What You Need to Know About 1upHealth’s Expanding Payer-to-Payer Network

Cristina Wyse
October 27, 2023

In my last blog, I covered the expansion of 1upHealth’s patient-mediated network, with a focus on the transfer of EHR data through clinical endpoints. But, 1upHealth’s network of endpoints is more than just clinical endpoints. In addition to the 7,000+ EHR endpoints available to 1up Patient Connect customers, we also have 150+ payer endpoints – specifically Patient Access and Payer-to-Payer endpoints – available. Access to these endpoints enables our payer customers to offer their members more control over their healthcare data from multiple streams. Now that you know we have payer endpoints available, let’s dive into more detail about Payer-to-Payer endpoints.

What are Payer-to-Payer endpoints and how do they work?

Payer-to-Payer endpoints are used to enable patients to transfer clinical, claims, encounter, and prior authorization data (beginning in 2026) from their previous insurer to a new insurer. The current Payer-to-Payer regulation, which was released by the Centers for Medicare and Medicaid Services (CMS) in 2020, was recently revamped in a proposed rule by CMS in December 2022 to create a more seamless experience for patients.

In the previous rule, the process required patients to authorize data sharing on a case-by-case basis. With the new regulations, patients opt in to transferring their data when they enroll with a new insurer, and it is then the new insurer who ultimately makes the data transfer request.

This likely means patients will no longer have to grant data access to insurers every time they change insurance providers. Instead, a more appropriate workflow will include the patient’s insurance company asking them to both opt in to the Payer-to-Payer data exchange process and to identify their previous insurers. Then, the new insurer will pull the patient’s data on their behalf from those identified as prior insurers. Per the updated regulation, payers receiving such requests must share clinical, claims, encounter, and prior authorization data.

What is the value of Payer-to-Payer Data Exchange for 1up customers and their members?

As a patient, the journey of accessing and moving data after switching insurance providers can be long and tedious. 1upHealth believes that when a patient changes insurers, the process of moving data between the two insurers should be seamless.

With 1upHealth’s Payer-to-Payer endpoints, the data transfer process becomes much easier for payers and their members. Once the patient grants approval through a configurable front-end application, clinical, claims, encounter, and prior authorization data begins to flow between the previous payer and the new payer, freeing the patient from the previous, tedious back and forth process. 1upHealth’s Payer-to-Payer APIs provide simple yet effective technical solutions, significantly decreasing the administrative time and stress our payer customers would otherwise experience.

What Payer-to-Payer Endpoints are Available to 1upHealth Customers Today?

1upHealth has over 150 payer endpoints and a handful of Payer-to-Payer endpoints available in our network now, but with the new regulations coming out in 2026, payers will likely revamp their technology to accommodate the requirements, adding more endpoints for 1upHealth to connect to.

We are continuously monitoring the industry to identify when payers make Payer-to-Payer endpoints available. These new endpoints are added to our network so that more payer customers and their members can enjoy the benefits of our expanding network.

1upHealth’s Network Effect

1upHealth closely follows changing industry requirements to ensure our customers have access to the most robust network of endpoints. With 1up Patient Connect, we aim to give patients the most visibility into, and control over, their health data. This not only helps patients, but also makes data exchange easier for payers, removing administrative burden and the cost of manual work. It also improves the members’ experience, creating a competitive advantage in the market.

If you are a payer looking to learn more about our Payer-to-Payer network, please contact us today.