CMS Requirements

1upHealth enables Health Plans to meet the CMS requirements slated for 2021 and beyond. Effective July 1, 2021, these requirements include:

• Patient Access API - requires claims, encounter, clinical & formulary data to be accessible via HL7 FHIR® (Release 4.0.1) API endpoints for a patient to share to a third party app of their choice.

• Provider Directory API - Health plans must make available a FHIR® API based list of providers that are in-network.

Implementation

Following a discovery phase, there will be 4 work streams operating in parallel for up to 12 weeks:

• FHIR Environment

• Member Authentication & Consent

• FHIR Data Ingestion & Management

• Training & Maintenance

Product Overview

Our product suite enables Health plans to choose one module or a fully integrated solution to cover all CMS requirements.

Architectural Overview

1upHealth converts healthcare data from C-CDA to FHIR®, which entails extracting the patient's health history from a large XML document into a highly organized RESTful API.

Our Payer Platform provides an API Gateway enabling connectivity to Member's app, third party apps and other data management capabilities.