Work Consultation and Reply for Medical Insurance Expense Settlement Audit: Tool Calling and Plugins

Work Consultation and Reply for Medical Insurance Expense Settlement Audit: Tool Calling and Plugins

What this category of data looks like

Data sources for this category include the national medical insurance information platform, hospital HIS and medical insurance interfaces, medical insurance catalog and coding library, and cross-regional medical settlement platform. The update frequency is daily. Daily processed documents include medical insurance settlement lists, expense details, medical record homepages, prescriptions, rejection lists, and settlement statements. Fields covered include settlement number, insured person identifier, diagnosis and treatment project code, consumables code, expense amount, rejection reason, and more. A single business data entry is associated with multiple types of documents. Compliance verification must be completed by matching against the official coding library.

Constraints for tool calling and plugins workflow

Data sources are scattered and require integration with multiple system interfaces. Tool calling must support cross-source data retrieval. Daily updated batch data involves large-volume documents. Plugins must adapt to parameter limits for batch calls. Medical insurance coding matching requires strict calls to official library interfaces. Tool parameters must point to compliant data sources. The feature of single-piece data being associated with multiple documents requires plugins to pass multiple document identifiers during calls to avoid matching deviations. Rejection list reconciliation processing requires real-time retrieval of latest data. Tool calling must set a reasonable synchronization trigger mechanism.

Configuration Settings

Reference only; verify against the target FastGPT release and deployment documentation.

Configuration ItemRecommended ValueRationale
toolChoiceautoAdapts to automatic matching requirements for multiple types of medical insurance business documents
functionCallSet based on actual testingAdapts to parameter passing formats for single or batch settlement data
Plugin data sourceBind to the national medical insurance catalog coding library and hospital HIS interfacesEnsure compliance of coding matching and data retrieval
Batch call limitFirst 200 entriesMatches the scale of daily updated batch settlement data
Call timeout300 secondsAdapts to response durations for cross-platform data retrieval
Associated parameter rulePass settlement number and insured person identifierMatches multiple business documents associated with single-piece data

Three Common Mistakes

  • Issue: Plugin call returns parameter q is empty error. Cause: Failed to accurately extract keywords such as user-consulted expense details and settlement number and pass them to tool parameters, resulting in missing required fields.
  • Issue: Unable to re-export a schema file compliant with OPENAI V3 format after editing the plugin. Cause: Failed to select the correct format export option on the plugin configuration page, and did not perform format conversion operations after saving directly.
  • Issue: Unable to complete the plugin addition operation within the platform. Cause: Did not enter the correct plugin configuration page, or did not complete necessary permission verification steps.

How to Verify Successful Configuration

  • Initiate a consultation test for single-piece settlement data, and verify that the coding matching results returned by tool calling are consistent with the official medical insurance catalog.
  • Export the current plugin's configuration file, and confirm that the format complies with the required specifications.
  • Simulate batch data calls, and check whether the plugin executes requests according to the set limit.
  • View plugin call logs, and confirm that all required parameters have been correctly passed.

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 2026-09-28.