Tool Calling and Plugins for Expense Statement Insurance Claim Initial Review

Expense statement data mainly comes from settlement documents from cooperating medical institutions, exported files from insurance company internal

What the data for this category looks like

Expense statement data mainly comes from settlement documents from cooperating medical institutions, exported files from insurance company internal claim systems, and synchronized data from electronic invoice platforms. Updates trigger in real time when claim applications are submitted. Each document includes fixed headers and multiple detailed items. Document structures typically include summary fields such as claim number and treating institution name. They also include detailed fields such as diagnosis/treatment item name, unit price, quantity, total price, medical insurance reimbursement ratio, and out-of-pocket amount. The currency unit is uniformly yuan. Some fields carry exclusive identifiers such as medical insurance catalog codes.

Constraints Imposed on Tool Calling and Plugins

The multi-field structure and exclusive identifiers of expense statements require precise extraction of specified fields during tool calling. This avoids redundant data interfering with the workflow. Documents with large numbers of detailed items increase resource consumption for parsing and batch processing. Single-batch processing scale must be limited. Document formats vary across sources. Plugins must adapt to multiple file types including PDF, Excel, and images. The real-time data update feature means expired caches cannot be used during tool calling. The latest file must be re-parsed for each call.

Configuration Settings

Configuration ItemRecommended ValueRationale
PARSE_FILE_TIMEOUT_SECONDS600 secondsExpense statements contain multiple pages of detailed items. Parsing must cover all content to avoid mid-process timeouts
UPLOAD_FILE_MAX_SIZE200 MBSingle PDF or Excel expense statement files may include dozens of pages of settlement details. Large file uploads must be supported
extract_fields["claim number", "treating institution", "item name", "unit price", "quantity", "total price", "medical insurance catalog code", "out-of-pocket amount", "total cost"]Only extract core fields required for claim initial review. This reduces redundant data processing volume
BATCH_EXECUTE_MAX_ITEMS50Upper limit of detailed items processed per batch. This avoids excessive resource usage during batch execution
plugin_param_fallback_strategyusedefaultif_emptyWhen the tool cannot retrieve specified fields from the expense statement, use plugin preset default values to fill gaps. This ensures workflow continuity
MAX_CONTEXT_LENGTH8000 charactersLimit post-parsing context length for expense statements. This avoids exceeding large model context window limits

The parameter values provided on this page are common recommended starting points for configuration. Actual values are affected by material format, data volume, and business rules. Specific issues require individual analysis. Test on your own samples before finalizing settings.

Three Common Misconfigurations

  • Phenomenon: When calling the knowledge base to search for expense statement-related content, returned results do not match, and the interface displays "No matching documents found". Reason: Exclusive fields such as medical insurance catalog codes and out-of-pocket amounts for expense statements were not added to knowledge base retrieval keyword configurations. This leads to an overly narrow search scope.
  • Phenomenon: Some fields are empty during plugin calls, and the workflow's preset default value filling logic is not triggered. Reason: The plugin_param_fallback_strategy parameter was not configured correctly. The rule to use default values for empty variables was not enabled.
  • Phenomenon: When batch processing multiple expense statements with the tool, some items are not processed, and the workflow status shows "Missing parameters". Reason: The BATCH_EXECUTE_MAX_ITEMS parameter was not adjusted. The number of items processed per batch exceeded the system default upper limit.

How to Verify Correct Configuration

  • Upload a standard-format expense statement file, run the tool calling process, and confirm all fields listed in extract_fields are included in the returned results.
  • Intentionally omit some fields from a single statement, run the process, and check if preset default values are automatically filled in.
  • Submit multiple expense statements, check if the batch execution tool processes them in batches according to the configured size, and no timeout errors occur.
  • Check the knowledge base retrieval configuration, confirm exclusive field keywords for expense statements have been added, and run retrieval to return relevant matching results.

Question material comes from public community discussions. Configuration values are common starting points and should be measured against your own samples. Verified on 2026-09-14.