API for estimated accumulators (deductible progress, out-of-pocket progress, etc)

[healthbjk]

Today, the Flexpa API returns information related to healthcare finances via a patient's insurance coverage and claims - the FHIR Coverage and ExplanationOfBenefit resources.

Accumulators are a concept within a patient's financial situation that represent the cumulative financial obligations and expenditures over a given period, typically a year. These can include deductibles, out-of-pocket maximums, and co-payments. Accurate tracking of these accumulators is crucial for both healthcare providers and patients to understand the remaining financial liability for medical services.

Today, most payers do not return this information in the API responses via Coverage or ExplanationOfBenefit. However, it is possible to estimate progress towards the accumulators by summing the patient responsibilities present in claims via ExplanationOfBenefit.

While it is possible for customers to do this on their own today, we are exploring whether offering a value-add API that performs this estimation would be useful to customers.

[hannahg141]

This would be very valuable to us!