Pertinência de materiais
Overview
Rule for evaluating material pertinence in hospitalization (day hospital) settings. Identifies materials used in short-term hospitalization where they may not be necessary. Patients with special classifications (renal, oncology, neonatal) are excluded from glosa. Agent ID: C065
Architecture
| Field | Value |
|---|---|
| Name | Pertinência de materiais |
| Agent ID | C065 |
| Version | 0.0.0 |
| Nature | tech |
| Layer | — |
Inheritance
PertinentHospitalizationRule → PertinenceRule → BaseAgent
Core Functionality
- load_artifacts
- prepare_data
- rule_assessment
Business Rules
Pertinência da cobrança
Constantes:
DAY_HOSPITAL_CATEGORIES = ["DIARIA", "PACOTE", "CODIGO PROPRIO"]DAY_HOSPITAL_EXCLUSIONS = ["global", "hernio", "hemodiali"]
Usage
from agents.pertinenthospitalizationrule import PertinentHospitalizationRule
rule = PertinentHospitalizationRule()
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 |
- | - |
EVENT_COLUMNS.regime_atendimento |
- | - |
ARVO_COLUMNS.code_type |
- | - |
BENEFICIARY_COLUMNS.id_matricula |
- | - |
ARVO_COLUMNS.id_evento_predicted |
- | - |
ARVO_COLUMNS.code_type_predicted |
- | - |
Output Format
Glosa DataFrame Columns
| Column | Description |
|---|---|
agent_id |
C065 |
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.