Flexpa Data Overview

Flexpa Records API provides patient-consented claims and clinical data directly from health plans and providers. Records include medications data, conditions lists, lab results, medical notes, detailed medical claim adjudication, health plan details, provider lists, and more.

Get a preview of the rich healthcare data available through Flexpa. Below is a snapshot of key data elements you can access.

Patient Identification and Contact

Detail	Description	Answers the question	Example data
Full name	Legal name of the user	How can I verify this member's identity against other records?	`Johnny Appleseed`
Date of birth	Legal date of birth	How can I verify age-based eligibility for services?	`1985-03-15`
Gender	Gender recorded in health records	How should I tailor health screening recommendations?	`Male`
Address	Primary residential address	Is this member eligible for region-specific programs?	`123 Main St, Apt 4B, Boston, MA 02118`
Phone number	Primary telephone number	How can I enable SMS-based health reminders?	`(555) 123-4567`
Email	Primary email address	Where should I send digital care plans and appointment reminders?	`john.doe@email.com`

Plan and Benefits Details

Detail	Description	Answers the question	Example data
Member ID	Insurance member identifier	How can I track this member's interactions across different systems?	`ABC123456789`
Payer	Insurance company name	Which payer specific programs can I offer?	`Blue Cross Blue Shield of Massachusetts`
Plan Name	The specific insurance product or plan type	What specific benefits and limitations apply to this plan?	`Blue Choice PPO Silver 2000`
Plan Type	The category of insurance plan	How should cost sharing be calculated for this plan type?	`Commercial`
Network Type	The type of provider network associated with the plan	Which provider directory should I reference?	`PPO`
Coverage Status	Current status of the member's insurance coverage	Should services be authorized for this member?	`Active`
Coverage Start	Start and end dates of the insurance coverage period	Is the member currently eligible for benefits?	`2024-01-01`
Coverage End	End date of the insurance coverage period	When did the last coverage period end?	`2024-12-31`
Group Name	Employer or organization name for the insurance plan	What wellness programs are available through their employer?	`Acme Corporation Employee Health Plan`
Group Number	Insurance group plan identifier	What employer-specific benefits are available?	`GRP98765432`

Claims Management and Adjudication

Detail	Description	Answers the question	Example data
Claim Identifiers	Unique claim tracking number	How can I track this claim across multiple systems?	`CLM20240115987654`
Service Date	Date of service delivery	What was this user's healthcare journey?	`2024-01-15`
Claim Status	Current processing status of the claim	Should we initiate follow-up actions on this claim?	`Paid`
Billed Amount	Provider's charged amount	How does this charge compare to regional averages?	`$1,500.00`
Allowed Amount	Insurance-approved amount	Is this service priced according to our fee schedule?	`$1,200.00`
Insurance Paid Amount	Amount paid by insurance	What portion of the annual benefit maximum has been used?	`$950.00`
Patient Responsibility	Amount owed by patient	What portion of the bill is the patient ultimately responsible for paying?	`$250.00`
Coinsurance	Amount paid by patient based on their coinsurance rate	Has the member met conditions for reduced cost sharing?	`$150.00`
Copay	Fixed amount patient pays for service	Should this visit qualify for waived copay?	`$30.00`
Deductible Applied	Amount applied to patient's deductible	How close is the member to meeting their deductible?	`$220.00`
Payment Date	Date when the claim was paid	Is this claim within timely filing limits?	`2024-01-30`

