@mindbill/react 0.24.0 → 0.25.0

package/README.md

@@ -161,6 +161,8 @@ Partners supply tenant-specific bootstrap data, one short-lived browser session
 
 Validation is component-owned as well. A missing routing payer is highlighted immediately; Submit highlights every invalid control with a specific message, focuses and scrolls to the first problem, and continues validating as the user corrects the form.
 
+The complete immutable snapshot requires patient identity and address; employer, injury date, service date, and a canonical claims-administrator directory selection; at least one ICD-10 diagnosis and procedure line; billing provider name, Tax ID, NPI, phone, and address; rendering provider name, NPI, and taxonomy; and service-facility address plus place-of-service code. Address line 2 and physician license metadata remain optional. For California workers-comp CMS-1500 output, `renderingProvider.taxonomy` is the 10-character provider taxonomy placed in shaded Box 24J with qualifier `ZZ`; it is not replaced by the physician license number.
+
 `BILL_SUBMISSION_REQUIRED_FIELDS` and `validateBillSubmission` expose the same contract for tests and non-visual integrations. The component never creates a draft; `onSubmitted` fires only after MindBill accepts a locally valid immutable snapshot. The legacy `onSubmit` escape hatch remains optional for unusual deployments, but connected integrations should omit it so the library owns the complete contract.
 
 `BillReviewForm` remains available for legacy integrations that already own a custom review model. New integrations should use `BillSubmissionForm`.

package/dist/index.d.ts

@@ -367,6 +367,7 @@ declare const BILL_SUBMISSION_REPORT_TYPES: readonly BillSubmissionReportTypeOpt
 type BillSubmissionEvaluationType = "qme" | "ame" | "psych_qme";
 type BillSubmissionAddress = {
     line1: string;
+    line2?: string;
     city: string;
     state: string;
     postalCode: string;
@@ -455,6 +456,36 @@ type BillSubmissionInput = {
         diagnosisPointers?: number[];
     }>;
 };
+/** A validated, submission-ready bill. The form accepts partial provider data while editing,
+ * but only emits this complete contract after every required field has passed validation. */
+type CompleteBillSubmissionInput = Omit<BillSubmissionInput, "claim" | "billingProvider" | "renderingProvider" | "serviceLocation" | "diagnoses" | "serviceLines"> & {
+    claim: BillSubmissionInput["claim"] & {
+        employer: string;
+        dateOfInjury: string;
+        claimsAdministrator: {
+            id: string;
+            name: string;
+        };
+    };
+    billingProvider: {
+        name: string;
+        taxId: string;
+        npi: string;
+        phone: string;
+        address: BillSubmissionAddress;
+    };
+    renderingProvider: NonNullable<BillSubmissionInput["renderingProvider"]> & {
+        name: string;
+        npi: string;
+        taxonomy: string;
+    };
+    serviceLocation: NonNullable<BillSubmissionInput["serviceLocation"]> & {
+        address: BillSubmissionAddress;
+        placeOfServiceCode: string;
+    };
+    diagnoses: string[];
+    serviceLines: BillSubmissionInput["serviceLines"];
+};
 type BillSubmissionSourceAttachment = {
     id: string;
     fileName: string;
@@ -475,7 +506,7 @@ type BillSubmissionUpload = {
     reportTypeCode?: string;
 };
 type BillSubmissionFormValue = {
-    bill: BillSubmissionInput;
+    bill: CompleteBillSubmissionInput;
     sourceAttachmentIds: string[];
     sourceAttachmentReportTypes: Record<string, string>;
     uploads: BillSubmissionUpload[];
@@ -518,7 +549,7 @@ type BillSubmissionFormProps = {
      */
     children?: ReactNode;
 };
-declare const BILL_SUBMISSION_REQUIRED_FIELDS: readonly ["patient.firstName", "patient.lastName", "patient.dateOfBirth", "patient.address.line1", "patient.address.city", "patient.address.state", "patient.address.postalCode", "claim.claimNumber", "claim.claimsAdministrator", "service.date", "diagnoses[]", "serviceLines[].code", "serviceLines[].units"];
+declare const BILL_SUBMISSION_REQUIRED_FIELDS: readonly ["patient.firstName", "patient.lastName", "patient.dateOfBirth", "patient.address.line1", "patient.address.city", "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"];
 type BillSubmissionValidation = {
     valid: boolean;
     fieldErrors: Record<string, string>;

package/dist/index.js

@@ -1376,8 +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"
@@ -1537,8 +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.";
   }
@@ -1546,7 +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) => {
@@ -1559,7 +1604,7 @@ 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-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-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)}
@@ -1952,10 +1997,11 @@ 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, sourceAttachmentReportTypes, 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({
@@ -1966,7 +2012,7 @@ function BillSubmissionForm({
           ...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) {
@@ -2010,8 +2056,8 @@ 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__ */ jsxs3(Field2, { path: "claim.claimsAdministrator", label: "Claims administrator", required: true, span: true, error: claimsAdministratorError, children: [
@@ -2073,17 +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: [
@@ -2093,9 +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", {}),
         " "