Pertinencia de procedimento por sexo
Overview
Rule engine responsible for validating procedure pertinence based on the beneficiary's sex. This rule loads a sex-based pertinence artifact and filters events that are incompatible with expected sex restrictions. The rule: - Loads a TUSS-to-sex pertinence artifact. - Validates input metadata and required columns. - Removes events with missing or invalid sex information. - Filters events whose (code_tuss, sex) pair is not allowed. - Tracks evaluated items and emits flags for inconsistent data. - Outputs glosa (denial/adjustment) items when pertinence fails. - Carryover (Arraste): If enabled, identifies and denies associated items (materials, medications, and fees) in invoices where the main procedure was denied due to sex pertinence, ensuring financial consistency for the entire bill.
Architecture
| Field | Value |
|---|---|
| Name | Pertinencia de procedimento por sexo |
| Agent ID | C066 |
| Version | 0.0.1 |
| Nature | tech |
| Layer | — |
Inheritance
PertinentProcSexRule → PertinenceRule → BaseAgent
Core Functionality
- load_artifacts
- prepare_artifact
- prepare_data
- rule_assessment
Business Rules
Pertinência da cobrança
Consultar código-fonte para regras de negócio detalhadas.
Usage
from agents.pertinentprocsexrule import PertinentProcSexRule
rule = PertinentProcSexRule()
violations_df = rule.rule_assessment(claims_df)
Configuration
Sem parâmetros configuráveis identificados.
Input Requirements
| Column | Type | Description |
|---|---|---|
EVENT_COLUMNS.id |
- | - |
EVENT_COLUMNS.id_evento |
- | - |
ARVO_COLUMNS.id_evento_predicted |
- | - |
EVENT_COLUMNS.id_fatura |
- | - |
EVENT_COLUMNS.evento |
- | - |
EVENT_COLUMNS.vl_pago |
- | - |
EVENT_COLUMNS.qt_paga |
- | - |
EVENT_COLUMNS.regime_atendimento |
- | - |
EVENT_COLUMNS.categoria |
- | - |
BENEFICIARY_COLUMNS.sexo |
- | - |
ARVO_COLUMNS.code_type |
- | - |
Output Format
Glosa DataFrame Columns
| Column | Description |
|---|---|
agent_id |
C066 |
version |
0.0.1 |
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.