Professional Claims - Office and Outpatient Services

Detail	Description	Answers the question	Example data
Procedure / Service Codes	CPT/HCPCS codes for services performed	Is this service covered under the member's benefit plan?	`CPT 99213`
Procedure / Service Description	Description of the service provided	Does this procedure qualify them for additional benefits or discounts?	`Office visit, established patient`
Service Location	Place of service where care was provided	Was this service provided in the most cost-effective setting?	`Office, Outpatient Hospital`
Rendering Provider	Primary physician or provider who delivered the service	Is this provider in-network and accepting new patients?	`Dr. Sarah Johnson, MD (NPI: 1234567890)`
Care Team Roles	Roles of providers involved in the service delivery	What types of providers were involved in this member's care?	`Primary, Supervising, Referring, Ordering`
Provider Qualifications	Professional qualifications of care team members	Are the providers appropriately qualified for the services rendered?	`MD, RN, PA-C, Board Certified Family Medicine`
Network Contracting Status	Whether the billing provider is in-network or out-of-network	Should different cost-sharing apply based on network status?	`In-Network, Out-of-Network`
Insurance Paid Amount	Amount paid by insurance to provider	Was this service paid at the contracted rate?	`$950.00`
Coinsurance	Amount paid by patient based on their coinsurance rate	Should preventive service benefits be applied?	`$150.00`
Patient Responsibility	What portion of the bill is the patient ultimately responsible for paying?	Has secondary insurance been billed for remaining balance?	`$250.00`

Institutional Claims - Hospital and Facility Services

Detail	Description	Answers the question	Example data
Revenue Codes	UB-04 revenue codes indicating specific hospital departments or services	Which hospital services did the member utilize?	`0250 (Pharmacy), 0636 (Operating Room)`
Type of Bill	Code indicating the type of institutional claim	What kind of institutional stay or service was this?	`111 (Inpatient), 131 (Outpatient)`
Admission Type	How the patient was admitted to the facility	Was this an emergency or planned admission?	`Emergency, Elective, Urgent`
Admission Source	Where the patient was admitted from	What was the patient's care pathway before this admission?	`Emergency Room, Physician Referral, Transfer`
Admission Period	Start and end dates of the institutional stay	How long was the member's length of stay?	`2024-01-15 to 2024-01-18 (3 days)`
Discharge Status	Patient's condition and destination upon discharge	What level of follow-up care does this member need?	`Home, Skilled Nursing Facility, Deceased`
DRG Code	Diagnosis Related Group used for payment classification	How does this case complexity compare to similar admissions?	`DRG 470 - Major Joint Replacement`

Diagnosis and Conditions

Detail	Description	Answers the question	Example data
Diagnosis Codes	ICD/SNOWMED/LOINC/etc codes for conditions diagnosed	What care management programs would benefit this patient?	`J45.901 - Unspecified asthma`
Diagnosis Description	Description of the condition diagnosed	How should we adjust risk scores based on this condition?	`Unspecified asthma`

Individual Provider Information

Detail	Description	Answers the question	Example data
Provider Name	Name of the individual healthcare provider who delivered the service	Who should be contacted for clinical documentation?	`Dr. Sarah Johnson`
Provider NPI	National Provider Identifier number for the individual provider	How can I verify this provider's network status and credentials?	`1234567890`
Provider Specialty	Medical specialty of the treating provider	What types of specialty providers does this member need?	`Cardiology`
Provider Qualifications	Professional qualifications and certifications	Is this provider qualified for specialized procedures?	`MD, Board Certified Internal Medicine`
Languages Spoken	Languages the provider can communicate in	Can this provider communicate effectively with the member?	`English, Spanish, Portuguese`
Provider Address	Location where provider practices	Is this provider accessible for the member's location?	`456 Medical Plaza, Suite 300, Boston, MA 02118`

Organization and Facility Information

Detail	Description	Answers the question	Example data
Organization Name	Name of the healthcare organization or facility	What facility-specific quality metrics and programs apply?	`Metropolitan General Hospital`
Organization NPI	National Provider Identifier for the organization	How can I verify this organization's network status?	`9876543210`
Organization Type	Category of healthcare organization	Is this the appropriate setting for this type of service?	`Acute Care Hospital, Ambulatory Surgery Center`
Organization Address	Physical location of the healthcare facility	Is this facility accessible and convenient for the member?	`789 Hospital Drive, Boston, MA 02118`
Organization Contact	Phone and contact information for the facility	How can care coordinators reach this facility?	`(617) 555-1234, info@metrohealth.org`

