:first-child{margin-top:0;padding-top:0;border-top:0}.mbsf-span{grid-column:1/-1}.mbsf-field{display:grid;align-content:start;gap:7px;min-width:0}.mbsf-label{font-weight:680}.mbsf-input,.mbsf-select{width:100%;min-height:46px;padding:10px 12px;border:1px solid var(--mb-border);border-radius:var(--mb-control-radius);background:var(--mb-input);color:var(--mb-text);font:inherit}.mbsf-input:focus,.mbsf-select:focus{outline:3px solid color-mix(in srgb,var(--mb-accent) 22%,transparent);border-color:var(--mb-accent)}.mbsf-field[data-invalid=true] .mbsf-input,.mbsf-field[data-invalid=true] .mbsf-select,.mbsf-invalid-control .mbsf-input{border-color:var(--mb-danger);background:color-mix(in srgb,var(--mb-danger) 4%,var(--mb-input))}.mbsf-field[data-invalid=true] .mbsf-input:focus,.mbsf-field[data-invalid=true] .mbsf-select:focus{outline-color:color-mix(in srgb,var(--mb-danger) 24%,transparent)}
 .mbsf-combo{position:relative}.mbsf-menu{position:absolute;z-index:20;top:calc(100% + 5px);left:0;right:0;max-height:min(360px,46vh);overflow:auto;overscroll-behavior:contain;padding:7px;border:1px solid var(--mb-border);border-radius:12px;background:var(--mb-surface);box-shadow:0 14px 35px rgba(17,38,49,.16)}.mbsf-option{display:grid;width:100%;gap:2px;padding:10px;border:0;border-radius:8px;background:transparent;color:var(--mb-text);font:inherit;text-align:left;cursor:pointer}.mbsf-option:hover,.mbsf-option:focus{background:color-mix(in srgb,var(--mb-accent) 9%,var(--mb-surface))}.mbsf-option small{color:var(--mb-muted)}.mbsf-menu-status{padding:12px;text-align:center;color:var(--mb-muted);font-size:13px}
+.mbsf-payer-status{display:flex;align-items:center;gap:7px;color:#087f5b;font-size:13px;font-weight:650}.mbsf-payer-intro{margin:4px 0 0;color:var(--mb-muted)}.mbsf-payer-list{display:grid;gap:8px}.mbsf-payer-option{display:flex;align-items:center;justify-content:space-between;gap:14px;padding:11px 12px;border:1px solid var(--mb-border);border-radius:var(--mb-control-radius);background:color-mix(in srgb,var(--mb-accent) 3%,var(--mb-surface))}.mbsf-payer-option-main{display:grid;gap:5px;min-width:0}.mbsf-payer-option-main strong{overflow-wrap:anywhere}.mbsf-payer-signals{display:flex;flex-wrap:wrap;gap:6px}.mbsf-payer-signal{padding:2px 7px;border:1px solid var(--mb-border);border-radius:999px;color:var(--mb-muted);font-size:12px}.mbsf-payer-signal[data-state=match]{border-color:color-mix(in srgb,#159447 45%,var(--mb-border));color:#087f5b}.mbsf-payer-signal[data-state=warning]{border-color:color-mix(in srgb,#c56a00 55%,var(--mb-border));color:#9a5200}
 .mbsf-chips,.mbsf-quick-picks{display:flex;flex-wrap:wrap;gap:7px;margin-bottom:8px}.mbsf-chip,.mbsf-quick-pick{display:inline-flex;align-items:center;gap:7px;padding:5px 9px;border:1px solid var(--mb-border);border-radius:999px;background:var(--mb-input)}.mbsf-chip button{border:0;background:transparent;color:var(--mb-muted);cursor:pointer;font:inherit}.mbsf-quick-pick{color:var(--mb-text);font:inherit;cursor:pointer}.mbsf-quick-pick[data-selected=true]{border-color:var(--mb-accent);color:var(--mb-accent)}
 .mbsf-segments{display:grid;grid-template-columns:repeat(3,1fr);border:1px solid var(--mb-border);border-radius:var(--mb-control-radius);overflow:hidden}.mbsf-segment{min-height:44px;border:0;border-right:1px solid var(--mb-border);background:var(--mb-input);color:var(--mb-text);font:inherit;font-weight:700;cursor:pointer}.mbsf-segment:last-child{border-right:0}.mbsf-segment[aria-pressed=true]{background:var(--mb-accent);color:var(--mb-accent-contrast)}
 .mbsf-lines{margin-top:18px;border:1px solid var(--mb-border);border-radius:var(--mb-control-radius);overflow:visible}.mbsf-lines[data-invalid=true]{border-color:var(--mb-danger)}.mbsf-line-head,.mbsf-line{display:grid;grid-template-columns:minmax(190px,1.05fr) minmax(220px,1.5fr) 100px 120px 42px;gap:12px;align-items:start;padding:12px}.mbsf-line-head{color:var(--mb-muted);font-size:13px;font-weight:700;border-bottom:1px solid var(--mb-border)}.mbsf-line{border-bottom:1px solid var(--mb-border)}.mbsf-line:last-child{border-bottom:0}.mbsf-line [data-invalid=true] .mbsf-input{border-color:var(--mb-danger);background:color-mix(in srgb,var(--mb-danger) 4%,var(--mb-input))}.mbsf-money{padding-top:12px;text-align:right;font-variant-numeric:tabular-nums}.mbsf-total{display:flex;justify-content:flex-end;gap:45px;padding:16px 56px 16px 16px;font-size:17px;font-weight:760}
-.mbsf-icon-btn{width:40px;height:42px;border:0;background:transparent;color:var(--mb-text);font-size:22px;cursor:pointer}.mbsf-secondary{min-height:40px;padding:8px 14px;border:1px solid var(--mb-border);border-radius:var(--mb-control-radius);background:var(--mb-surface);color:var(--mb-text);font:inherit;font-weight:680;cursor:pointer}.mbsf-attach-list{display:grid;gap:10px;margin-bottom:18px}.mbsf-attach-row{padding:14px;border:1px solid var(--mb-border);border-radius:var(--mb-control-radius)}.mbsf-attach-row[data-auto=true]{border-color:color-mix(in srgb,#159447 45%,var(--mb-border));background:color-mix(in srgb,#159447 5%,var(--mb-surface))}.mbsf-attach-main{display:flex;align-items:center;gap:12px;min-width:0;flex:1}.mbsf-attach-actions{display:flex;align-items:center;gap:6px;flex:0 0 auto}.mbsf-file{min-width:0}.mbsf-file strong{overflow-wrap:anywhere}.mbsf-badge{display:inline-block;margin-left:8px;padding:2px 7px;border:1px solid var(--mb-border);border-radius:7px;color:var(--mb-muted);font-size:12px;font-weight:600}.mbsf-drop{display:grid;width:100%;place-items:center;min-height:210px;padding:30px;border:2px dashed color-mix(in srgb,var(--mb-muted) 55%,transparent);border-radius:var(--mb-control-radius);background:color-mix(in srgb,var(--mb-accent) 3%,var(--mb-surface));color:var(--mb-text);font:inherit;text-align:center;cursor:pointer}.mbsf-drop[data-active=true]{border-color:var(--mb-accent);background:color-mix(in srgb,var(--mb-accent) 10%,var(--mb-surface))}.mbsf-alert{padding:12px 14px;border-radius:var(--mb-control-radius);background:color-mix(in srgb,var(--mb-danger) 10%,transparent);color:var(--mb-danger)}.mbsf-actions{justify-content:flex-end}.mbsf-submit{min-width:180px;min-height:48px;padding:11px 24px;border:0;border-radius:var(--mb-control-radius);background:var(--mb-accent);color:var(--mb-accent-contrast);font:inherit;font-weight:780;cursor:pointer}
