Pertinência de materiais
Overview
Consolidated rule for evaluating material pertinence in ambulatory settings. This rule analyzes healthcare claims to determine if materials used in ambulatory procedures are clinically appropriate and justified. It identifies cases where expensive materials are used in outpatient settings where they may not be necessary or covered by insurance. Key Features: - Consolidated filtering (ambulatory regime + positive values) - Integrated patient history and classification processing - Unified pertinence rule application with inline evaluation logic - Classifies patients by medical condition (renal, oncology, neonatal) - Maintains full compatibility with original rule functionality Architecture Benefits: - Consolidated methods for better performance - Reduced code complexity and abstractions - Improved maintainability through inline logic - High testability with focused responsibilities Agent ID: C057 (Material Pertinence)
Architecture
| Field | Value |
|---|---|
| Name | Pertinência de materiais |
| Agent ID | C057 |
| Version | 2.0 |
| Nature | tech |
| Layer | — |
Inheritance
PertinentAmbulatoryRule → BaseRule → BaseAgent
Core Functionality
- load_artifacts
- prepare_data
- rule_assessment
Business Rules
Pertinência da cobrança
Consultar código-fonte para regras de negócio detalhadas.
Usage
from agents.pertinentambulatoryrule import PertinentAmbulatoryRule
rule = PertinentAmbulatoryRule()
violations_df = rule.rule_assessment(claims_df)
Configuration
Sem parâmetros configuráveis identificados.
Input Requirements
| Column | Type | Description |
|---|---|---|
ARVO_COLUMNS.code_type_predicted |
- | - |
ARVO_COLUMNS.id_evento_predicted |
- | - |
EVENT_COLUMNS.regime_atendimento |
- | - |
EVENT_COLUMNS.id_evento |
- | - |
EVENT_COLUMNS.evento |
- | - |
EVENT_COLUMNS.vl_pago |
- | - |
EVENT_COLUMNS.id_fatura |
- | - |
EVENT_COLUMNS.id |
- | - |
EVENT_COLUMNS.qt_paga |
- | - |
EVENT_COLUMNS.categoria |
- | - |
ARVO_COLUMNS.code_type |
- | - |
EVENT_COLUMNS.subcategoria |
- | - |
BENEFICIARY_COLUMNS.idade |
- | - |
ARVO_COLUMNS.proced_cir_inv_agg |
- | - |
ARVO_COLUMNS.tempo_internacao_uti |
- | - |
BENEFICIARY_COLUMNS.id_matricula |
- | - |
Output Format
Glosa DataFrame Columns
| Column | Description |
|---|---|
agent_id |
C057 |
version |
2.0 |
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.