Pharmacy / Rx Information

Detail	Description	Answers the question	Example data
Drug Name	Medication name and strength	Are there generic alternatives available on formulary?	`Lisinopril 10mg tablets`
Drug Code	NDC/RxNorm and other standard medications identifiers	How do I match this drug to our formulary?	`00078057205`
Quantity	Number of medication units	Does this quantity align with dosing guidelines?	`30 tablets`
Days Supply	Duration of prescription	Is an extended day supply more cost-effective?	`30 days`
Fill Date	Date when prescription was filled	Is the member adherent to their medication schedule?	`2024-01-20`
Refills Remaining	Number of refills left on prescription	Should we proactively contact for renewal authorization?	`2`
Prescriber	Healthcare provider who wrote the prescription	Is this prescriber authorized for controlled substances?	`Dr. Michael Smith`
Pharmacy	Name and location of dispensing pharmacy	Is this pharmacy in our preferred network?	`CVS Pharmacy #1234`
Brand/Generic Indicator	Whether the dispensed medication is brand name or generic	Are generic alternatives being utilized to control costs?	`Generic, Brand`
Prescription Origin	How the prescription was transmitted to the pharmacy	Are providers using efficient electronic prescribing?	`Electronic, Written, Telephone`

Healthcare Encounters and Visits

Detail	Description	Answers the question	Example data
Encounter Type	Classification of the healthcare interaction	What type of care setting was utilized?	`Ambulatory, Emergency, Inpatient, Virtual`
Service Type	Specific type of healthcare service provided	What specialized services did the member receive?	`Primary Care, Cardiology, Emergency Medicine`
Encounter Status	Current status of the healthcare encounter	Is this encounter completed or ongoing?	`Planned, In Progress, Finished, Cancelled`
Visit Duration	Length of the healthcare encounter	How intensive was this care episode?	`45 minutes, 3 days (inpatient stay)`
Visit Priority	Urgency level of the healthcare encounter	How urgent was this member's need for care?	`Routine, Urgent, Emergency, STAT`
Encounter Reason	Primary reason for the healthcare visit	What health concerns prompted this visit?	`Annual physical, Chest pain, Follow-up care`

Clinical Observations and Measurements

Detail	Description	Answers the question	Example data
Observation ID	Unique identifier for the clinical observation	How can I track this measurement across different encounters?	`obs-12345`
Observation Status	Status of the observation result	Is this measurement final or preliminary?	`final, preliminary, registered, cancelled`
Observation Category	High-level categorization of the observation	What type of clinical measurement is this?	`vital-signs, laboratory, exam, procedure`
Observation Code	LOINC or other standardized code for the observation	What specific measurement or test was performed?	`8480-6 (Systolic blood pressure)`
Observation Description	Human-readable name of the observation	What was measured in plain language?	`Systolic blood pressure`
Value Quantity	Numerical result with units	What was the measured value and its unit?	`120 mmHg`
Value String	Text-based observation result	What was the descriptive result?	`Normal heart sounds, no murmur`
Value Boolean	True/false observation result	Was the condition present or absent?	`true (present), false (absent)`
Reference Range	Normal range for the observation	Is this result within normal limits?	`90-140 mmHg (normal range)`
Observation Date	When the observation was made	When was this measurement taken?	`2024-01-15T10:30:00Z`
Performing Provider	Healthcare provider who made the observation	Who performed this measurement?	`Dr. Sarah Johnson (NPI: 1234567890)`
Body Site	Anatomical location where observation was made	Where on the body was this measured?	`Right arm, Left wrist`
Interpretation	Clinical interpretation of the result	How should this result be interpreted clinically?	`High, Normal, Low, Critical`

