For health plans
Review new member history with their authorization.
Flexpa can retrieve a new member's available claims from a supported prior health plan for onboarding and risk review. The member must authorize access, and the prior plan must still permit the connection. Use the history to identify records and questions for follow-up, not as an automatic risk-adjustment coding decision.
Updated 2026-11-11
How it works
- Check prior-plan access
- Member authorizes retrieval
- Team reviews available history
Review at onboarding
- Look for recorded diagnoses and procedures that warrant follow-up.
- Identify past providers and services from available claims.
- Confirm clinical and coding conclusions separately rather than treating a historical claim as a current assessment.
Questions
How can a health plan get a new member's prior claims?
A member can authorize a supported prior plan through Flexpa Consent. The health plan's integration can retrieve the available claims, provided the previous plan still allows the member to connect. Access and history vary by endpoint.
Does retrieving historical claims establish risk-adjustment coding eligibility?
Flexpa retrieves available records; it does not determine whether a diagnosis meets a risk-adjustment program's coding or submission requirements. Use historical claims to guide further review rather than assuming they qualify for submission.