Medical Insurance Cost Settlement Audit Service Inquiry and Reply: Forms and Interaction

Medical Insurance Cost Settlement Audit Service Inquiry and Reply: Forms and Interaction

What the data for this category looks like

Data sources include the national medical security information platform, hospital HIS and medical insurance interfaces, medical insurance catalog and coding library, and cross-regional medical treatment settlement platform. The update frequency is daily. Documents processed daily include medical insurance settlement lists, expense details, medical record homepages, prescriptions, rejection payment lists, and settlement reconciliation statements. Core fields cover diagnosis and treatment item codes, pharmaceutical and consumable codes, expense amount, insured person identity identifier, settlement status, and more. All data is in structured or semi-structured format, must strictly match medical insurance catalog codes, and has no additional custom fields.

Since data sources involve cross-system cross-domain interfaces, form interactions must support cross-data source field linkage verification to ensure unified field formats returned by different interfaces. Daily updated batch data requires forms to support batch import and batch processing, to avoid interface timeouts caused by overload from single submissions. Core fields must strictly match medical insurance catalog codes, so the interaction link must include built-in coding verification logic to prevent invalid code inputs from causing subsequent audit failures. Additionally, this category’s business involves single or batch cost audits, so forms must support switching between single-item and batch processing to adapt to operational needs of different handling scenarios.

Configuration Settings

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

Configuration ItemRecommended SettingRationale
formInputEnable multi-field grouped input, support uploading structured settlement list attachmentsMatch the structured format of daily documents for this category; grouped input reduces entry errors for core fields
userSelectPreset high-frequency inquiry options for medical insurance settlement audits, such as coding mismatch, expense inconsistencyCover common scenarios of service inquiries, reduce invalid user inputs
Maximum data volume per submission100 items per submissionAdapt to the batch processing scale of daily updated data, avoid cross-interface call timeouts
Field verification rulesReal-time verification linked to medical insurance catalog coding libraryBased on the fact that this category’s data sources include medical insurance coding libraries, ensure input field compliance
Timeout setting600 secondsMatch the average response duration of cross-medical system interface calls
Batch import formatSupport CSV format matching settlement list fieldsCorrespond to the common file format used in daily office work for this category

Three common configuration mistakes

  • The interface returns an InvalidParameter error, prompting that a specified parameter is empty. The cause is that required field verification for formInput is not enabled, and non-empty constraints are not set for core fields such as medical insurance codes and expense amounts.
  • After batch importing a settlement list, the number of returned results does not match expectations. The cause is that maximum data volume per submission is not configured, and the imported data volume exceeds the system processing limit.
  • Custom input prompt text does not match the business scenario. The cause is that userSelect options are not preset based on high-frequency inquiry scenarios of medical insurance settlement audits, leading to user inputs deviating from audit-related questions.

How to verify correct configuration

  • Submit an empty medical insurance code field, check if the system triggers the corresponding error prompt.
  • Upload a CSV file of settlement lists with more than 100 items, check if the system intercepts or splits the processing.
  • Select a preset userSelect option, check if it jumps to the corresponding inquiry process.
  • Wait 600 seconds, check the interface call status to confirm there are no timeout errors.

Note: The configuration values listed above are common starting points. They should be evaluated against the reader’s own specific 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.