Revolutionizing Prior Authorization with 1upHealth

We all know how painful and fragmented prior authorization (PA) processes can be – the manual work, the inefficiencies, and the delays. That’s exactly why the team at 1upHealth is so passionate about revolutionizing Prior Authorization through digitization.

To ensure what we’re building not only solves the problem but is compatible across the broader healthcare ecosystem, our regulatory and interoperability experts regularly take part in events and work groups run by HL7 Da Vinci, the private sector organization that created the standards transforming payer data exchange and prior authorization decision turnaround time.

During a recent HL7 Da Vinci Virtual event “Strategy to Execution: Better Prior Authorization by Integrating Operations, FHIR and CMS-0057”, members of the 1upHealth team shared our approach to electronic Prior Authorization (ePA).

Led by 1upHealth’s Chief Strategy Officer Don Rucker and Senior Product Manager Jeremy Yoon, we showcased how 1upHealth’s FHIR-native, cloud-powered platform is poised to revolutionize ePA. Watch the video or read on to learn more.

“Our brains are exploding”

Reflecting on the Da Vinci event, Don said, “This has been a wonderful event… Our brains are exploding with all of the nuance and things we’ve learned here.”

And he was right. The Da Vinci ePA Virtual Event brought together some of the sharpest minds in health IT and interoperability – all focused on unpacking regulatory changes, payer-provider dynamics, and the real-world challenges of streamlining prior authorization.

The foundation: A FHIR‑native, cloud‑powered platform

At the heart of 1up Prior Authorization is our core platform – a powerful blend of cloud infrastructure and native FHIR capabilities. The 1up Platform is:

• Built for modern computation.
• Designed to power the CMS-0057 APIs for payer-to-patient, payer-to-provider, and payer-to-payer data sharing.
• Powering a fully electronic prior authorization process that reduces manual touchpoints and speeds up decision-making.

Intelligent routing for maximum ePA adoption

One of the key takeaways from our session at the event is that Intelligent Routing is non-negotiable.
There’s no one-size-fits-all in 1up Prior Authorization. Each payer has its own playbook. Our routing engine intelligently adapts to each payer’s workflows, requirements, and capabilities, ensuring the request gets to the right place, the first time.

It’s not just about automating prior authorization, it’s about removing real-world complexity and supporting the scale needed today and well into the future.

Built for today’s – and tomorrow’s – regulatory landscape

1up Prior Authorization is built to help organizations meet and exceed CMS-0057 regulatory requirements. Our solution:

• Supports CMS-0057 APIs out of the box.
• Streamlines payer-provider data exchange using open standards.
• Delivers faster, more accurate authorization decisions aligned with policy mandates.

1up Prior Authorization offers:

1. A Flexible Platform that supports a variety of data exchange use cases – from prior authorization to quality measures to population health analytics.
2. A Cloud-First Design that is built for enterprise health workloads.
3. An Intelligent Routing Engine that dynamically directs requests to the most efficient electronic pathways.
4. Regulatory Compliance designed to keep payers and providers ahead of CMS mandates and industry expectations.

Smarter ePA starts now

The energy coming out of the Da Vinci ePA Virtual Event was electric – and for good reason. We’re not just responding to federal and state regulations. We’re seizing this moment to revolutionize a highly manual and costly process with the important goals of improving patient outcomes, patient and provider experience, and driving cost out in the process.

Prior authorization has long been a pain point, but with 1up Prior Authorization we’re turning complexity into clarity, and delays into decisions.

To learn more about 1up Prior authorization, contact us today.