1up Prior Authorization API

Streamline prior authorization with a centralized hub for prior authorization requests

Prior Authorization API

The current challenges 

Your utilization management team needs an automated and standardized approach to handle prior authorizations with in-network providers. Automating this process can lead to operational efficiencies, reduced provider burden, and improved patient care.

However, prior authorization today relies on disparate, manual intake channels, which puts a heavy burden on providers and often lacks the necessary supporting clinical documentation. This results in a greater administrative burden on your UM team, clinician burnout, and delayed or abandoned treatment for patients.

Automate prior authorization for in-network providers

Designed to meet CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requirements and leveraging industry standards, 1up’s Prior Authorization API automates the prior authorization process using a standard FHIR®-based API to connect in-network providers with your prior authorization rules and existing utilization management systems.

Our Prior Authorization solution enables provider partners to confirm whether prior authorization is necessary for a given service or procedure, discover specific prior authorization documentation requirements, and submit a prior authorization request with the required documentation to your utilization management team for review and receive a response.

With the 1up Prior Authorization API, you can:

Gavel Icon

Meet Regulatory Requirements

Adhere to CMS-0057-F compliance requirements for Prior Authorization

Stopwatch Icon

Streamline Processes

Shift from point-to-point connectivity with individual providers to centralized connectivity via 1upHealth

Document Icon

Realize Cost Savings

Eliminate manual processes and operational inefficiencies by limiting the number of denials or appeals and minimizing requests for additional documentation

Icon of a stethoscope and a heart

Reduce Provider Burden

Enable providers to submit prior authorization requests faster and easier and receive more timely decisions

Handshake Icon

Improve Member Outcomes

Improve the quality of care for members by permitting faster scheduling of necessary services or filing appeals, depending on the decision

How 1up Prior Authorization Works

Why 1up Prior Authorization


Streamlines connectivity between payers and providers, creating a centralized hub for prior authorization requests


Adheres to FHIR R4 and US Core standards for exchanging clinical data


Allows for easy integration with your rules engine and existing utilization management systems

These new requirements for the prior authorization process will reduce administrative burden on the healthcare workforce, empower clinicians to spend more time providing direct care to their patients, and prevent avoidable delays in care for patients.”
Centers for Medicare & Medicaid Services
Interoperability and Prior Authorization final rule

Ready to Learn More About Healthcare’s Modern Data Platform?