-@media(max-width:820px){.mbsf{gap:16px}.mbsf-grid{grid-template-columns:1fr}.mbsf-span{grid-column:auto}.mbsf-card{padding:18px 16px}.mbsf-line-head{display:none}.mbsf-line{position:relative;display:grid;grid-template-columns:minmax(0,1fr) 86px;gap:14px;padding:18px 16px}.mbsf-line>div:before{display:block;margin-bottom:6px;color:var(--mb-muted);font-size:12px;font-weight:700;content:attr(data-label)}.mbsf-line>div:nth-child(1),.mbsf-line>div:nth-child(2){grid-column:1/-1}.mbsf-money{align-self:end;padding:0 0 12px;text-align:right}.mbsf-line .mbsf-icon-btn{position:absolute;right:8px;bottom:3px}.mbsf-total{padding:16px 18px;gap:24px}.mbsf-head{align-items:flex-start}.mbsf-segments{grid-template-columns:repeat(3,minmax(0,1fr))}.mbsf-segment{min-width:0;padding:8px 4px;border-right:1px solid var(--mb-border);border-bottom:0;font-size:13px}.mbsf-segment:last-child{border-right:0}.mbsf-attach-row{align-items:flex-start;flex-wrap:wrap}.mbsf-attach-main{align-items:flex-start}.mbsf-attach-actions{margin-left:auto}.mbsf-drop{min-height:190px;padding:24px 18px}.mbsf-actions{position:sticky;bottom:86px;z-index:10}.mbsf-submit{width:100%}}
+.mbsf-icon-btn{width:40px;height:42px;border:0;background:transparent;color:var(--mb-text);font-size:22px;cursor:pointer}.mbsf-secondary{min-height:40px;padding:8px 14px;border:1px solid var(--mb-border);border-radius:var(--mb-control-radius);background:var(--mb-surface);color:var(--mb-text);font:inherit;font-weight:680;cursor:pointer}.mbsf-attach-list{display:grid;gap:10px;margin-bottom:18px}.mbsf-attach-row{padding:14px;border:1px solid var(--mb-border);border-radius:var(--mb-control-radius)}.mbsf-attach-row[data-auto=true]{border-color:color-mix(in srgb,#159447 45%,var(--mb-border));background:color-mix(in srgb,#159447 5%,var(--mb-surface))}.mbsf-attach-main{display:flex;align-items:center;gap:12px;min-width:0;flex:1}.mbsf-attach-type{width:min(360px,32vw);flex:0 1 360px}.mbsf-attach-type .mbsf-label{display:block;margin-bottom:6px;font-size:12px}.mbsf-attach-actions{display:flex;align-items:center;gap:6px;flex:0 0 auto}.mbsf-file{min-width:0}.mbsf-file strong{overflow-wrap:anywhere}.mbsf-badge{display:inline-block;margin-left:8px;padding:2px 7px;border:1px solid var(--mb-border);border-radius:7px;color:var(--mb-muted);font-size:12px;font-weight:600}.mbsf-drop{display:grid;width:100%;place-items:center;min-height:210px;padding:30px;border:2px dashed color-mix(in srgb,var(--mb-muted) 55%,transparent);border-radius:var(--mb-control-radius);background:color-mix(in srgb,var(--mb-accent) 3%,var(--mb-surface));color:var(--mb-text);font:inherit;text-align:center;cursor:pointer}.mbsf-drop[data-active=true]{border-color:var(--mb-accent);background:color-mix(in srgb,var(--mb-accent) 10%,var(--mb-surface))}.mbsf-alert{padding:12px 14px;border-radius:var(--mb-control-radius);background:color-mix(in srgb,var(--mb-danger) 10%,transparent);color:var(--mb-danger)}.mbsf-actions{justify-content:flex-end}.mbsf-submit{min-width:180px;min-height:48px;padding:11px 24px;border:0;border-radius:var(--mb-control-radius);background:var(--mb-accent);color:var(--mb-accent-contrast);font:inherit;font-weight:780;cursor:pointer}
+@media(max-width:820px){.mbsf{gap:16px}.mbsf-grid{grid-template-columns:1fr}.mbsf-span{grid-column:auto}.mbsf-card{padding:18px 16px}.mbsf-line-head{display:none}.mbsf-line{position:relative;display:grid;grid-template-columns:minmax(0,1fr) 86px;gap:14px;padding:18px 16px}.mbsf-line>div:before{display:block;margin-bottom:6px;color:var(--mb-muted);font-size:12px;font-weight:700;content:attr(data-label)}.mbsf-line>div:nth-child(1),.mbsf-line>div:nth-child(2){grid-column:1/-1}.mbsf-money{align-self:end;padding:0 0 12px;text-align:right}.mbsf-line .mbsf-icon-btn{position:absolute;right:8px;bottom:3px}.mbsf-total{padding:16px 18px;gap:24px}.mbsf-head{align-items:flex-start}.mbsf-segments{grid-template-columns:repeat(3,minmax(0,1fr))}.mbsf-segment{min-width:0;padding:8px 4px;border-right:1px solid var(--mb-border);border-bottom:0;font-size:13px}.mbsf-segment:last-child{border-right:0}.mbsf-payer-option{align-items:flex-start}.mbsf-attach-row{align-items:flex-start;flex-wrap:wrap}.mbsf-attach-main{align-items:flex-start;flex-basis:calc(100% - 150px)}.mbsf-attach-type{width:100%;flex-basis:100%;order:3}.mbsf-attach-actions{margin-left:auto}.mbsf-drop{min-height:190px;padding:24px 18px}.mbsf-actions{position:sticky;bottom:86px;z-index:10}.mbsf-submit{width:100%}}
 `;
 function RequiredMark() {
   return /* @__PURE__ */ jsx3("span", { className: "mbsf-star", children: " *" });
@@ -1522,7 +1645,7 @@ function TextDateInput({ value, onChange, disabled, required, ariaLabel }) {
     invalid ? /* @__PURE__ */ jsx3("small", { className: "mbsf-error", children: "Use MM/DD/YYYY" }) : null
   ] });
 }
-function ComboBox({ value, placeholder, options, disabled, loading, loadingMore, invalid, onOpen, onQuery, onEndReached, onSelect, createOption, ariaLabel }) {
+function ComboBox({ value, placeholder, options, disabled, loading, loadingMore, invalid, preserveValueOnOpen = false, onOpen, onQuery, onEndReached, onSelect, createOption, ariaLabel }) {
   const [open, setOpen] = useState2(false);
   const [query, setQuery] = useState2("");
   const visible = useMemo2(() => {
@@ -1534,9 +1657,11 @@ function ComboBox({ value, placeholder, options, disabled, loading, loadingMore,
   const showMenu = open && (loading || visible.length > 0 || query.trim().length >= 2);
   return /* @__PURE__ */ jsxs3("div", { className: "mbsf-combo", children: [
     /* @__PURE__ */ jsx3("input", { className: "mbsf-input", role: "combobox", "aria-label": ariaLabel, "aria-invalid": invalid, "aria-expanded": showMenu, autoComplete: "off", disabled, placeholder, value: open ? query : value, onFocus: () => {
+      const next = preserveValueOnOpen ? value : "";
       setOpen(true);
-      setQuery("");
+      setQuery(next);
       onOpen?.();
+      if (next) onQuery?.(next);
     }, onChange: (event) => {
       setOpen(true);
       setQuery(event.target.value);
@@ -1546,7 +1671,7 @@ function ComboBox({ value, placeholder, options, disabled, loading, loadingMore,
       const menu = event.currentTarget;
       if (menu.scrollHeight - menu.scrollTop - menu.clientHeight < 120) onEndReached?.();
     }, children: [
-      loading && !visible.length ? /* @__PURE__ */ jsx3("div", { className: "mbsf-menu-status", children: "Loading codes\u2026" }) : visible.length ? visible.map((option) => /* @__PURE__ */ jsxs3("button", { className: "mbsf-option", type: "button", role: "option", onMouseDown: (event) => event.preventDefault(), onClick: () => {
