How does Flexpa work?
What are the primary use cases for Flexpa?
Flexpa helps apps obtain authorization directly from patients to access their PHI from health plan payers. Many of the use cases for Flexpa focus around accessing claims histories (see our Explanation of Benefits guide).
- Open enrollment
- Health wallet data sources
- Decentralized clinical trials
- Payer data exchange
- Digital provider insurance onboarding
- Medicare plan recommendation
- Release of information
Does Flexpa work with provider data sources?
Flexpa focuses on connectivity to health plan payers and does not integrate with provider data sources to pull clinical data today. Are you interested in data from provider data sources? Let us know.
What data is available?
Patient Access APIs are HTTP-based APIs with HL7 FHIR interfaces and JSON document responses. All data available via the today uses the FHIR R4 version. Flexpa API
- 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 here.
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 provide an API for eligibility queries. Are you interested in eligibility? Let us know.
Does Flexpa provide acculumated 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 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 any copays, coinsurance, and other health care costs, but not your monthly premium payments.
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 provide an API for accumulated totals yet.
Given the Flexpa API returns the adjudicated claims for a patient, the accumulated totals can be calculated by summing the non-covered charges paid by the patient across different ExplanationOfBenefits resources. Are you interested in accumulated totals? Let us know.
How is the data structured? Format? Version?
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 exclusively supports the JSON content type. Flexpa API
Read more about this standard in our Patient Access guide and in . Flexpa API
What time periods is 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.
Who can trigger the authorization workflow?
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.
Can Flexpa pull pharmacy benefits?
Flexpa can be used to check pharmacy benefit claims histories via the Explanation of Benefits resource.
Does Flexpa store PHI?
Can Flexpa retrieve in-process claims?
Typically claims histories are available via Explanation of Benefits statements only after claim processing (adjudication).