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CMS-9115

Health insurers

Claims, coverage, and clinical history from health insurers, shared by the member through the Patient Access APIs required by CMS-9115.

Read the docs Markdown for agents

For people and teams

A health plan sees the care it paid for, from every doctor, pharmacy, and hospital. One sign-in to a member account can share that history across all of them.

What comes back

  • Claims with financial adjudication: what was billed, what the plan paid, and what the member owed.
  • Insurance coverage, including plan details, member ID, and coverage period.
  • Pharmacy claims that show which prescriptions were filled, not only which were written.
  • Clinical details such as diagnoses and procedures. Notes and lab results are sometimes included.

How people connect

  1. Search for the health plan by name.
  2. Choose the plan type when support depends on it: employer, Medicare Advantage, Marketplace, bought directly from the insurer, or Medicaid. Some plans also ask for the state.
  3. Sign in with the member account at the health plan and approve sharing.

Good to know

  • Claims arrive within 24 hours of adjudication, which typically comes 5 to 30 days after the visit.
  • Each sign-in shares one plan member. To share a dependent’s records, connect again for that member.

Scale and context

Enrollment reached, by plan type

The share of enrollment in each government program plan type held by health insurers whose Patient Access API Flexpa connects to.

95.1%of 176,531,810 enrollments in these plan types

  • Original Medicare100% of 27,790,912
  • Medicare Advantage94.7% of 39,329,575
  • Medicaid93.2% of 76,008,956
  • CHIP96.6% of 3,597,128
  • Dual eligibles97% of 6,433,822
  • ACA Marketplace95.5% of 23,371,417
Show the data as a table
Enrollment reached, by plan type
Plan typeEnrollmentEnrollment reachedShare
Original Medicare27,790,91227,790,912100%
Medicare Advantage39,329,57537,235,68594.7%
Medicaid76,008,95670,815,48693.2%
CHIP3,597,1283,474,70196.6%
Dual eligibles6,433,8226,243,61997%
ACA Marketplace23,371,41722,327,80695.5%
  • Counts enrollments, not unique people, from the payer enrollment data behind Flexpa’s coverage summary.
  • An insurer counts when its endpoint in the Endpoint Directory is connected, or connected with intermittent issues, and supports that plan type. This measures which insurers Flexpa reaches, not whether a given member’s sign-in succeeds.
  • Employer and other commercial plans are not shown.

Sources: Flexpa network coverage summary (November 12, 2026); Flexpa Endpoint Directory (November 12, 2026).

In the docs

Other networks

All three work together in one Flexpa integration and return the same FHIR R4 API.

  • ONC (g)(10)

    Medical record systems

    Clinical records from the EHRs at hospitals and practices, shared by the patient through ONC (g)(10) certified Patient Access APIs, now with Epic MyChart Central sign-in across linked Epic organizations.

  • TEFCA IAS

    Nationwide exchanges

    One identity verification finds a person’s records across facilities on the TEFCA network. Flexpa is an Individual Access Services provider through two QHINs, Kno2 and CommonWell.

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