Overview

Learn about the high level architecture of 1upHealth technology.

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
  • 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.

Provider Directory API

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.

1upHealth Payer Solutions

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.

Architectural Overview