What we don't do
Flexpa retrieves patient‑consented, identified claims data from 300+ U.S. health plans via a single FHIR R4 API. We deliver complete adjudicated claims and coverage details directly from payers in seconds, with a Provider Directory endpoint powered by nightly CMS NPPES ingests.
Claims data isn't always what you need. Rather than force-fitting solutions, we'll help you find the right tools from today's interoperability and API options.
Here are common healthcare interoperability challenges and some solution options.
#Provider directory data
Provider directories are surprisingly difficult to maintain. Providers change affiliations, addresses, and names, while organizations merge, get acquired, or close.
Your use cases may require provider details (name, address, phone, taxonomy, NPI) and organization information. While Flexpa includes some provider data in claims (prescribing providers for MedicationRequests, attending providers for Encounters), a comprehensive provider directory may better serve your needs.
➡️ Flexpa tie‑in: Flexpa customers can query our Provider Directory by NPI, name, specialty, or geo‑radius, then enrich with claim‑level utilization to see what a provider actually does.
#Built‑in to Flexpa
#Other public datasets
- CMS NPPES — Free NPI registry that Flexpa already ingests nightly.
#Commercial solutions
- Ribbon Health — Enriches phone/fax, affiliations & quality scores instead of payer‑sourced utilization.
- Defacto Health — Credentialing & performance insights without direct claims data.
- LeapOrbit — Medicare‑focused enrichment versus Flexpa's multi‑payer scope.
#Price transparency & cost data
Beyond identifying providers, patients and vendors need to know services offered and costs—the essence of price transparency.
The regulatory trifecta of CMS Hospital Price Transparency, CMS Transparency in Coverage Rule, and No Surprises Act has prioritized price transparency. These regulations require hospitals and payers to publish machine-readable price data for various applications.
➡️ Flexpa tie‑in: Combine member‑level OOP totals from Flexpa with MRF rates for true personalized cost forecasts.
#Open‑source
- MRF Parse — Parses raw MRF JSON where Flexpa offers no MRF tooling.
- Dolthub MRF bounties — Community‑cleaned SQL tables vs. Flexpa's adjudicated amounts.
#Commercial
- Serif Health — Normalizes hospital price files instead of member claims.
- Turquoise Health — Benchmarks negotiated rates rather than historical spend.
- Citrus — Aggregates payer & hospital MRFs instead of returning EOBs.
#Eligibility & coverage discovery
Verifying patient eligibility for services is the first step toward care delivery and reimbursement. Claims clearinghouses and eligibility verification services typically address this need.
Flexpa claims data enhances eligibility information by providing a complete benefits picture, revealing deductible progress and improving cost prediction accuracy to reduce administrative corrections.
➡️ Flexpa tie‑in: Our Coverage resources include real‑time deductible & OOP accumulators that clearinghouses never return.
#Clearinghouse networks
Claims clearinghouses securely connect healthcare practices to insurers. These established networks serve all provider types and cover nearly all payers through interconnected agreements.
HIPAA transaction rules require clearinghouses to use the complex X12 standard, making them the primary channel for eligibility verification.
- Availity — EDI hub for eligibility without patient‑authorized claim history.
- Change Healthcare — Large clearinghouse network vs. Flexpa's OAuth payer access.
- Waystar — Revenue‑cycle platform not a payer FHIR API.
#Developer on‑ramps
Several companies have built tools to simplify the outdated X12 standard, translating it to modern formats like JSON for easier application development.
These on-ramps add costs beyond clearinghouse fees but accelerate eligibility data integration.
- Change Healthcare — Large clearinghouse network vs. Flexpa's OAuth payer access.
- Stedi — JSON over X12 eligibility while Flexpa stays FHIR‑native.
- Sohar Health — Wraps multiple clearinghouses where Flexpa bypasses them.
- Eligible — Instant eligibility checks but no longitudinal claims.
- pVerify — Batch eligibility & benefits instead of adjudicated claim feeds.
#Coverage Discovery
Unlike eligibility checks that use member IDs, coverage discovery uses demographics (name, DOB, address) to find benefits information.
Flexpa claims data enriches payer coverage data to reveal deductible progress and improve cost predictions, reducing billing corrections.
#Summary of benefits & plan design
Understanding patient benefits and coverage is the second critical step toward care delivery and reimbursement.
Flexpa's API provides coverage details that complement vendors offering detailed plan information. This allows developers to link patients to specific plan structures to determine service eligibility.
➡️ Flexpa tie‑in: Use Coverage.id as a foreign key to benefit catalogs.
- Ideon — Normalized SBC & formulary APIs versus Flexpa's claims‑derived accumulators.
- Quotit — Plan quoting & comparison rather than retrieving EOBs.
#Clinical data
Aggregating clinical history across providers is essential, especially for complex patients seeing multiple specialists. Flexpa's payer claims data enhances clinical information by showing network status and total cost of care.
Clinical data access follows three paths: patient authorization, direct integrations, and health information networks.
➡️ Flexpa tie‑in: Merge Flexpa claims with clinical data to validate encounters, close HEDIS gaps, and support risk adjustment.
#Patient‑authorized EHR access
Similar to Flexpa's model, several companies offer clinical data via patient authorization. Patients provide portal credentials to access their provider EHR data, enabling care coordination and population health management.
This data typically comes in standardized FHIR format.
- 1Up Health — Patient‑portal CCDAs instead of payer claims.
- Human API — Aggregates EHR + wearable data not adjudicated claims.
