Member Services Training Material
Member Services Training Material

Patient Access and Interoperability (PAI) solution

The Patient Access and Interoperability (PAI) solution is in response to the 21st Century Cures Act CMS Final Rule released March of 2020. The Final Rule focuses on the empowerment of patients/members in the cost and outcomes of their care by providing data transparency through the use of modern application-based services.
Essentially, the rule requires that each organization that provides services to federally funded beneficiaries make the member data available via a standard FHIR-based Application Programming Interface (API) so that any application the member selects can access that data in a ubiquitous way.

Overview of Solution

    1.
    Member (or personal representative) opens authorized 3rd Party application
    2.
    Find Health Plan
    3.
    Authenticate member (or personal representative)
    4.
    Member able to view data on application

Authentication Solution

There are two flavors of authenticated solutions: 1up Hosted Authentication solution and external authentication solution.

1up Hosted Authentication Solution

1up's authentication application can be deployed to any of our hosted environments. We can customize the solution based on customer's needs and preferences. We use member's identification characteristics such as first name, last name, birth date and MemberID to match and verify identity. The 1up platform then associates an email with the member's profile and an authorization code is sent to the email as a final verification step.

External Authentication Solution

1up has the ability to integrate into existing authentication solutions such as Identity Providers (IdPs) or member portals. A typical use case for external authentication solutions are integration with customer's existing portal. In this approach we will use an API mechanism to send a request and receive a response from the client's identity provider.

List of Approved 3rd Party Applications

List of 3rd Party applications can be found on the 1up App Gallery: https://1up.health/health-apps/audience/payers
All apps are required to go through our app vetting process that can be found here: https://app.gitbook.com/@1uphealth-1/s/admin/3rd-party-app-vetting

Frequently Asked Questions from Members:

What information do I need to authorize an application to see my health plan data?

There are two possible methods of authorizing an application to see your health plan data:
To provide access to your data to an application, you must create an account by providing your First Name, Last Name, Date of Birth, Member Plan ID, Zip code, and a unique email address.
If your health plan supports integration with their member portal, you will be presented with an authentication screen to enter your portal credentials, and a link to your health plan site in order to create a portal account .

If I have already authorized one application to see my health plan data, will I have to create another account to authorize a second application?

No. Once you have authorized one application to see your health plan data, you only have to authenticate using your email address and corresponding code to allow a second application to see the data.

What email is used to authorize an application to see my health plan data?

You must use the unique email address that you initially used to authorize and allow access to your data. An authorization code will be sent to the email address, and you will be required to enter it into the Health Plan application. If you do not remember the email address, contact your health plan to obtain the information.

Are the name fields case sensitive?

No.

How can I find my Member ID?

It is the member ID listed on the member ID card provided to you by your health plan. If you do not have this card, or if the number entered resulted in an error, contact your health plan support team.

I have authenticated and authorized successfully but I don't see any data or see a discrepancy in the data.

Contact the application developer via the support mechanism that they have provided on the application. The application developer will try to resolve the issue and if they are unable to, they will contact 1upHealth to troubleshoot together until the issue is resolved. Your application developer will provide progress of the issue until resolution.

What data can I share?

Your health plan has made available all claims, encounter, and clinical data (including laboratory results) that they control and maintain in their systems related to you as an individual. The availability of this data varies by health plan and individual member, and 3rd party applications will pull certain aspects of the data depending on the application's use. In general, the types of data you can expect to be available from your health plan might include: fully adjudicated medical and pharmacy claims, clinical lab results, care management documentation (e.g.health assessments, care goals), clinical measures such as vital signs (blood pressure, weight, height, smoking status, etc.), and provider and organization information related to care you have received. Review the app's documentation or contact your application support team in order to determine exactly what data they utilize from your health plan. Currently, you cannot choose to share only certain aspects of your data; if you authorize data-sharing, the app will have full access to any data your health plan makes available.

I am not able to see data from within the last week.

Recent updates to your claims or clinical data may not appear right away. Check again in one week. If you still cannot find the data, contact the application developer via the support mechanism they have provided. The application developer will try to resolve the issue or contact 1upHealth to troubleshoot together until the issue is resolved. Your application developer will provide progress of the issue until resolution.
Last modified 2mo ago