For developers
Accumulators, from the claims.
Flexpa's financial data guide describes claim-based deductible and out-of-pocket totals. For a selected benefit period, sum deductible amounts for the deductible total; sum deductible, copay, and coinsurance amounts for the out-of-pocket total. Treat these as calculations from available claims, not a guarantee of the plan's current balance.
Updated 2026-11-11
How it works
- Available claims
- Confirmed benefit period
- Claim-based totals
The math
| Accumulator | Sum of |
|---|---|
| Deductible | Deductible amounts |
| Out-of-pocket | Copay plus coinsurance plus deductible |
Find the benefit year
The guide uses Coverage.period.start and adds one year as a simplifying assumption. It notes that some plans have shorter coverage periods. Confirm the applicable benefit period rather than treating every coverage start as a guaranteed annual reset.
curl https://api.flexpa.com/fhir/Coverage \
-H "Authorization: Bearer $ACCESS_TOKEN"Good to know
- Only covered services count toward accumulators.
- Flexpa normalizes adjudication codes in ExplanationOfBenefit resources for supported payers, so the sums use one set of codes.
Questions
Can I calculate deductible progress from claims data?
Flexpa's financial data guide calculates a claim-based deductible total by summing deductible amounts in ExplanationOfBenefit records for the benefit period. Confirm the period and available claims before presenting the result as an estimate of plan progress.
How do I find the benefit year?
Flexpa's financial data example starts with Coverage.period.start and assumes a 12-month period. The guide notes that this assumption does not fit every plan. Confirm the actual benefit period for the coverage you are analyzing.