Pertinência de Equipo de Artroscopia em Histeroscopia
Overview
Rule to deny arthroscopy materials billed with hysteroscopy procedures. Identifies invoices containing hysteroscopy procedures and checks whether any material in the same invoice matches the pertinence_artroscopia artifact (blacklist). Non-pertinent materials receive a total glosa. Agent ID: AI003
Architecture
| Field | Value |
|---|---|
| Name | Pertinência de Equipo de Artroscopia em Histeroscopia |
| Agent ID | AI003 |
| Version | 0.0.0 |
| Nature | tech |
| Layer | — |
Inheritance
PertinentArthroscopyRule → PertinenceRule → BaseAgent
Core Functionality
- load_artifacts
- prepare_data
- rule_assessment
Business Rules
Pertinência da cobrança
Constantes:
HYSTEROSCOPY_PROCEDURE_CODES = [HYSTEROSCOPY_MATERIAL_KEYWORDS = [
Usage
from agents.pertinentarthroscopyrule import PertinentArthroscopyRule
rule = PertinentArthroscopyRule()
violations_df = rule.rule_assessment(claims_df)
Configuration
Sem parâmetros configuráveis identificados.
Input Requirements
| Column | Type | Description |
|---|---|---|
EVENT_COLUMNS.id |
- | - |
EVENT_COLUMNS.id_fatura |
- | - |
EVENT_COLUMNS.id_evento |
- | - |
EVENT_COLUMNS.evento |
- | - |
EVENT_COLUMNS.vl_pago |
- | - |
EVENT_COLUMNS.qt_paga |
- | - |
EVENT_COLUMNS.categoria |
- | - |
ARVO_COLUMNS.code_type |
- | - |
ARVO_COLUMNS.id_evento_predicted |
- | - |
ARVO_COLUMNS.code_type_predicted |
- | - |
Output Format
Glosa DataFrame Columns
| Column | Description |
|---|---|
agent_id |
AI003 |
version |
0.0.0 |
id_arvo |
Original record ID |
vl_glosa_arvo |
Glosa value |
qt_glosa_arvo |
Glosa quantity |
score_arvo |
Confidence score |
motivo_glosa_arvo |
Detailed reason in Portuguese |
motivo_glosa_ANS |
ANS standard code |
data_dict |
JSON metadata with calculation details |
Error Handling
- DataFrames vazios retornam estrutura vazia com colunas obrigatórias.
- Colunas ausentes geram warning mas não causam crash.
- Conversões numéricas usam
errors="coerce"para evitar falhas.