Meet the CMS Regulations For Payer 2 Payer APIs
Payer to Payer Data Exchange
CMS requires health plans to enable payer to payer data exchange for their former members with up to 5 years of historical data. 1upHealth supports both the ability to comply to the regulations and leverage the newly available clinical data from other health plans. Use 1up to meet the regs, request data from other payers, and ingest it in the computable FHIR standard.
Features
A Complete Payer to Payer Data Exchange Solution
With over 40 health plans using 1upHealth to meet the CMS Payer to Payer Mandate and years of work connecting to health systems, 1upHealth brings experience to not only comply with the regulations, but also ensure your plan and members get the most from the new data interoperability interfaces from other plans.
Meet the CMS Regulations for all the Payer to Payer API and Data Exchange requirements
- Leverage an existing network built and maintained and tested by 1upHealth
- Present members with a pre-built, fully connected, and white-labeled user interface
- Work with disparate data sources that are presented to you as FHIR regarless of soure data formats
- Dont limit connections to Clinical data from payers only. Connect to providers and claims data from other plans
Comply
Meet the regs to Send and Receive clinical data with other payers
Our solution provides a method to send data to other payers via FHIR APIs and receive FHIR and non FHIR data from external health plans. For health plans using us just to meet compliance we have you covered.
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Send data to external health plans
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Receive data from external health plans
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Maintaine data for future sharing with subsequent plans
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Meet the CMS Regulations for Payer to Payer Data Exchange
Leverage
Connect to external health plans to Request and Ingest Clinical & Claims
1up integrates with hundreds of other health plans (clinical and claims data) and thousands of provider organizations (clinical data). We have both the directory and keys to get that data to our customers.
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Connect to 1000s of external FHIR endpoints
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Match your members to request external data
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Ingest it into the FHIR data store
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Use it in a format that can support pop health analytics
Connect APIs to Access both Payers & Providers
On January 1, 2022 hundreds of other health plans are required to enable payer to payer data exchange APIs which 1up will be connected to. This will enable your member to onboard with years of clinical history from those payers.
In additional to the clinical data, 1up is already live with patient access APIs for both claims and clinical data from payers which were published in July 2021.
On top of that, we are connected to 1000s of provider clinical systems.
This means that your members have many more options to share connected health systems spanning clinical data from the EHR to claims and pricing data from their current and former health plans.
Fully Integrated Health History App Interface
1upHealth offers a complete managed solution with user interfaces to help your members share data from other health plans and providers. You don't need any complicated technical development or deployments.
With 1upHealth's Health History App, you can customize & white label the url path, logo, content, & footer sections as needed to meet your branding and policy requirements. Integrated search and connectivity lets you get started by building on the rails that 1up has painstakingly built over many years.
Once members share data, data is instantly available to you via FHIR APIs.
Use cases
Streamlined Member Onboarding
Request prior health pland data from members while onboarding to improve member experience and risk management
Network and Pricing Intelligence
Data from members clinical and claims records have much more than just their own data. It contains networks, pricing, and performance measures as well
Gaps in Care and VBC Incentives
Holistic data from external health systems can be analyzed and interrogated to reduce cost and improve quality for your members' care.
Contact 1upHealth to get started
