If you’ve spent any time in utilization management (UM), you know the drill: a request comes in, someone has to figure out which system it belongs to, route it there manually, wait, follow up, and hope nothing falls through the cracks. Multiply that across multiple UM vendors and lines of business and it’s no wonder prior authorization has become one of the biggest sources of friction in healthcare.
We built 1up Electronic Prior Authorization to fix that, not with another one-off integration, but with a network. We’ve stood up the APIs and workflows, and we’re actively adding UM vendors to the 1up Network as we operationalize and scale the solution. Today, I’m excited to share that we’ve now established connectivity with several major UM vendors, including Evolent and MHK. And we’re not stopping there.
We’ve set a goal of over 30 UM vendors on the 1up Network by the end of the year. Every vendor we add doesn’t just create one new connection. It creates a connection every health plan on our platform can use. Build once, connect to everyone. This is what will ensure rapid implementation of 1up Prior Authorization for our current customers, along with future customers who entrust us with digitizing their prior authorization processes.
Read on to learn more about our approach and why this matters.
The Prior Authorization Routing Problem
Here’s the thing about prior authorization at scale: it’s rarely just one system. Health plans often work with multiple UM vendors depending on the line of business, service type, or delegation arrangement. That means every incoming request needs to land in the right place – and figuring out where that is has traditionally required manual triage, phone calls, or clunky portal logins.
That’s where 1upHealth comes in. Our 1up Platform now sits at the center of that flow as an intelligent routing engine. When a request comes in, 1upHealth automatically routes it to the correct UM system for review, using configurable rules that support even complex, multi-UM environments, and returns the decision once it’s available. No manual sorting. No guesswork. Just requests going where they need to go, automatically.
With connectivity now established across Evolent, MHK and other UM vendors, this isn’t a future promise. It’s live infrastructure that’s already reducing friction for the plans and providers using it. And because these connections are already in place, new 1up customer integrations become significantly more plug-and-play, cutting down implementation time and technical lift for health plans looking to launch ePA with any of these vendors.
Why We’re Building a Network, Not Just an Integration
Most connectivity in healthcare gets built the hard way: one payer, one vendor, one custom integration at a time. It works, but it doesn’t scale, and every new health plan starts back at square one.
The 1up Network flips that model. Instead of point-to-point connections that live and die with a single relationship, every UM vendor we connect with becomes a shared, reusable piece of infrastructure, available to any health plan on the platform on day one. The more vendors that join, the more valuable the network becomes for every customer already on it, and the faster the next customer can get up and running. That compounding effect of the network is the real differentiator here.
1up Electronic Prior Authorization Scales With You
Our routing engine is modular and vendor-agnostic by design, built to grow alongside your UM ecosystem and not force you into a single-vendor box. Real-time event streams keep prior authorization data flowing to the downstream systems that need it, so care coordination doesn’t stall out at the handoff.
Connectivity with Evolent, MHK, and others are just examples of an expanding 1up Network, with additional vendor milestones on the roadmap. As the network grows, so does the value for every health plan on it. That’s the part we’re most excited to keep building. If you’re navigating a multi-UM environment and want to see how 1up’s routing engine can simplify things on your end, we’d love to talk. Contact us today.