+      loading && !visible.length ? /* @__PURE__ */ jsx3("div", { className: "mbsf-menu-status", children: "Loading\u2026" }) : visible.length ? visible.map((option) => /* @__PURE__ */ jsxs3("button", { className: "mbsf-option", type: "button", role: "option", onMouseDown: (event) => event.preventDefault(), onClick: () => {
         onSelect(option);
         setOpen(false);
         setQuery("");
@@ -1590,6 +1715,16 @@ function mergeOptions(defaults, supplied) {
 function mergeDiagnosisOptions(options) {
   return [...new Map(options.map((item) => [item.code.toUpperCase(), item])).values()].sort((left, right) => left.code.localeCompare(right.code, void 0, { numeric: true }));
 }
+function normalizeClaimsAdministratorName(value) {
+  return value.toUpperCase().replace(/\[[^\]]*]/g, " ").replace(/\b(?:INCORPORATED|INC|COMPANY|CO|CORPORATION|CORP|GROUP|INSURANCE|SERVICES)\b/g, " ").replace(/[^A-Z0-9]+/g, " ").trim().replace(/\s+/g, " ");
+}
+function exactClaimsAdministratorMatch(results, suppliedName) {
+  const normalized = normalizeClaimsAdministratorName(suppliedName);
+  return results.find((payer) => normalizeClaimsAdministratorName(payer.name) === normalized) ?? results.find((payer) => payer.confidence === "high" && payer.recommended);
+}
+function claimsAdministratorRecommendations(results, limit = 5) {
+  return [...results].sort((left, right) => Number(Boolean(right.recommended)) - Number(Boolean(left.recommended))).slice(0, Math.max(0, limit));
+}
 var BillSubmissionSectionsContext = createContext(null);
 function BillSubmissionSection({ id }) {
   const sections = useContext(BillSubmissionSectionsContext);
@@ -1632,6 +1767,9 @@ function BillSubmissionForm({
   onLookupPostalCode,
   procedureOptions,
   modifierOptions,
+  attachmentReportTypeMode = "auto",
+  attachmentReportTypes = BILL_SUBMISSION_REPORT_TYPES,
+  defaultAttachmentReportType,
   appearance,
   className = "bill-submission-form",
   style,
@@ -1646,6 +1784,7 @@ function BillSubmissionForm({
   const [removedSourceIds, setRemovedSourceIds] = useState2([]);
   const [uploads, setUploads] = useState2([]);
   const [errors, setErrors] = useState2({});
+  const [sourceAttachmentReportTypes, setSourceAttachmentReportTypes] = useState2(() => Object.fromEntries(attachments.flatMap((item) => item.reportTypeCode ? [[item.id, item.reportTypeCode]] : [])));
   const [validationActive, setValidationActive] = useState2(false);
   const [formError, setFormError] = useState2(null);
   const [submitting, setSubmitting] = useState2(false);
@@ -1662,6 +1801,7 @@ function BillSubmissionForm({
   const fileInput = useRef2(null);
   const diagnosisRequest = useRef2(0);
   const diagnosisAppendPending = useRef2(false);
+  const payerRequest = useRef2(0);
   const procedures = useMemo2(() => mergeOptions(DEFAULT_BILL_SUBMISSION_PROCEDURES, procedureOptions), [procedureOptions]);
   const modifiers = useMemo2(() => mergeOptions(DEFAULT_BILL_SUBMISSION_MODIFIERS, modifierOptions), [modifierOptions]);
   const [evaluationType, setEvaluationType] = useState2(() => initialEvaluationType(initialBill));
@@ -1669,12 +1809,17 @@ function BillSubmissionForm({
   const referenceClient = useMemo2(() => getSession || sessionEndpoint || connected ? createBillReferenceClient({ getSession, sessionEndpoint, apiBaseUrl, fetch: fetchOverride }) : null, [getSession, sessionEndpoint, apiBaseUrl, fetchOverride, connected]);
   const submissionClient = useMemo2(() => connected ? createBillSubmissionClient({ getSession, sessionEndpoint, apiBaseUrl, fetch: fetchOverride }) : null, [getSession, sessionEndpoint, apiBaseUrl, fetchOverride, connected]);
   const locked = disabled || submitting;
+  const showAttachmentReportTypes = attachmentReportTypeMode === "visible" || attachmentReportTypeMode === "auto" && bill.billingMode !== "med_legal";
+  const forcedAttachmentReportType = showAttachmentReportTypes ? void 0 : defaultAttachmentReportType ?? MED_LEGAL_REPORT_TYPE_CODE;
+  const reportTypeOptions = useMemo2(() => attachmentReportTypes.map((item) => ({ id: item.code, label: item.code.replace(/^OZ:/, ""), detail: item.label })), [attachmentReportTypes]);
+  const missingAttachmentReportType = showAttachmentReportTypes && (selectedIds.some((id) => !(sourceAttachmentReportTypes[id] || attachments.find((item) => item.id === id)?.reportTypeCode || defaultAttachmentReportType)) || uploads.some((upload) => !(upload.reportTypeCode || defaultAttachmentReportType)));
   useEffect2(() => {
     setBill(cloneInitialBill(initialBill));
     setEvaluationType(initialEvaluationType(initialBill));
     setSelectedIds(attachments.map((item) => item.id));
     setRemovedSourceIds([]);
     setUploads([]);
+    setSourceAttachmentReportTypes(Object.fromEntries(attachments.flatMap((item) => item.reportTypeCode ? [[item.id, item.reportTypeCode]] : [])));
     setErrors({});
     setValidationActive(false);
     setFormError(null);
@@ -1685,8 +1830,10 @@ function BillSubmissionForm({
     diagnosisAppendPending.current = false;
   }, [initialBill, attachments]);
   useEffect2(() => {
-    if (validationActive) setErrors(validateBillSubmission(bill).fieldErrors);
-  }, [bill, validationActive]);
+    if (!validationActive) return;
+    const next = validateBillSubmission(bill).fieldErrors;
+    setErrors(missingAttachmentReportType ? { ...next, attachments: "Select a report type for every attachment." } : next);
+  }, [bill, missingAttachmentReportType, validationActive]);
   const addFiles = useCallback((fileList) => {
     const files = Array.from(fileList);
     if (!files.length) return;
@@ -1698,8 +1845,8 @@ function BillSubmissionForm({
     const nextBytes = [...uploads.map((item) => item.file), ...files].reduce((sum, file) => sum + file.size, 0);
     if (nextBytes > MAX_UPLOAD_BYTES) return setFormError("Attachments exceed the 100 MB upload limit.");
     if (selectedIds.length + uploads.length + files.length > MAX_DOCUMENTS) return setFormError(`A bill can include at most ${MAX_DOCUMENTS} attachments.`);
-    setUploads((current) => [...current, ...files.map((file) => ({ file, documentType: "other" }))]);
-  }, [selectedIds.length, uploads]);
+    setUploads((current) => [...current, ...files.map((file) => ({ file, documentType: "other", ...defaultAttachmentReportType ? { reportTypeCode: defaultAttachmentReportType } : {} }))]);
+  }, [defaultAttachmentReportType, selectedIds.length, uploads]);
   useEffect2(() => {
     const over = (event) => {
       if (event.dataTransfer?.types.includes("Files")) {
@@ -1740,16 +1887,41 @@ function BillSubmissionForm({
     return next;
   })) }));
