FAQ
How does Flexpa work?
Flexpa does not store or persist PHI. See our privacy policy.
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 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 currently available via the Flexpa API uses the FHIR R4 version.
- 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
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.
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 copays, coinsurance, and other health care costs, but not 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 currently provide an API for accumulated totals.
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 Explanation of Benefits resources. Are you interested in accumulated totals? Let us know.
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 accounts 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.
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.
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.
Can Flexpa retrieve in-process claims?
Claims histories are typically available via Explanation of Benefits statements only after claim processing (adjudication).
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.
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.