Automating Hungary's Travel Cost Reimbursement with Oracle Siebel & Intelligent Advisor

Hungary’s Travel Cost Reimbursement Program (TCRP) grants citizens the right to reimbursement of travel expenses when receiving healthcare in a town other than their own. The laws and regulations concerning the TCRP were significantly reworked and revised in 2021, enabling applicants to submit requests electronically and occasioning the need for a new system that could process these requests with the reduced intervention of administrators.  

The requirement included that the system should be able to check if the personal data provided is valid, the applicant has health insurance and the visit to the doctor had been recorded in ELUKER (system used by healthcare workers for this purpose). In addition, it should be able to calculate the distance between the beneficiary’s home and the healthcare provider. Finally, it is expected to calculate how much to pay the applicant, elaborate on how the sum was reached and transfer the money to the beneficiary.  

EvoCRM implemented all these requirements using Oracle Siebel and OIA. Once the application is submitted through the official website Siebel receives it and creates a new case with all the data including that of the relevant persons and the travels. Then through various interfaces Siebel validates the incoming data. Should there be a mismatch between the data provided by the beneficiary and the data received through the interfaces a task is created for an administrator to handle the case manually. If no discrepancy is detected, the process continues automatically and the distance between the towns is calculated. 

When all the necessary data is available to make a decision, a call is made to the rule base system implemented in OIA. The rule base system checks eligibility and if there are no disqualifying reasons, it calculates the sum the beneficiary is entitled to, based on a number of factors, such as, the travel distance, the type of healthcare received, whether the applicant is able to use public transportation and if they need an attendant to accompany them. In addition to returning the sum, OIA also gives a detailed explanation of how the sum was calculated, to facilitate the work of administrators in case of enquiries. Upon receiving an answer from OIA, Siebel stores the relevant data and depending on eligibility transfers the money to the beneficiary or sends out the negative decision.  

Since the system went live on 1st of July 2022, 277,429 requests have been submitted for travel cost reimbursement. 136,509 requests were submitted electronically which means that within less than a year nearly 50% of all applicants switched to the new system over the previously available paper-based one. 27,904 requests were processed fully automatically without the involvement of any administrators.  In these cases, the applicants received the money within 24 hours of submitting the form. What’s more, the time required to process a case has declined on average by 25%. In conclusion, the new system has simplified the process of applying for travel cost reimbursement, reduced the workload of administrators and helped cut red tape.