   const text = (value, onChange, options = {}) => /* @__PURE__ */ jsx3("input", { className: "mbsf-input", disabled: locked, value: value ?? "", onChange: (event) => onChange(event.target.value), ...options });
-  const searchPayers = (query) => {
-    if (query.trim().length < 2) return;
-    setPayerLoading(true);
-    const search = onSearchClaimsAdministrators ?? referenceClient?.searchClaimsAdministrators;
-    if (!search) {
-      setPayerLoading(false);
+  const runPayerSearch = useCallback(async (query, autoSelect) => {
+    const trimmed = query.trim();
+    if (trimmed.length < 2) {
+      setPayerResults([]);
       return;
     }
-    void search(query, bill.claim.claimNumber).then(setPayerResults).catch((caught) => setFormError(caught instanceof Error ? caught.message : "Claims administrator search is unavailable.")).finally(() => setPayerLoading(false));
+    const search = onSearchClaimsAdministrators ?? referenceClient?.searchClaimsAdministrators;
+    if (!search) return;
+    const request = ++payerRequest.current;
+    setPayerLoading(true);
+    try {
+      const results = await search(trimmed, bill.claim.claimNumber);
+      if (request !== payerRequest.current) return;
+      setPayerResults(results);
+      const exact = autoSelect ? exactClaimsAdministratorMatch(results, trimmed) : void 0;
+      if (exact) setBill((current) => ({ ...current, claim: { ...current.claim, claimsAdministrator: { id: exact.id, name: exact.name } } }));
+    } catch (caught) {
+      if (request === payerRequest.current) setFormError(caught instanceof Error ? caught.message : "Claims administrator search is unavailable.");
+    } finally {
+      if (request === payerRequest.current) setPayerLoading(false);
+    }
+  }, [bill.claim.claimNumber, onSearchClaimsAdministrators, referenceClient]);
+  const searchPayers = (query) => {
+    setBill((current) => {
+      const selected = current.claim.claimsAdministrator;
+      if (selected?.id && selected.name === query) return current;
+      return { ...current, claim: { ...current.claim, claimsAdministrator: { name: query } } };
+    });
+    void runPayerSearch(query, true);
   };
+  useEffect2(() => {
+    const payer = bill.claim.claimsAdministrator;
+    if (!payer?.name || payer.name.trim().length < 2) return;
+    void runPayerSearch(payer.name, !payer.id);
+  }, [bill.claim.claimsAdministrator?.id, bill.claim.claimsAdministrator?.name, bill.claim.claimNumber, runPayerSearch]);
   const loadDiagnoses = (query, append = false) => {
     const trimmed = query.trim();
     const search = onSearchDiagnoses ?? referenceClient?.searchDiagnosisCodes;
@@ -1811,12 +1983,13 @@ function BillSubmissionForm({
       return charge == null ? line : { ...line, charge };
     }) };
     const validation = validateBillSubmission(clean);
+    const fieldErrors = missingAttachmentReportType ? { ...validation.fieldErrors, attachments: "Select a report type for every attachment." } : validation.fieldErrors;
     setValidationActive(true);
-    setErrors(validation.fieldErrors);
+    setErrors(fieldErrors);
     setFormError(null);
-    if (!validation.valid) {
-      const count = Object.keys(validation.fieldErrors).length;
-      const first = Object.values(validation.fieldErrors)[0];
+    if (Object.keys(fieldErrors).length) {
+      const count = Object.keys(fieldErrors).length;
+      const first = Object.values(fieldErrors)[0];
       setFormError(`Fix ${count} highlighted field${count === 1 ? "" : "s"} before submitting. ${first}`);
       window.requestAnimationFrame(() => {
         if (formRef.current) focusFirstInvalid(formRef.current);
@@ -1824,19 +1997,22 @@ function BillSubmissionForm({
       return;
     }
     if (selectedIds.length + uploads.length > MAX_DOCUMENTS) return setFormError(`A bill can include at most ${MAX_DOCUMENTS} attachments.`);
+    const complete = clean;
     setSubmitting(true);
     try {
       if (onSubmit) {
-        await onSubmit({ bill: clean, sourceAttachmentIds: selectedIds, uploads });
+        await onSubmit({ bill: complete, sourceAttachmentIds: selectedIds, sourceAttachmentReportTypes, uploads });
       } else {
         if (!submissionClient) throw new Error("The connected billing client is unavailable.");
         const documents = await prepareBillSubmissionDocuments({
           attachments,
           selectedIds,
           uploads,
+          reportTypeCodeByAttachmentId: sourceAttachmentReportTypes,
+          ...forcedAttachmentReportType ? { defaultReportTypeCode: forcedAttachmentReportType } : {},
           ...fetchOverride ? { fetch: fetchOverride } : {}
         });
-        const result = await submissionClient.submitBill({ bill: clean, documents });
+        const result = await submissionClient.submitBill({ bill: complete, documents });
         await onSubmitted?.(result);
       }
     } catch (caught) {
@@ -1845,7 +2021,10 @@ function BillSubmissionForm({
       setSubmitting(false);
     }
   }
-  const claimsAdministratorError = errors["claim.claimsAdministrator"] ?? (!bill.claim.claimsAdministrator?.id ? "Required for routing \u2014 search and select a claims administrator." : void 0);
+  const claimsAdministratorError = errors["claim.claimsAdministrator"];
+  const selectedPayer = payerResults.find((payer) => payer.id === bill.claim.claimsAdministrator?.id);
+  const payerRecommendations = bill.claim.claimsAdministrator?.id ? [] : claimsAdministratorRecommendations(payerResults);
+  const choosePayer = (payer) => setBill((current) => ({ ...current, claim: { ...current.claim, claimsAdministrator: { id: payer.id, name: payer.name } } }));
   const headerSection = /* @__PURE__ */ jsxs3("div", { className: "mbsf-head", children: [
     /* @__PURE__ */ jsxs3("div", { children: [
       /* @__PURE__ */ jsx3("h3", { className: "mbsf-title", children: heading }),
@@ -1877,11 +2056,42 @@ function BillSubmissionForm({
     /* @__PURE__ */ jsx3("legend", { className: "mbsf-legend", children: "Injury & claim" }),
     /* @__PURE__ */ jsxs3("div", { className: "mbsf-grid", children: [
