Claims data and AI
This guide explains what claims data your AI assistant receives when you connect a health plan through Flexpa, how far back it goes, and how the assistant reads it. For setup in Claude or ChatGPT, see Connect your health records to Claude or ChatGPT. For a short overview, see Use your insurance claims history with AI.
#What your health plan shares
Plans covered by the CMS Patient Access Final Rule must make available, at a minimum, adjudicated claims (including provider remittances and your cost-sharing), encounters with capitated providers, and clinical data the plan maintains, including lab results.
Through Flexpa, that arrives as FHIR R4 resources:
#How far back it goes
Covered plans must expose data with a date of service on or after January 1, 2016, so a connection reaches back to that date or to the start of your enrollment with that plan, whichever is more recent. New data becomes available within 24 hours of your plan processing it.
#Which plans are covered
The federal requirement covers Medicare Advantage organizations, Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and QHP issuers on the federally facilitated exchanges. Original Medicare connects through Blue Button 2.0. Other plans, including some employer plans, also connect. See Plan definitions and the Endpoint Directory.
Employer plans: if you are the subscriber or a delegate of the subscriber, all plan members' information is shared.
#How your assistant reads claims
When you connect Flexpa to an assistant through the MCP server, the assistant uses tools and resources such as:
get_claims for your claims (ExplanationOfBenefit)get_coverage and flexpa://insurance-card for your plan and card detailsflexpa://medications for prescriptions and pharmacy claimsget_health_summary for a full clinical summary
Questions that work well: "Summarize my claims from the past year", "What did I pay out of pocket for each visit?", "What prescriptions have I filled?"
#Stop sharing
Revoke access at any time at privacy.flexpa.com. See Revoking access.