Launching NPI Enrichment and Provider Directory

We're excited to announce the launch of two powerful new features that make healthcare provider data more accessible and useful: Automatic NPI Enrichment and the Flexpa Provider Directory.

The Problem with Provider Data

Interestingly enough, we became our own first users of this feature. One of the challenges we've faced in making patient-accessed claims data useful is that payers often use logical references - instead of providing a literal reference.

What this means in practice is that the only provider-specific data available in patient-accessed claims data is an NPI. Here's an example of how that appears in a logical reference:

"provider": {
  "identifier": {
    "system": "http://hl7.org/fhir/sid/us-npi",
    "value": "1234567890"
  }
}

We really wanted this to be a much richer dataset. Where's the name? Or the address? Or contact information?

One of the most useful things about a claims history is that it acts as a natural aggregator and record locator service. It's one of the only fully above-board alternative pathways to access outside of treatment purpose of use HIE networks. So having provider names, addresses, and contact information is critical.

But enriching the data required us to parse the NPPES database. So we built the Flexpa Provider Directory and NPI Enrichment.

Automatic NPI Enrichment

How NPI Enrichment Works

When Flexpa processes a healthcare record like an ExplanationofBenefit, we:

1. Identify NPIs: We detect NPI references and identifiers
2. Lookup Provider Data: We fetch detailed provider information from the National Plan & Provider Enumeration System (NPPES)
3. Expand References: We convert basic NPI references into full FHIR references with detailed provider information
4. Backfill Data: We add names, addresses, specialties, and contact information to provider resources

This works with both Practitioner and Organization resources, enhancing references in resources like Patient, Coverage, and ExplanationOfBenefit.

Benefits of NPI Enrichment

• Richer Data: Get comprehensive provider details that may be missing in the original data
• Consistency: Access standardized provider information across different payers and sources
• Better UX: Display detailed provider information without additional API calls
• Automatic Processing: No extra work required - enrichment happens automatically during data processing

The Flexpa Provider Directory

What is the Provider Directory?

As we built out Automatic NPI Enrichment we had to deal with the fact that we needed to parse the NPPES database.

So we built a FHIR-native version of it.

The Flexpa Provider Directory is a FHIR API of healthcare providers in the United States, powered by NPPES data. It provides direct API access to over 8 million provider records.

How the Provider Directory Works

The Provider Directory implements the FHIR R4 specification for Practitioner and Organization resources, following the US Core profiles. It's accessible through our FHIR API using standard search parameters.

For example, to search for practitioners by name:

GET /fhir/Practitioner?name=smith

Or search for organizations by location:

GET /fhir/Organization?address-state=CA

Key Features

• Standardized Access: Access provider data through our FHIR API
• Comprehensive Coverage: Full access to every NPPES entry
• Powerful Search: Use FHIR's robust search capabilities

Use Cases

The Provider Directory helps our customers further enrich claims data:

• Claims Processing: Match NPIs with detailed provider information
• Data Enrichment: Add provider details to existing healthcare data
• Record Location: Identify contact details for further records requests

Getting Started

To access the Provider Directory, you'll need an Application Access Token, obtainable through the Token Endpoint using the OAuth 2.0 Client Credentials Grant Flow.

For detailed information on both features, check out our documentation.

We're excited to see what you build with these new features. If you have questions or need assistance, please reach out to our team at partnerships@flexpa.com.