Workflow Guidance for Medical Insurance Fund Supervision and Audit: Tool Calling and Plugins

Workflow Guidance for Medical Insurance Fund Supervision and Audit: Tool Calling and Plugins

What the data for this category looks like

This category’s data primarily comes from the medical insurance intelligent monitoring system, fund supervision rule base, medical insurance settlement data, drug and consumable traceability codes, and complaint clues. The update frequency is monthly. Commonly processed documents include audit notices, inspection work drafts, suspicious item lists, interview records, handling decisions, and rectification reports. Fields cover violation types, involved subject information, verification progress, involved amounts, and other relevant details. Common units include person-times, yuan, traceability code numbers, and more. The data focuses on information related to fraud, insurance deception, and improper fund use, and adapts to post-event audit and special inspection business scenarios.

Monthly updated data requires tool calling to adapt to batch data pulling rhythms, to avoid exceeding data source interface limits with high-frequency requests. Differences in fields across multiple document types require tool calling to support dynamic adaptation of parameter formats for different documents, to prevent parsing failures caused by field mismatches. Sensitive attributes of medical insurance-related data require tool calling to include permission verification steps, to prevent unauthorized access. The special inspection attribute of post-event audits requires tool calling to flexibly trigger single or batch tasks, to adapt to requirements of different inspection scales. The core suspicious item screening link takes a long time. Tool calling must quickly pull associated data to reduce waiting time for manual operations.

How to set configurations

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

Configuration ItemRecommended SettingRationale
toolChoiceautoAdapts to the demand for dynamic multi-tool calling in audit scenarios, automatically matches different tasks such as data pulling and rule verification
Return Content ControlReturn only tool execution resultsMeets the requirement of not outputting redundant AI responses in business workflow guidance, focusing on audit-related data
HTTP Toolset ConfigurationAssociate with medical insurance settlement data interfaces and rule base interfacesCovers core data sources required for audits, meets the calling needs for suspicious item screening and verification
Request Timeout Setting300–600 secondsAdapts to the time consumption of monthly batch data pulling, avoids request interruptions caused by large data volumes
Number of Returned ResultsTop 10 entriesPrioritizes displaying high-priority suspicious items, meets the rapid screening needs of special inspections, can be adjusted based on actual testing
functionCallenabledSupports structured calling of compliant tools, ensures that the format of audit data meets regulatory document requirements

Three Common Misconfigurations

  • An Invalid URL, code: 500 error occurs when configuring the HTTP toolset. This happens because the full path of the medical insurance data source interface is not correctly configured, or the interface permission is not enabled, causing the request to be blocked.
  • The tool calling node outputs redundant natural language AI responses. This happens because the default AI response generation switch is not turned off, or the return content control setting is not configured to return only tool results.
  • Unable to call the Oracle database to pull medical insurance settlement data. This happens because the corresponding database driver plugin is not installed, or the port and username configuration in the database connection parameters are incorrect.

How to Confirm the Configuration is Complete

  • Initiate a test call, check whether the returned results include core fields such as audit-required suspicious item lists and settlement data.
  • Check the output logs of the tool calling node, confirm that no Invalid URL or timeout errors appear.
  • Verify that the functionCall parameter is enabled, ensure that the results returned by tool calling are in structured format.
  • Adjust the number of returned results, confirm that the interface can display the corresponding number of audit data entries.

The values provided here are common starting points, and should be evaluated 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.