Tool Calling and Plugins for Medical Insurance Access

Data Characteristics

Medical insurance access registration data originates from policy documents issued by the National Healthcare Security Administration and provincial medical insurance departments. It also includes drug and medical consumable catalogs (e.g., the "National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance Drug Catalog") and internal enterprise data such as clinical trial results and economic evaluation reports. Policy documents are typically in PDF or Word format. Catalog data may be in Excel spreadsheets or structured database exports like CSV.

Data updates frequently. National catalogs are usually updated annually, while provincial additions or policy adjustments may occur quarterly or irregularly. Document structures are complex. Policy documents contain numerous legal provisions, technical guidelines, and appendices. Fields and units involve generic drug names, dosage forms, specifications, payment standards, indications, reimbursement ratios, and medical insurance payment scope. These require strict adherence to professional terminology and measurement units.

Constraints on Tool Calling and Plugins

The complexity of medical insurance access data requires tool calling and plugins to accurately identify and extract key information. The semi-structured nature of policy documents necessitates robust text parsing capabilities in plugins. These capabilities must extract specific policy clauses, timelines, and approval processes from non-standardized paragraphs.

Frequent catalog updates demand real-time capabilities from tools. Plugins should periodically or on-demand synchronize the latest catalog information from specified data sources to ensure accuracy in registration documents. Strict field and unit requirements, such as "mg/tablet" for drug specifications or "yuan/unit" for payment standards, require plugins to perform rigorous format validation and unit conversion during data processing. This prevents data errors due to unit inconsistencies. Furthermore, due to multi-department policy linkage, plugins must handle data format differences and authentication mechanisms across various external system interfaces.

Configuration Guidelines

Configuration Item	Recommended Value	Rationale
`Chunk size` (Segment Length)	`500–800 characters`	Accommodates longer clauses and complex descriptions in policy documents, ensuring contextual completeness.
`Recall count` (Recall Count)	`Top 10`	Covers multiple potentially relevant key clauses or drug information in medical insurance policies and catalogs.
`Similarity threshold` (Similarity Threshold)	`0.75–0.85`	Balances relevance and recall rate, avoiding omission of critical policy clauses with slightly different phrasing.
`maxContext`	`32000 token`	Supports processing large-scale contexts, including multiple policy documents or complex catalog data.
`PARSE_FILE_TIMEOUT_SECONDS`	`600 seconds`	Provides sufficient time to process large PDF or Excel files, preventing parsing interruptions.
`API_KEY`	Configured as per actual key	Ensures authentication when tools call external medical insurance catalog query or policy parsing interfaces.

Common Pitfalls

External interface calls return a 401 Unauthorized error because the API_KEY is incorrect or expired.
When generating registration documents, some drug payment standard fields are empty or have incorrect units. This occurs because the plugin failed to correctly parse or convert numerical formats from different source catalogs.
The large language model output contains internal markers like citation Marker：[1] (citation marker: [1]). This happens because citation markers were not disabled or post-processed in the plugin or model configuration.

Verification Steps

Verify with test cases that the tool successfully calls external interfaces and returns expected results, such as querying the payment standard for a specific drug in the medical insurance catalog.
Upload and parse a typical medical insurance policy PDF file. Check if the parsed text segments are logically complete and if key fields like "payment scope" and "reimbursement ratio" are correctly extracted.
Submit drug information containing complex units (e.g., "mg/ml", "IU"). Observe if these units are accurately identified and retained in the tool's output.

The values provided are common starting points and should be measured against the reader's own samples.

Question material comes from public community discussions. Configuration values are common starting points and should be measured against your own samples. Verified on 2026-09-21.