- Fasten Health — Personal health record vs. backend claims API.
- OneRecord — Consumer record app not programmatic payer access.
- Meld Rx — Medication CCDAs rather than payer adjudication data.
#Direct EHR integrations
Direct EHR integrations enable comprehensive workflows and detailed care information, but implementation is complex. These are typically limited to provider organizations or business associates involved in treatment.
These integrations use various formats including HL7, FHIR, custom APIs, or flat files.
- Redox — HL7/FHIR middleware not a claims source.
- Rhapsody — Interface engine versus purpose‑built claims API.
- Healthjump — Extracts EHR data but no coverage details.
- NexHealth — Practice‑management sync not claims retrieval.
#National & regional networks
Regional and national HIEs enable secure clinical data exchange between providers using C-CDA (XML) with query-based retrieval.
They're primarily available to provider organizations involved in treatment and typically require reciprocity—providers must share their data to access others' data.
#On‑ramps (FHIR & CDA gateways)
Several companies have built tools to simplify the complex C-CDA standard by translating it to modern formats like FHIR or JSON for easier clinical data integration.
These on-ramps add costs beyond HIE/HIN fees but accelerate clinical data application development.
➡️ Flexpa tie‑in: Pair verified encounter dates from claims with rich clinical context from on‑ramps.
- Gorilla — QHIN‑certified FHIR gateway while Flexpa is not a QHIN.
- Metriport — Converts CCDAs & device feeds to FHIR instead of adjudicated claims.
- Kno2 — Secure clinical exchange not payer connectivity.
- Particle Health — Nationwide clinical API vs. Flexpa's payer API.
- Redox Record Retrieval — Retrieves medical records not EOBs.
- Zus — FHIR backend‑as‑a‑service without direct payer ingest.
#Wearables & device data
Wearables and connected health devices offer continuous monitoring and insights impossible with traditional methods. These devices track metrics from basic (steps, heart rate, sleep) to advanced (ECG, blood oxygen, stress), providing comprehensive health insights when combined with clinical and claims data.
Data sources include fitness trackers, smartwatches, specialized wearables, and connected health devices.
#On-ramps
Middleware solutions integrate diverse device data by translating proprietary formats into standardized structures for easier implementation.
➡️ Flexpa tie‑in: Overlay device metrics onto claim‑dated events for longitudinal insight.
- Human API — Consumer data hub versus payer claims.
- Validic — Remote monitoring platform not adjudicated claims.
- Vital — Real‑time vitals API unlike retrospective claims.
- Rook — Fitness aggregation instead of EOB history.
- Terra — Normalizes wearable feeds while Flexpa normalizes EOBs.
#De-identified & aggregated data
Healthcare trend analysis, system evaluation, research, and policy often require large-scale anonymized data rather than individual information.
Deidentified claims data is insurance information stripped of PHI to protect patient privacy. HIPAA's Privacy Rule governs deidentification through either the Safe Harbor Method (removing 18 identifier types) or Expert Determination Method (statistical risk assessment).
➡️ Flexpa tie-in: Use Flexpa data to re-identify research cohorts (with consent).
#National networks
Regional and national networks enable secure exchange of anonymized population data between payers and providers, typically using custom formats (CSV, JSON).
#FHIR data stores
A FHIR Data Store efficiently manages FHIR-formatted clinical data, enabling interoperability between healthcare systems and accessibility for applications.
Since Flexpa provides access to external FHIR data, customers often need their own FHIR store for retention and management. While any database can store this data, a FHIR-native store better supports standard compliance.
➡️ Flexpa tie-in: Store Flexpa bundles in any managed FHIR repo:
Healthcare often requires data format conversion, such as transforming Flexpa's FHIR resources for database storage.
ETL tools handle these conversions by extracting source data, applying transformation rules, and loading it to a destination. Healthcare-specific tools can optimize Flexpa API data for your applications.
➡️ Flexpa tie-in: Flatten Flexpa data into analytics tables:
#Competitor comparison at a glance
| Company | Primary focus | Data type(s) | How data is obtained | Typical use cases | How Flexpa complements |
|---|
| Flexpa | Patient-authorized payer & directory API | Identified claims, coverage, NPPES providers | OAuth + nightly NPPES ingest | Claims analytics, provider search, benefit navigation, research, trials | Source of truth for adjudicated claims & canonical provider IDs |
| Bonfire | Market intelligence & provider propensity | De-identified claims + provider attributes | Commercial dataset (no PHI) | Provider targeting, sales | Enrich Bonfire segments with member-level outcomes |
| Citrus | Price transparency aggregation | Hospital & payer MRFs | Public TiC files | Cost-of-care estimators, rate benchmarks | Combine with historical spend from Flexpa |
| Gorilla | National clinical data QHIN | CDA/FHIR EHR documents | TEFCA/QHIN & HIEs | Point-of-care summaries, HEDIS | Validate encounters & bill types with claims |
| Metriport | HIE on-ramp & normalization | CCDAs, FHIR | TEFCA/QHIN & HIEs | Unified patient timelines, RPM | Validate encounters & bill types with claims |
| HDA Institute | Predictive analytics & risk scoring | De-identified claims & EHR | Purchased large datasets | Population health management | Feed identified claims to calibrate risk models |
| Zus | Shared FHIR platform & services | Clinical & partner claims (optional) | Network & partner ingestions | Backend for health apps | Push payer-sourced claims into Zus FHIR |
#Still not sure?
Request a demo — we'll help determine whether Flexpa or another vendor best fits your workflow.