Build Hungarian Reimbursement Claim (NEAK financing record)
Skill: Convert dispensing/treatment data into a NEAK subsidy/reimbursement claim
Region: Hungary (Magyarország) Category: Health care Does: Takes a pharmacy's dispensing or a provider's treatment/financing data and assembles the reimbursement / financing record (támogatási / finanszírozási elszámolás) for electronic submission to NEAK (Nemzeti Egészségbiztosítási Alapkezelő) — declaring the dispensed/treated items, the social-security subsidy basis, the patient co-payment, and the amount claimed from public health insurance. Spec: NEAK — reimbursement/financing reporting (portal- and version-specific — confirm the current schema)
NEAK administers the Health Insurance Fund and reimburses pharmacies and healthcare providers for the publicly subsidised portion of dispensed medicines, medical aids, and financed treatments. Pharmacies/providers submit a periodic financing/reimbursement record claiming the social-security subsidy (TB-támogatás); the patient pays the co-payment (térítési díj). Reporting format and content are portal- and contract-specific and versioned — this skill frames a generic structure; confirm the exact NEAK schema/portal requirement before use. Element names below follow the record structure, not a verbatim XSD.
When this applies
- A pharmacy claims reimbursement for the subsidised portion of dispensed medicines / medical aids, or a provider settles financed treatments with NEAK.
- The claim is periodic (e.g. per settlement period) and ties to the EESZT eRecept dispensing events and the contract with NEAK.
- Covers original claims and corrections/credits for previously reported items.
Structure (reimbursement record → submission)
header provider/pharmacy id (NEAK code), contract/financing code,
settlement period, record type (eredeti / helyesbítő), schema/portal version
per item product/service code (TTT / OENO etc.), quantity,
EESZT prescription/dispensing reference, subsidy basis (jogcím),
gross price, patient co-payment (térítési díj), claimed subsidy (TB-támogatás)
summary Σ gross, Σ co-payment, Σ claimed subsidy for the period
Data rules
- Provider/pharmacy identified by its NEAK code and financing contract; claims tie to dispensing events recorded in EESZT (eRecept reference).
- Claimed subsidy = gross price − patient co-payment for each item, computed per the product's subsidy category (jogcím) and the official subsidy rate/fixed amount.
- Period totals must reconcile: Σ item subsidy = period claim; corrections (helyesbítő) reference the original items/period.
- Amounts in HUF, whole forint; subsidy amounts follow the official drug-subsidy register (PUPHA / támogatási törzs) — do not recompute rates ad hoc.
- Sensitive patient/health data — handle per data-protection rules; the schema/portal version is contract-specific, so validate against the current NEAK requirement.
Worked example (outline)
header: NEAK pharmacy code=<ID>, period=2026-05, type=eredeti, version=<current>
item: TTT=<kód>, qty 1, eRecept ref=<EESZT id>, jogcím=<kód>
gross 3,000 HUF − co-payment 900 HUF = claimed subsidy 2,100 HUF
summary: Σ claimed subsidy = 2,100 HUF (period total)
Submitted to NEAK for the settlement period; reconciled against EESZT dispensing events and the subsidy register before payment.
Validation checklist
- Current NEAK schema/portal version confirmed (portal- and contract-specific)
- Provider/pharmacy NEAK code and financing contract correct
- Items reference EESZT eRecept/dispensing events; subsidy basis (jogcím) set
- Claimed subsidy = gross − co-payment per the official subsidy register (PUPHA)
- Period totals reconcile; corrections (helyesbítő) reference originals
- HUF whole-forint amounts; settlement deadline met
- Sensitive-data handling per data-protection rules
Last updated: 2026-06-04 — the NEAK reporting format is portal- and version-specific; confirm the current schema/version, identifiers, rounding, and deadline against current authority (neak.gov.hu) guidance before use.