For benefits companies
Benefits utilization, from member claims.
Flexpa retrieves member-authorized claims from supported health plans for benefits utilization analysis. Your application can review recorded services and calculate deductible and out-of-pocket accumulator estimates from available EOB fields. The results depend on the claims the plan has processed and shared, not a live view of every healthcare expense.
Updated 2026-11-11
How it works
- Member connects a supported plan
- Retrieve available claims
- Review utilization and spending fields
What to review
- Deductible, copay, and coinsurance amounts in available EOBs.
- Providers, service dates, and procedure codes recorded in claims.
- Coverage periods when grouping claims for a benefit year.
Before calculating accumulators
Use the financial data guide to interpret adjudication fields. Payers do not always supply every field, so identify missing values rather than treating them as zero.
Do not present a total from incomplete claims as the plan's confirmed remaining deductible or out-of-pocket balance.
Questions
Does Flexpa show healthcare utilization as it happens?
Flexpa retrieves the claims a supported health plan makes available after member authorization. Claims-based utilization is not a live event feed; it depends on plan processing and the application's sync schedule.
Can claims support deductible and out-of-pocket tracking?
Available Flexpa EOB fields can support accumulator calculations. Check the benefit period, missing claims, and missing financial fields before using a calculated total. A claims-based estimate is not confirmation of the plan's current balance.