       /* @__PURE__ */ jsx3(Field2, { path: "service.date", label: "Date of service", required: true, error: errors["service.date"], children: /* @__PURE__ */ jsx3(TextDateInput, { ariaLabel: "Date of service", value: bill.service.date, disabled: locked, required: true, onChange: (date2) => setBill((c) => ({ ...c, service: { ...c.service, date: date2 } })) }) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Date of injury", children: /* @__PURE__ */ jsx3(TextDateInput, { ariaLabel: "Date of injury", value: bill.claim.dateOfInjury, disabled: locked, onChange: (dateOfInjury) => setBill((c) => ({ ...c, claim: { ...c.claim, dateOfInjury } })) }) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Employer (optional)", children: text(bill.claim.employer, (employer) => setBill((c) => ({ ...c, claim: { ...c.claim, employer } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "claim.dateOfInjury", label: "Date of injury", required: true, error: errors["claim.dateOfInjury"], children: /* @__PURE__ */ jsx3(TextDateInput, { ariaLabel: "Date of injury", value: bill.claim.dateOfInjury, disabled: locked, required: true, onChange: (dateOfInjury) => setBill((c) => ({ ...c, claim: { ...c.claim, dateOfInjury } })) }) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "claim.employer", label: "Employer name", required: true, error: errors["claim.employer"], children: text(bill.claim.employer, (employer) => setBill((c) => ({ ...c, claim: { ...c.claim, employer } }))) }),
       /* @__PURE__ */ jsx3(Field2, { path: "claim.claimNumber", label: "Claim number", required: true, error: errors["claim.claimNumber"], children: text(bill.claim.claimNumber, (claimNumber) => setBill((c) => ({ ...c, claim: { ...c.claim, claimNumber } }))) }),
       /* @__PURE__ */ jsx3(Field2, { label: "WCAB / ADJ number (optional)", children: text(bill.claim.adjNumber, (adjNumber) => setBill((c) => ({ ...c, claim: { ...c.claim, adjNumber } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { path: "claim.claimsAdministrator", label: "Claims administrator", required: true, span: true, error: claimsAdministratorError, children: /* @__PURE__ */ jsx3(ComboBox, { ariaLabel: "Claims administrator", invalid: Boolean(claimsAdministratorError), disabled: locked, loading: payerLoading, value: bill.claim.claimsAdministrator?.name ?? "", placeholder: "Search the payer directory\u2026", options: payerResults.map((payer) => ({ id: payer.id, label: payer.name, detail: [payer.hasElectronic ? "Electronic" : "Work comp", ...payer.states ?? []].join(" \xB7 ") })), onQuery: searchPayers, onSelect: (option) => setBill((c) => ({ ...c, claim: { ...c.claim, claimsAdministrator: { id: option.id, name: option.label } } })) }) }),
+      /* @__PURE__ */ jsxs3(Field2, { path: "claim.claimsAdministrator", label: "Claims administrator", required: true, span: true, error: claimsAdministratorError, children: [
+        /* @__PURE__ */ jsx3(ComboBox, { ariaLabel: "Claims administrator", invalid: Boolean(claimsAdministratorError), disabled: locked, loading: payerLoading, preserveValueOnOpen: true, value: bill.claim.claimsAdministrator?.name ?? "", placeholder: "Search the payer directory\u2026", options: payerResults.map((payer) => ({ id: payer.id, label: payer.name, detail: [payer.hasElectronic ? "Electronic" : "Work comp", ...payer.states ?? []].join(" \xB7 ") })), onQuery: searchPayers, onSelect: (option) => choosePayer({ id: option.id, name: option.label }) }),
+        selectedPayer ? /* @__PURE__ */ jsxs3("div", { className: "mbsf-payer-status", role: "status", children: [
+          /* @__PURE__ */ jsx3("strong", { children: "\u2713 Routing match set:" }),
+          " ",
+          selectedPayer.name
+        ] }) : null,
+        selectedPayer?.signals?.length ? /* @__PURE__ */ jsx3("div", { className: "mbsf-payer-signals", children: selectedPayer.signals.map((signal, index) => /* @__PURE__ */ jsxs3("span", { "data-state": signal.state, children: [
+          signal.state === "match" ? "\u2713" : "!",
+          " ",
+          signal.label
+        ] }, `${signal.kind}-${index}`)) }) : null,
+        !selectedPayer && payerRecommendations.length ? /* @__PURE__ */ jsxs3(Fragment2, { children: [
+          /* @__PURE__ */ jsxs3("p", { className: "mbsf-payer-intro", children: [
+            "Confirm the best routing match for ",
+            /* @__PURE__ */ jsx3("strong", { children: bill.claim.claimsAdministrator?.name }),
+            ":"
+          ] }),
+          /* @__PURE__ */ jsx3("div", { className: "mbsf-payer-list", children: payerRecommendations.map((payer) => /* @__PURE__ */ jsxs3("div", { className: "mbsf-payer-option", children: [
+            /* @__PURE__ */ jsxs3("div", { className: "mbsf-payer-option-main", children: [
+              /* @__PURE__ */ jsx3("strong", { children: payer.name }),
+              payer.signals?.length ? /* @__PURE__ */ jsx3("div", { className: "mbsf-payer-signals", children: payer.signals.map((signal, index) => /* @__PURE__ */ jsxs3("span", { "data-state": signal.state, children: [
+                signal.state === "match" ? "\u2713" : "!",
+                " ",
+                signal.label
+              ] }, `${signal.kind}-${index}`)) }) : /* @__PURE__ */ jsx3("small", { className: "mbsf-help", children: "Directory match" })
+            ] }),
+            /* @__PURE__ */ jsx3("button", { className: "mbsf-secondary", type: "button", onClick: () => choosePayer(payer), children: "Use" })
+          ] }, payer.id)) })
+        ] }) : null,
+        !selectedPayer && !payerLoading && !payerRecommendations.length && (bill.claim.claimsAdministrator?.name.trim().length ?? 0) >= 2 ? /* @__PURE__ */ jsx3("small", { className: "mbsf-help", children: "No confident route selected yet. Search the directory and choose a claims administrator." }) : null
+      ] }),
       /* @__PURE__ */ jsx3(Field2, { label: "Injury description (optional)", span: true, children: text(bill.claim.description, (description2) => setBill((c) => ({ ...c, claim: { ...c.claim, description: description2 } }))) }),
       /* @__PURE__ */ jsxs3(Field2, { path: "diagnoses", label: "Diagnosis codes (ICD-10)", required: true, span: true, error: errors.diagnoses, children: [
         /* @__PURE__ */ jsx3("div", { className: "mbsf-quick-picks", "aria-label": "Common diagnosis codes", children: BILL_SUBMISSION_DIAGNOSIS_QUICK_PICKS.map((option) => {
@@ -1909,17 +2119,34 @@ function BillSubmissionForm({
   const providersSection = /* @__PURE__ */ jsxs3("fieldset", { className: "mbsf-card", disabled: locked, children: [
     /* @__PURE__ */ jsx3("legend", { className: "mbsf-legend", children: "Providers & place of service" }),
     /* @__PURE__ */ jsxs3("div", { className: "mbsf-grid", children: [