Document References and Clinical Notes

Detail	Description	Answers the question	Example data
Document ID	Unique identifier for the document	How can I reference this specific document?	`doc-67890`
Document Status	Current status of the document	Is this document finalized or still in draft?	`current, superseded, entered-in-error`
Document Type	Type of clinical document	What kind of clinical document is this?	`Progress note, Discharge summary, Lab report`
Document Category	High-level classification of document content	What broad category does this document belong to?	`clinical-note, summary, report, plan`
Creation Date	When the document was created	When was this document originally authored?	`2024-01-15T14:30:00Z`
Document Title	Human-readable title of the document	What is the title of this clinical document?	`Cardiology Consultation Note`
Author	Healthcare provider who authored the document	Who wrote this clinical document?	`Dr. Michael Chen, MD (Cardiology)`
Authenticator	Provider who authenticated/signed the document	Who verified and signed this document?	`Dr. Michael Chen, MD`
Document Description	Brief description of document contents	What does this document contain?	`Consultation for chest pain evaluation`
Content Type	Format/MIME type of the document	In what format is this document stored?	`text/plain, application/pdf, text/html`
Document Size	Size of the document in bytes	How large is this document?	`2048 bytes`
Security Label	Confidentiality and access controls	What are the privacy restrictions on this document?	`Normal, Restricted, Very Restricted`

Diagnostic Reports and Study Results

Detail	Description	Answers the question	Example data
Report ID	Unique identifier for the diagnostic report	How can I track this specific report?	`report-54321`
Report Status	Current status of the diagnostic report	Is this report finalized or still pending?	`final, preliminary, registered, cancelled`
Report Category	Service category that produced the report	What type of diagnostic service was performed?	`Radiology, Laboratory, Cardiology, Pathology`
Report Code	Standardized code for the diagnostic study	What specific diagnostic test was performed?	`LOINC 36643-5 (Chest X-ray)`
Report Description	Human-readable name of the diagnostic study	What diagnostic procedure was performed?	`Chest X-ray, 2 views`
Study Date	When the diagnostic study was performed	When was this diagnostic test conducted?	`2024-01-15T09:00:00Z`
Report Date	When the report was issued	When were the results finalized?	`2024-01-15T16:00:00Z`
Performing Provider	Healthcare provider who performed the study	Who conducted this diagnostic procedure?	`Dr. Lisa Wong, MD (Radiology)`
Results Summary	Key findings from the diagnostic study	What are the main results of this test?	`Normal chest X-ray, no acute findings`
Clinical Conclusion	Provider interpretation and recommendations	What is the clinical significance of these results?	`No evidence of pneumonia or heart failure`
Associated Observations	Related observation results	What specific measurements were documented?	`Heart size normal, lung fields clear`
Imaging Studies	References to associated imaging	Are there images associated with this report?	`DICOM series 1.2.840.113619...`

Laboratory Specimens and Sample Collection

Detail	Description	Answers the question	Example data
Specimen ID	Unique identifier for the specimen	How can I track this specific sample?	`specimen-98765`
Specimen Status	Current status of the specimen	Is this specimen available for testing?	`available, unavailable, unsatisfactory, entered-in-error`
Specimen Type	Type of biological specimen collected	What kind of sample was collected?	`Blood, Urine, Tissue, Swab, Saliva`
Collection Date	When the specimen was collected	When was this sample obtained?	`2024-01-15T08:00:00Z`
Collection Method	Technique used to collect the specimen	How was this specimen obtained?	`Venipuncture, Clean catch urine, Biopsy`
Collection Site	Anatomical location where specimen was collected	From where on the body was this sample taken?	`Left antecubital fossa, Midstream urine`
Collector	Healthcare provider who collected the specimen	Who obtained this specimen?	`Nurse Jennifer Smith, RN`
Collection Volume	Amount of specimen collected	How much sample was obtained?	`10 mL, 50 mL, 1 tube`
Container Type	Type of container used for specimen storage	How is this specimen stored and preserved?	`Red top tube, Sterile container, Formalin jar`
Processing Notes	Special handling or processing requirements	Are there special requirements for this specimen?	`Keep refrigerated, Process within 2 hours`
Parent Specimen	Reference to original specimen if this is a derivative	Is this derived from another specimen?	`specimen-98764 (original blood draw)`
Quality Assessment	Quality indicators for the specimen	Is this specimen suitable for testing?	`Acceptable, Hemolyzed, Insufficient quantity`