Better Together: 1upHealth’s Partnership Approach to Prior Authorization

Let’s face it: Prior Authorization in the U.S. healthcare system is broken.

The current prior authorization process often creates bottlenecks that delay treatment and frustrate everyone involved. It’s a system plagued by outdated infrastructure, manual workflows, disparate data standards, and a lack of real-time data sharing. Patients experience significant delays or forgo care entirely, providers are overwhelmed by administrative burdens, and payers face inefficiencies in processing approvals. All of this leads to wasted time, increased costs, and, in some cases, poorer health outcomes.

At 1upHealth, we’re driving the modernization of Prior Authorization by facilitating secure, seamless health data exchange between payer and provider systems. We’re building cloud-native, standards-based APIs to enable real-time, interoperable data exchange – giving payers the information they need to make faster decisions so patients get care sooner and providers face less administrative burden.

But Prior Authorization is simply too big and too complex to tackle alone.

Between clinical data gathering, coverage checks, policy validation, and final approvals, there are a lot of steps and a lot of disparate systems involved. No one company or solution can realistically handle the entire Prior Authorization process from end to end.

That’s why we’re partnering with other technology companies to solve each customer’s unique prior authorization challenges. We’re bringing incredible innovations to the table – from AI-powered clinical review to automated workflows and real-time insights – providing payers with the flexibility to integrate seamlessly with any utilization or policy management vendor.

1upHealth’s Approach to Prior Authorization

At 1upHealth, we’re building a centralized, standards-based orchestration layer that simplifies the prior authorization process across fragmented systems. Sitting between providers and payers, our FHIR-based Prior Authorization API acts as a single integration point, reducing complexity for providers and helping payers intelligently route each request to the right utilization management (UM) system. It’s a solution built with true interoperability in mind.

Think of us as the connective tissue building and maintaining a robust network of providers connected to our platform, and developing strong partnerships with utilization and policy management systems to ensure routing and decision-making are coordinated across all parties.

Every provider we onboard strengthens the network and increases ePA adoption. We take on the hard work of integration, so payers don’t have to. At the same time, we serve as the central routing engine, streamlining decision-making across all lines of business.

The Benefits of 1upHealth’s Partnership Model

We’re actively partnering with utilization management vendors, policy managers, EHR platforms, and other health tech innovators to ensure the full prior authorization journey is seamless and scalable for payers and providers.

Together, we can:

• Reduce the chaos of “which systems talk to each other”
• Deliver a single integration point for EHRs and providers
• Ensure actionable responses and timely approvals
• Create the kind of experience patients and clinicians actually deserve

Partnership isn’t a nice-to-have, it’s the strategy

We know healthcare needs improvement. We also know it’s going to take a whole ecosystem working together to get there. Our goal is to be the most developer-friendly, standards-first, interoperability-focused platform out there and to make it easy for others to plug in, add value, and innovate at scale.

At the end of the day, we’re not just trying to fix prior authorization, we’re trying to build a better healthcare system by making secure data exchange more effective and efficient. 

(And yes, one that finally lets us retire the fax machine for good.)

Want to partner with 1up Health? We’d love to explore how we can work together to make healthcare data and the Prior Authorization process more accessible, actionable, and intelligent for everyone. Contact us today.