-      /* @__PURE__ */ jsx3(Field2, { label: "Billing provider", children: text(bill.billingProvider?.name, (name) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, name } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Billing tax ID", children: text(bill.billingProvider?.taxId, (taxId) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, taxId } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Billing NPI", children: text(bill.billingProvider?.npi, (npi) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, npi } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Billing phone", children: text(bill.billingProvider?.phone, (phone) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, phone } })), { type: "tel" }) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Rendering provider", children: text(bill.renderingProvider?.name, (name) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, name } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Specialty", children: text(bill.renderingProvider?.specialty, (specialty) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, specialty } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Rendering NPI", children: text(bill.renderingProvider?.npi, (npi) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, npi } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "License number", children: text(bill.renderingProvider?.licenseNumber, (licenseNumber) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, licenseNumber } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "License state", children: text(bill.renderingProvider?.licenseState, (licenseState) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, licenseState: licenseState.toUpperCase() } })), { maxLength: 2 }) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Service location", children: text(bill.serviceLocation?.name, (name) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, name } }))) }),
-      /* @__PURE__ */ jsx3(Field2, { label: "Place of service", children: text(bill.serviceLocation?.placeOfServiceCode, (placeOfServiceCode) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, placeOfServiceCode } })), { maxLength: 2 }) })
+      /* @__PURE__ */ jsx3("h4", { className: "mbsf-subhead", children: "Billing provider" }),
+      /* @__PURE__ */ jsx3(Field2, { path: "billingProvider.name", label: "Billing provider name", required: true, error: errors["billingProvider.name"], children: text(bill.billingProvider?.name, (name) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, name } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "billingProvider.taxId", label: "Tax ID (EIN / SSN)", required: true, error: errors["billingProvider.taxId"], children: text(bill.billingProvider?.taxId, (taxId) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, taxId } })), { inputMode: "numeric" }) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "billingProvider.npi", label: "Billing provider NPI", required: true, error: errors["billingProvider.npi"], children: text(bill.billingProvider?.npi, (npi) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, npi } })), { inputMode: "numeric", maxLength: 10 }) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "billingProvider.phone", label: "Billing provider phone", required: true, error: errors["billingProvider.phone"], children: text(bill.billingProvider?.phone, (phone) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, phone } })), { type: "tel" }) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "billingProvider.address.line1", label: "Billing address line 1", required: true, span: true, error: errors["billingProvider.address.line1"], children: text(bill.billingProvider?.address?.line1, (line1) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, address: { line1, line2: c.billingProvider?.address?.line2 ?? "", city: c.billingProvider?.address?.city ?? "", state: c.billingProvider?.address?.state ?? "", postalCode: c.billingProvider?.address?.postalCode ?? "" } } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { label: "Billing address line 2 (optional)", span: true, children: text(bill.billingProvider?.address?.line2, (line2) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, address: { line1: c.billingProvider?.address?.line1 ?? "", line2, city: c.billingProvider?.address?.city ?? "", state: c.billingProvider?.address?.state ?? "", postalCode: c.billingProvider?.address?.postalCode ?? "" } } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "billingProvider.address.city", label: "Billing city", required: true, error: errors["billingProvider.address.city"], children: text(bill.billingProvider?.address?.city, (city) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, address: { line1: c.billingProvider?.address?.line1 ?? "", line2: c.billingProvider?.address?.line2 ?? "", city, state: c.billingProvider?.address?.state ?? "", postalCode: c.billingProvider?.address?.postalCode ?? "" } } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "billingProvider.address.state", label: "Billing state", required: true, error: errors["billingProvider.address.state"], children: text(bill.billingProvider?.address?.state, (state) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, address: { line1: c.billingProvider?.address?.line1 ?? "", line2: c.billingProvider?.address?.line2 ?? "", city: c.billingProvider?.address?.city ?? "", state: state.toUpperCase(), postalCode: c.billingProvider?.address?.postalCode ?? "" } } })), { maxLength: 2 }) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "billingProvider.address.postalCode", label: "Billing ZIP", required: true, error: errors["billingProvider.address.postalCode"], children: text(bill.billingProvider?.address?.postalCode, (postalCode) => setBill((c) => ({ ...c, billingProvider: { ...c.billingProvider, address: { line1: c.billingProvider?.address?.line1 ?? "", line2: c.billingProvider?.address?.line2 ?? "", city: c.billingProvider?.address?.city ?? "", state: c.billingProvider?.address?.state ?? "", postalCode } } }))) }),
+      /* @__PURE__ */ jsx3("h4", { className: "mbsf-subhead", children: "Rendering provider" }),
+      /* @__PURE__ */ jsx3(Field2, { path: "renderingProvider.name", label: "Rendering provider name", required: true, error: errors["renderingProvider.name"], children: text(bill.renderingProvider?.name, (name) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, name } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "renderingProvider.npi", label: "Rendering provider NPI", required: true, error: errors["renderingProvider.npi"], children: text(bill.renderingProvider?.npi, (npi) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, npi } })), { inputMode: "numeric", maxLength: 10 }) }),
