EOBs are the most accurate, current source of negotiated reimbursement data available in the market — guaranteed.
Machine-Readable Files are often incomplete. Claims databases lag. Commercial datasets rely on estimates. FlexPoint is different. We are the only company in the United States that collects Explanation of Benefits (EOB) documents 100% directly from patients — giving us access to reimbursement rate intelligence no other source can provide.
Our proprietary methodology allows us to recruit patients in any market, procure their EOBs, and extract the exact contractual rates negotiated between any insurer and any provider — with 100% accuracy, guaranteed. Whether you're verifying existing benchmarks or filling critical data gaps, EOBs deliver a level of accuracy and completeness no other method can match.
FlexPoint has proprietary methods to recruit patients who recently received care from targeted providers.
FlexPoint's U.S.-based, bilingual (English & Spanish) patient call center is owned and operated by FlexPoint.
Representatives screen recruited patients by explaining the EOB collection program and compensation.
All recruitment and outreach is HIPAA-compliant.
Patients provide their Explanation of Benefits documents. FlexPoint authenticates, validates, and strips all Protected Health Information (PHI) prior to client delivery.
The exact billed and allowed amounts are extracted — specific to code (CPT, DRG, Rev Code), place of service, insurer product (PPO/HMO), provider (Tax ID/NPI), and date of service.
Verified EOB data delivered with full documentation. 100% accuracy guaranteed. NSA/IDR-compliant formatting available.
| Data Attribute | FlexPoint EOB Data | What This Means for You |
|---|---|---|
| Validity | Validated — actual EOBs (stripped of PHI) provided to client. | EOBs serve as irrefutable, concrete evidence in negotiations and IDR arbitration. |
| Age / Date of Service | Current — DOS within last 30 days. Time period customization: last 1, 3, 6, 12, 18, or 24 months. | Guaranteed more current than any other data source — critical for IDR where recency of evidence matters. |
| Accuracy | 100% Guaranteed Accurate. | No modeling. No estimates. No approximations. The actual negotiated rate, every time. |
| Granularity | EOB line-item detail: specific by insurer (PPO vs. HMO), provider (Tax ID/NPI), and reimbursement methodology. | Market-rate intelligence at the claim level — not averages or ranges. Exactly what the insurer pays this provider under this product. |
| Evidence Standard | Certified and submittable — the source document itself, not just a summary or report derived from data. | Directly submittable as an IDR exhibit. No other data source meets this standard. |
| Dimension | 835 Remittance / Aggregated Claims Data | APCD (All-Payer Claims Database) | FlexPoint Patient-Direct EOB ✓ |
|---|---|---|---|
| Data Origin & Primary Source | Derived — aggregated from payer-submitted claims files. Payers control what they submit, how it is coded, and what gets included. Sample is never complete. | Derived — built from mandated payer claims reporting. Still filtered through each payer's submission process, not the original source document. | Primary source — the original EOB document issued by the insurer to the patient. Not submitted, filtered, or processed by any payer. Exactly what the insurer paid, guaranteed. |
| Data Recency & Lag Time | Even after a claim is adjudicated, it must be aggregated and delivered by a data vendor before it's usable. Industry research on commercial claims data puts this lag at roughly 4–12 months from date of service, with 6–8 months typical. | State reporting cycles add further delay on top of claims aggregation — data typically lags 6–18 months behind current market. | Current — reflects rates as recent as the last 30 days, since data comes directly from patients rather than through a claims-aggregation pipeline. |
| Coverage & Completeness | Reflects only claims processed by the specific payer submitting the file — no cross-payer visibility. | Self-funded ERISA plans — a large share of commercial coverage — are frequently exempt or report only voluntarily. Coverage is also state-by-state, with no unified national view. | Sourced directly from patients nationwide, regardless of plan funding type or state — no coverage gaps. |
| Admissibility in IDR Arbitration | Not directly submittable as evidence. A benchmark or report derived from 835 data can be challenged on sample methodology, vintage, inclusion criteria, and whether it represents the specific market, provider, and product type at issue. | Same aggregation problem as 835 data — an APCD-derived benchmark is still a model, not a source document, and faces the same methodology and vintage challenges. | Certified and submittable directly as an IDR exhibit — the source document itself, not a summary. Arbitrators under the No Surprises Act are required to weigh "additional information" including credible market rate evidence. No other data source meets this standard. |
| Attack Surface in Negotiation or Litigation | High attack surface. An insurer's legal team can challenge the sample size, dispute whether their Tax ID/NPI is adequately represented, argue that vintage doesn't reflect current market, and question product-type mix. These challenges introduce enough uncertainty to shift an IDR outcome or soften a negotiating position. | Same vulnerabilities as 835 data, plus an added weakness: ERISA/self-funded coverage gaps can be used to argue the dataset doesn't represent the relevant market at all. | Zero attack surface. The document exists — the payer name, allowed amount, date of service, and provider Tax ID/NPI are all on the face of the EOB. An insurer's attorney cannot argue with a document their client's own patient received from their insurance company. |
| 835 and APCD data tell you what was reported. | FlexPoint EOBs tell you what was actually paid — and can prove it in court. |
| Benchmarks are argued about. | Evidence is submitted. In IDR arbitration, the side with primary source EOB evidence enters with a structural advantage. The side with a 835- or APCD-derived benchmark enters with an attack surface. |
| Aggregated claims data is a model. | A FlexPoint EOB is a document. There is no methodology to challenge, no sample size to dispute, no vintage to question, and no ERISA/self-funded coverage gap to explain away. It is the original record of an actual transaction between a specific patient, a specific provider, and a specific payer. |