Cobrança de materiais e medicamentos - Intercâmbio
Overview
Implements the price comparison rule for UNIMED Interchange charges of Materials and Medications. Agent: I004 This agent evaluates interchange events (regra_intercambio = NACIONAL) by comparing the unit amount paid against the reference amount from the price artifact (ceiling), while enforcing allowed units of measure and validity periods. Items priced above the ceiling, within configured thresholds, are flagged for denial (glosa) with explanatory messages and metadata. Optionally, it returns a tracking DataFrame (evaluated) with per-item status. Artifact: - Price table keyed by [categoria, code_type_predicted, id_evento_predicted] with validity columns [dt_inicio_vigencia, dt_fim_vigencia], plus 'vl_intercambio_teto', 'unidade_minima', and 'var_percentil_75'.
Architecture
| Field | Value |
|---|---|
| Name | Cobrança de materiais e medicamentos - Intercâmbio |
| Agent ID | I004 |
| Version | 0.0.0 |
| Nature | adm |
| Layer | — |
Inheritance
InterchangeMatMedPriceRule → BaseRule → BaseAgent
Core Functionality
- load_artifacts
- prepare_data
- rule_assessment
Business Rules
Conformidade da cobrança
Consultar código-fonte para regras de negócio detalhadas.
Usage
from agents.interchangematmedpricerule import InterchangeMatMedPriceRule
rule = InterchangeMatMedPriceRule()
violations_df = rule.rule_assessment(claims_df)
Configuration
Sem parâmetros configuráveis identificados.
Input Requirements
| Column | Type | Description |
|---|---|---|
EVENT_COLUMNS.id |
- | - |
self.id_evento_predicted |
- | - |
EVENT_COLUMNS.id_evento |
- | - |
EVENT_COLUMNS.evento |
- | - |
EVENT_COLUMNS.categoria |
- | - |
ARVO_COLUMNS.code_type_predicted |
- | - |
EVENT_COLUMNS.vl_pago |
- | - |
EVENT_COLUMNS.qt_paga |
- | - |
EVENT_COLUMNS.vl_unitario_pago |
- | - |
EVENT_COLUMNS.dt_atendimento |
- | - |
EVENT_COLUMNS.tipo_intercambio |
- | - |
Output Format
Glosa DataFrame Columns
| Column | Description |
|---|---|
agent_id |
I004 |
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.