+      /* @__PURE__ */ jsxs3(Field2, { path: "renderingProvider.taxonomy", label: "Rendering taxonomy code", required: true, error: errors["renderingProvider.taxonomy"], children: [
+        text(bill.renderingProvider?.taxonomy, (taxonomy) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, taxonomy: taxonomy.toUpperCase() } })), { maxLength: 10, placeholder: "10-character NUCC code" }),
+        /* @__PURE__ */ jsx3("small", { className: "mbsf-help", children: "Sent in CMS-1500 Box 24J with qualifier ZZ." })
+      ] }),
+      /* @__PURE__ */ jsx3(Field2, { label: "Specialty (optional)", children: text(bill.renderingProvider?.specialty, (specialty) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, specialty } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { label: "License number (optional)", children: text(bill.renderingProvider?.licenseNumber, (licenseNumber) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, licenseNumber } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { label: "License state (optional)", children: text(bill.renderingProvider?.licenseState, (licenseState) => setBill((c) => ({ ...c, renderingProvider: { ...c.renderingProvider, licenseState: licenseState.toUpperCase() } })), { maxLength: 2 }) }),
+      /* @__PURE__ */ jsx3("h4", { className: "mbsf-subhead", children: "Service facility (CMS-1500 Box 32)" }),
+      /* @__PURE__ */ jsx3(Field2, { label: "Service facility name (optional)", children: text(bill.serviceLocation?.name, (name) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, name } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "serviceLocation.placeOfServiceCode", label: "Place of service code", required: true, error: errors["serviceLocation.placeOfServiceCode"], children: text(bill.serviceLocation?.placeOfServiceCode, (placeOfServiceCode) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, placeOfServiceCode } })), { inputMode: "numeric", maxLength: 2, placeholder: "11" }) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "serviceLocation.address.line1", label: "Service address line 1", required: true, span: true, error: errors["serviceLocation.address.line1"], children: text(bill.serviceLocation?.address?.line1, (line1) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, address: { line1, line2: c.serviceLocation?.address?.line2 ?? "", city: c.serviceLocation?.address?.city ?? "", state: c.serviceLocation?.address?.state ?? "", postalCode: c.serviceLocation?.address?.postalCode ?? "" } } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { label: "Service address line 2 (optional)", span: true, children: text(bill.serviceLocation?.address?.line2, (line2) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, address: { line1: c.serviceLocation?.address?.line1 ?? "", line2, city: c.serviceLocation?.address?.city ?? "", state: c.serviceLocation?.address?.state ?? "", postalCode: c.serviceLocation?.address?.postalCode ?? "" } } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "serviceLocation.address.city", label: "Service city", required: true, error: errors["serviceLocation.address.city"], children: text(bill.serviceLocation?.address?.city, (city) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, address: { line1: c.serviceLocation?.address?.line1 ?? "", line2: c.serviceLocation?.address?.line2 ?? "", city, state: c.serviceLocation?.address?.state ?? "", postalCode: c.serviceLocation?.address?.postalCode ?? "" } } }))) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "serviceLocation.address.state", label: "Service state", required: true, error: errors["serviceLocation.address.state"], children: text(bill.serviceLocation?.address?.state, (state) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, address: { line1: c.serviceLocation?.address?.line1 ?? "", line2: c.serviceLocation?.address?.line2 ?? "", city: c.serviceLocation?.address?.city ?? "", state: state.toUpperCase(), postalCode: c.serviceLocation?.address?.postalCode ?? "" } } })), { maxLength: 2 }) }),
+      /* @__PURE__ */ jsx3(Field2, { path: "serviceLocation.address.postalCode", label: "Service ZIP", required: true, error: errors["serviceLocation.address.postalCode"], children: text(bill.serviceLocation?.address?.postalCode, (postalCode) => setBill((c) => ({ ...c, serviceLocation: { ...c.serviceLocation, address: { line1: c.serviceLocation?.address?.line1 ?? "", line2: c.serviceLocation?.address?.line2 ?? "", city: c.serviceLocation?.address?.city ?? "", state: c.serviceLocation?.address?.state ?? "", postalCode } } }))) })
     ] })
   ] });
   const serviceLinesSection = /* @__PURE__ */ jsxs3("fieldset", { className: "mbsf-card", disabled: locked, children: [
@@ -1929,9 +2156,15 @@ function BillSubmissionForm({
     /* @__PURE__ */ jsx3("p", { className: "mbsf-help", children: evaluationType === "ame" ? "Agreed Medical Evaluator \u2014 eligible ML evaluation codes default to modifier -94." : evaluationType === "psych_qme" ? "Psychiatric QME \u2014 eligible ML evaluation codes default to modifier -96 (-95 for ML200)." : "Qualified Medical Evaluator \u2014 eligible ML evaluation codes default to modifier -95." }),
     /* @__PURE__ */ jsxs3("div", { className: "mbsf-lines", "data-field-path": "serviceLines", "data-invalid": Boolean(errors.serviceLines), children: [
       /* @__PURE__ */ jsxs3("div", { className: "mbsf-line-head", children: [
-        /* @__PURE__ */ jsx3("span", { children: "Procedure code" }),
+        /* @__PURE__ */ jsxs3("span", { children: [
+          "Procedure code",
+          /* @__PURE__ */ jsx3(RequiredMark, {})
+        ] }),
         /* @__PURE__ */ jsx3("span", { children: "Modifiers" }),
-        /* @__PURE__ */ jsx3("span", { children: "Units" }),
+        /* @__PURE__ */ jsxs3("span", { children: [
+          "Units",
+          /* @__PURE__ */ jsx3(RequiredMark, {})
+        ] }),
         /* @__PURE__ */ jsx3("span", { children: "Allowed" }),
         /* @__PURE__ */ jsx3("span", {}),
         " "
@@ -1967,12 +2200,13 @@ function BillSubmissionForm({
     ] }),
     errors.serviceLines ? /* @__PURE__ */ jsx3("p", { className: "mbsf-error", role: "alert", children: errors.serviceLines }) : null
   ] });
-  const attachmentsSection = /* @__PURE__ */ jsxs3("fieldset", { className: "mbsf-card", disabled: locked, children: [
+  const attachmentsSection = /* @__PURE__ */ jsxs3("fieldset", { className: "mbsf-card", "data-field-path": "attachments", "data-invalid": Boolean(errors.attachments), disabled: locked, children: [
     /* @__PURE__ */ jsx3("legend", { className: "mbsf-legend", children: "Attachments" }),
