For developers
Patient responsibility, from the claim.
Patient liability is the amount a claim assigns to the member, not necessarily an unpaid bill. Flexpa's financial data guide shows how to read member responsibility from ExplanationOfBenefit adjudication values and separates liability from payments already made.
Updated 2026-11-11
How it works
- Claim adjudication
- Member liability
- Separate payment values
Who owes what
| Party | Also called |
|---|---|
| Member | Patient |
| Insurer | Payer |
| Provider | Healthcare service provider |
Member liability
The guide models member liability as noncovered, deductible, copay, and coinsurance amounts. Read the claim's adjudication values and distinguish this responsibility from amounts the patient has already paid.
curl https://api.flexpa.com/fhir/ExplanationOfBenefit/{id} \
-H "Authorization: Bearer $ACCESS_TOKEN"Normalized for you
For supported payers, Flexpa translates each payer's adjudication codes to a standard set and calculates missing financial values from the liability and payment equations before returning the resource.
Questions
How do I get patient responsibility from claims data?
Flexpa's financial data guide shows how to read memberliability from ExplanationOfBenefit totals or calculate it from noncovered, deductible, copay, and coinsurance amounts. Liability is not necessarily the unpaid balance: payments are separate values.
Does Flexpa normalize adjudication codes?
For supported payer endpoints, Flexpa normalizes adjudication codes and calculates missing financial values using the equations documented in its financial data guide. This does not mean every payer has the same normalization coverage.