FAQ
#What does Flexpa do?
Flexpa provides patient-mediated access to claims and clinical data from health plan payers in an easy-to-use API.
Flexpa connects to individual health plan payers via officially supported Patient Access APIs.
#What data does Flexpa provide?
Flexpa provides access to claims and clinical data from health plan payers, including:
- Health plan policy history (via FHIR R4 resources like Coverage)
- Claims histories (via FHIR R4 resources like Explanation of Benefits)
- United States Core Data for Interoperability, a standardized set of health data classes (via FHIR Resources like Observation, Procedure, and DiagnosticReport); see a list of FHIR R4 resources supported by Flexpa API
More detail about the data provided by Flexpa can be found in our FHIR Resources overview.
HL7 FHIR is a healthcare interoperability standard supporting most Patient Access APIs in production by health plan payers today.
Data is formatted according to schemas defined in the base R4 FHIR implementation guide and according to Implementation Guides such as US Core and CARIN BlueButton IG.
The Flexpa API exclusively supports the JSON content type.
Read more about this standard in our Patient Access guide and in Flexpa API.
#Which patients / health plans / payers are covered by the Flexpa? Which health plans are supported?
Flexpa provides broad support for CMS-regulated plans as described in our Patient Access guide.
This includes traditional Medicare, Medicare Advantage, Medicaid Fee For Service, Medicaid MCOs, CHIP, and ACA plans purchased on healthcare.gov or federally supported exchanges.
Flexpa also supports commercial plans from a select group of payers including Anthem and Kaiser Permanente.
Starting on January 1, 2024, payers will be required to support the Patient Access API for all plan types in California, including commercial lives.
Flexpa has limited support for Medigap plans, which are supplemental insurance plans that help pay for some of the costs that Original Medicare doesn’t cover.
Flexpa also has limited coverage for ACA plans purchased on state-run exchanges or off-exchange.
Full details about our coverage can be found in our Endpoint Directory.
#How does Flexpa work?
Flexpa caches data for the purpose of service reliability.
See our privacy policy.
#How quickly can I go live with Flexpa?
Flexpa aims to be self-service and straightforward with minimal setup time.
Our Quickstart will get you up and running in minutes to explore our application and available data.
The steps to get live with Flexpa are listed here on our Go-live checklist.
The process is straightforward and can be completed in a few days.
The longest step is generally external to Flexpa - parsing and using the available data within your application's workflow.
This can be quick for some applications that need simple data, such as member demographics, but for others that need more complex data, such as claims history, it can take longer.
#Does Flexpa work with provider data sources?
Flexpa focuses on connectivity to health plan payers and does not currently integrate with provider data sources to pull clinical data.
Are you interested in clinical data from provider data sources? Let us know or learn about clinical data sources.
#Does Flexpa provide eligibility data?
Flexpa focuses on connectivity to health plan payers and can pull basic coverage information such as member ID, group ID, and coverage dates, but does not currently provide an API for eligibility queries.
Are you interested in eligibility? Let us know or learn about eligibility data sources.
#Does Flexpa provide accumulated coverage totals like progress towards deductible and out-of-pocket maximum?
An accumulated total is a sum of the money a patient has paid towards their deductible (the limit above which their insurer starts to pay for some of the healthcare services cost) and out-of-pocket maximum (the limit above which an insurer starts to pay for all healthcare services costs).
These totals are generated by adding together copays, coinsurance, and other health care costs, but not monthly premium payments.
You can calculate accumulated coverage totals by following the financial guide, specifically the accumulators section.
#Does Flexpa provide prior authorization data?
Prior authorization is a process that requires health insurance companies to approve certain healthcare services, treatments, medications, or equipment before they are provided.
This process is used to ensure that care is medically necessary and covered by the plan, and to control costs.
Flexpa does not provide prior authorization data today because it is not included in existing CMS Patient Access APIs as of the time of writing (July 2024).
However starting 2027, prior authorization data will be included in CMS Patient Access APIs.
This requirement is stated in CMS-0057-F.
#Can Flexpa provide pharmacy benefits data?
Flexpa can be used to check pharmacy benefit claims histories via the Explanation of Benefits resource.
#Can Flexpa provide FSA and HSA data?
A Flexible Spending Account (FSA, also called a “flexible spending arrangement”) is a special account you put money into that you use to pay for certain out-of-pocket health care costs.
A Health Savings Account (HSA) is a tax-advantaged savings account that can be used to pay for qualified medical expenses.
These accounts are typically maintained by banks or other traditional financial institutions.
Flexpa focuses on connectivity to health plan payers and can pull basic account information, but does not currently provide an API for accessing accounts which are typically maintained by traditional financial institutions such as HSAs and FSAs.
Are you interested in FSAs or HSAs? Let us know and we can recommend other solutions.
#What time periods are data available for? When does it get updated?
Patient authorizations happen on a single-source basis.
Data availability is best from 2016 onwards for a given source.
Most claims-history-specific SLAs provided by health plan payer implementations are 24 hours after processing the claim.
#Can Flexpa retrieve in-process claims?
Claims histories are typically available via Explanation of Benefits statements only after claim processing (adjudication).
#How does authorization work? How does a patient authorize access?
Health plan members dictate how their data can be used and by whom, with identity and authorization controlled by the health plan payer.
#How do patients without login credentials authorize access?
A member ID card and identifiable information are required to complete account setup in the identity systems (SMART App Launch) implemented by the health plan payers.
#I'm having problems with some of the test payer portals. What can I do?
Some payer portals have restrictions, such as geofencing, that prevent access to their portals
To test against payer endpoints with these restrictions, consider using a VPN service such as NordVPN or Mullvad.
Flexpa is not a Health Information Exchange (HIE)
HIEs are organizations that facilitate the exchange of health information between providers and other healthcare organizations.
They have a wide array of capabilities but are typically focused on the exchange of clinical data, usually for treatment purposes.
Flexpa is a platform that enables members to authorize access to their health plan payer data.
Flexpa is focused on claims data.
Read more about what Flexpa is and isn't at what we don't do.
#Does Flexpa include data from prior plans? How far back does Flexpa go?
Flexpa can be used to retrieve claims history data from 2016 onwards for a given source.
In the event that a patient has changed their insurance, Flexpa can be used to link multiple plans, including prior plans a patient may have been on.
Using Flexpa, the patient can select their prior plan data and authorize access.
After retrieving that data, they could then authorize access to their current plan data.
The patient would then be able to see their full claims history across both plans.
#What languages does Flexpa support?
Flexpa supports English, Spanish, and Korean in Flexpa Link.
Users can toggle between English, Spanish, and Korean in the Flexpa Link user interface using the language selector in the bottom right-hand corner of the Link modal.
Let us know if there are other languages you'd like supported.
Flexpa does not translate financial or clinical content into other languages in Flexpa API.
#Can I access data for dependents through Flexpa?
Yes. Each patient must be separately authorized and will be billed as a separate patient link.