     /* @__PURE__ */ jsxs3("div", { className: "mbsf-attach-list", children: [
       attachments.filter((attachment) => !removedSourceIds.includes(attachment.id)).map((attachment) => {
         const auto = attachment.autoAttached || attachment.documentType === "w9";
         const removable = !auto && attachment.removable !== false;
+        const reportTypeCode = sourceAttachmentReportTypes[attachment.id] || attachment.reportTypeCode || defaultAttachmentReportType || "";
         return /* @__PURE__ */ jsxs3("div", { className: "mbsf-attach-row", "data-auto": auto, children: [
           /* @__PURE__ */ jsxs3("div", { className: "mbsf-attach-main", children: [
             auto ? /* @__PURE__ */ jsx3("span", { "aria-label": "Always attached", role: "img", children: "\u2713" }) : null,
@@ -1982,6 +2216,7 @@ function BillSubmissionForm({
               /* @__PURE__ */ jsx3("span", { className: "mbsf-help", style: { display: "block" }, children: attachment.description || (auto ? "Included automatically with every bill." : documentLabels[attachment.documentType]) })
             ] })
           ] }),
+          showAttachmentReportTypes ? /* @__PURE__ */ jsx3("div", { className: "mbsf-attach-type", children: /* @__PURE__ */ jsx3(ComboBox, { ariaLabel: `Report type for ${attachment.fileName}`, invalid: !reportTypeCode, disabled: locked, preserveValueOnOpen: true, value: reportTypeCode, placeholder: "Select report type\u2026", options: reportTypeOptions, onSelect: (option) => setSourceAttachmentReportTypes((current) => ({ ...current, [attachment.id]: option.id })) }) }) : null,
           /* @__PURE__ */ jsxs3("div", { className: "mbsf-attach-actions", children: [
             attachment.previewUrl ? /* @__PURE__ */ jsx3("a", { className: "mbsf-secondary", href: attachment.previewUrl, target: "_blank", rel: "noopener noreferrer", children: "Preview" }) : null,
             removable ? /* @__PURE__ */ jsx3("button", { className: "mbsf-icon-btn", type: "button", "aria-label": `Remove ${attachment.fileName}`, disabled: locked, onClick: () => {
@@ -1991,20 +2226,25 @@ function BillSubmissionForm({
           ] })
         ] }, attachment.id);
       }),
-      uploads.map((upload, index) => /* @__PURE__ */ jsxs3("div", { className: "mbsf-attach-row", children: [
-        /* @__PURE__ */ jsx3("div", { className: "mbsf-attach-main", children: /* @__PURE__ */ jsxs3("span", { className: "mbsf-file", children: [
-          /* @__PURE__ */ jsx3("strong", { children: upload.file.name }),
-          /* @__PURE__ */ jsxs3("span", { className: "mbsf-help", style: { display: "block" }, children: [
-            (upload.file.size / 1024 / 1024).toFixed(1),
-            " MB"
+      uploads.map((upload, index) => {
+        const reportTypeCode = upload.reportTypeCode || defaultAttachmentReportType || "";
+        return /* @__PURE__ */ jsxs3("div", { className: "mbsf-attach-row", children: [
+          /* @__PURE__ */ jsx3("div", { className: "mbsf-attach-main", children: /* @__PURE__ */ jsxs3("span", { className: "mbsf-file", children: [
+            /* @__PURE__ */ jsx3("strong", { children: upload.file.name }),
+            /* @__PURE__ */ jsxs3("span", { className: "mbsf-help", style: { display: "block" }, children: [
+              (upload.file.size / 1024 / 1024).toFixed(1),
+              " MB"
+            ] })
+          ] }) }),
+          showAttachmentReportTypes ? /* @__PURE__ */ jsx3("div", { className: "mbsf-attach-type", children: /* @__PURE__ */ jsx3(ComboBox, { ariaLabel: `Report type for ${upload.file.name}`, invalid: !reportTypeCode, disabled: locked, preserveValueOnOpen: true, value: reportTypeCode, placeholder: "Select report type\u2026", options: reportTypeOptions, onSelect: (option) => setUploads((current) => current.map((item, itemIndex) => itemIndex === index ? { ...item, reportTypeCode: option.id } : item)) }) }) : null,
+          /* @__PURE__ */ jsxs3("div", { className: "mbsf-attach-actions", children: [
+            /* @__PURE__ */ jsx3("button", { className: "mbsf-secondary", type: "button", onClick: () => previewUploadedPdf(upload.file), children: "Preview" }),
+            /* @__PURE__ */ jsx3("button", { className: "mbsf-icon-btn", type: "button", "aria-label": `Remove ${upload.file.name}`, onClick: () => setUploads((current) => current.filter((_, itemIndex) => itemIndex !== index)), children: "\xD7" })
           ] })
-        ] }) }),
-        /* @__PURE__ */ jsxs3("div", { className: "mbsf-attach-actions", children: [
-          /* @__PURE__ */ jsx3("button", { className: "mbsf-secondary", type: "button", onClick: () => previewUploadedPdf(upload.file), children: "Preview" }),
-          /* @__PURE__ */ jsx3("button", { className: "mbsf-icon-btn", type: "button", "aria-label": `Remove ${upload.file.name}`, onClick: () => setUploads((current) => current.filter((_, itemIndex) => itemIndex !== index)), children: "\xD7" })
-        ] })
-      ] }, `${upload.file.name}-${index}`))
+        ] }, `${upload.file.name}-${index}`);
+      })
     ] }),
+    errors.attachments ? /* @__PURE__ */ jsx3("p", { className: "mbsf-error", role: "alert", children: errors.attachments }) : null,
     /* @__PURE__ */ jsx3("input", { ref: fileInput, hidden: true, type: "file", accept: "application/pdf,.pdf", multiple: true, onChange: (event) => {
       if (event.target.files) addFiles(event.target.files);
       event.target.value = "";
@@ -3256,6 +3496,7 @@ function MindBillBillReview(props) {
 export {
   BILL_SUBMISSION_DIAGNOSIS_QUICK_PICKS,
   BILL_SUBMISSION_DOCUMENT_TYPES,
+  BILL_SUBMISSION_REPORT_TYPES,
   BILL_SUBMISSION_REQUIRED_FIELDS,
   BillActivityTimeline,
   BillAgingSummary,
@@ -3283,6 +3524,7 @@ export {
   ConnectedBillStatus,
   DEFAULT_BILL_SUBMISSION_MODIFIERS,
   DEFAULT_BILL_SUBMISSION_PROCEDURES,
+  MED_LEGAL_REPORT_TYPE_CODE,
   MindBillBillReview,
   MindBillBillTimeline,
   PSYCH_QME_DEFAULT_DIAGNOSIS,
@@ -3297,13 +3539,16 @@ export {
   buildBillingReportCsv,
   buildBillingReportRows,
   calculateBillSubmissionAllowedAmount,
+  claimsAdministratorRecommendations,
   createBillLifecycleClient2 as createBillLifecycleClient,
   createBillStatusClient,
   ensureTrailingBillSubmissionLine,
   ensureTrailingProcedureLine,
+  exactClaimsAdministratorMatch,
   formatBillSubmissionDate,
   mindBillAppearanceStyle,
   mindBillThemePresets,
+  normalizeClaimsAdministratorName,
   parseBillSubmissionDate,
   prepareBillSubmissionDocuments,
   resolveMindBillAppearance,