FFT-Faturista - Brazilian Medical Billing

Optional pack

FFT-Faturista is part of the recebimento-medico pack. It is not in the base roster. Install the pack when you need it:

flowforge agents install recebimento-medico

This installs the whole pack: fft-faturista and its peer fft-tiss-xml. The pack is carried inside the FlowForge binary, so installing it downloads nothing. To remove it:

flowforge agents remove recebimento-medico

Both commands are safe to repeat. flowforge agents list shows whether the pack is installed on your machine.

Overview

FFT-Faturista owns recebimento médico, the work of getting a clinic or cooperativa paid. It covers the whole cycle from elegibilidade to recurso de glosa. It knows why a lote came back, what a glosa motivo means, whether a recurso is worth filing, and which deadline is about to expire.

It is citation-first. Every normative rule it states carries its source. Anything it cannot source is labelled não verificado. It reads glosa motivos from the current Tabela 38 distribution, never from its own memory. Where the law leaves a prazo to the contract, it tells you so and points you to the clause. It never invents a default. A PT-BR question gets a PT-BR answer, and normative text is quoted in Portuguese, word for word, with its source.

Capabilities

• The revenue cycle, end to end: elegibilidade, autorização, atendimento, codificação, lote, demonstrativo, glosa triage, recurso and conciliação
• Glosa triage: sorts motivos into process defects to prevent, coding errors to correct and reapresentar, and items worth a recurso. It reads the motivos from the current ANS table at answer time
• Recurso de glosa: the strategy for each glosa class and the evidence it needs. The administrativa / técnica / linear split is labelled as practitioner convention, not as an ANS legal taxonomy
• Clock discipline: separates the deadlines set by statute, the ones bound by the RN 503 symmetry rule (your contract must set your contestação prazo equal to the operadora’s answer prazo) and the ones set only by your contract
• The cooperativa boundary: before it answers a prazo question, it asks which relationship the money flows through. RN 503 does not govern the cooperado–cooperativa relationship
• Coding versus pricing: TUSS coding against contract pricing. It never quotes a CBHPM porte as “the price”. The porte is a negotiation reference at the edition and multiplier your contract names

When to Use

• Routing rule: money, process and judgment (glosa, recurso, prazo, faturamento, pricing) → fft-faturista. File, schema and wire (XSD, versions, validation, malformed XML, integration) → fft-tiss-xml. Brazilian-healthcare breadth outside the revenue cycle (clinical terminology, LGPD, compliance) → fft-medical
• A demonstrativo de análise came back with glosas and you need them triaged and ranked
• A recurso has to be drafted before its prazo runs out
• You are specifying a billing feature (glosa triage, prazo tracking) and need the real taxonomy behind it

Do NOT dispatch it to validate XML or debug a portal integration. Send those to fft-tiss-xml. It does not do clinical medicine, LGPD architecture, database design or product builds. It does not replace your contract or your counsel. Where a prazo is contractual, it says so.

Example Prompts

"Recebemos o demonstrativo de análise com várias guias glosadas. Faça a triagem por motivo de glosa, separe o que é erro de processo do que cabe recurso e diga qual prazo está correndo em cada caso."

"Draft a recurso de glosa for the técnica-class items in this demonstrativo and list the evidence each one needs. Cite the rule behind every deadline you name."

"Somos uma cooperativa médica. Qual prazo vale para contestar a glosa na conta de um cooperado?"