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Easily and cost-effectively share member data with your trusted provider partners.
The current challenges of sharing member data
Your value-based care partners need a holistic view of their patients to improve the quality of care, reduce waste, and decrease costs. Giving providers access to your rich member data, including claims history, is essential to their success.
Unfortunately, today, sharing member data with your in-network providers is time-consuming, inefficient, and costly—often relying on manual processes that do not scale and impede data exchange, like sharing flat files. These processes can potentially result in a five-month lag between the data shared and when the provider can take action on that data.
Efficiently & automatically share member data with in-network providers
Designed to meet CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requirements and leveraging industry standards, the 1up Provider Access API eliminates these manual processes, making it easy and cost-effective for you to share data with providers.
Our FHIR®-based API enables authorized healthcare providers to securely access your member clinical, claims, encounter, and prior authorization data. This automated process ensures providers get timely information, thus improving their quality measure performance and ultimately saving you money.
With the 1up Provider Access API, you can:
Meet Regulatory Requirements
Adhere to CMS-0057-F compliance requirements for Provider Access API
Streamline Processes
Eliminate manual processes and reduce administrative burden related to sharing data with providers
Realize Cost Savings
Reduce unnecessary tests and procedures
Provide Better Member Care
Streamline care coordination with in-network providers
Be a Better Risk-based Partner
Empower your provider partners to improve quality measure performance with timely data
How 1up Provider Access Works
- Send your member data to the 1up FHIR platform. It will be converted to FHIR format and exposed via the Provider Access API.
- Provide 1up with member attribution information for in-network providers and member data sharing opt-outs on a recurring basis.
- In-network providers register on the 1up FHIR Platform. They are granted scoped permissions to read-only APIs to access the clinical, claims, encounter, and prior authorization data of attributed members who have not opted out.
- Providers use the credentials they receive upon registration to obtain an OAuth 2.0 access token. They can then make regular FHIR API calls to retrieve member data from the 1up FHIR platform.
- Based on the provider relationship, you can filter out any cost information shared via the Provider Access API.
Why 1up Provider Access
Secure
Accessible only to authorized users with valid access tokens and proper scope of permissions.
Standardized
Adheres to the FHIR R4 standard for Bulk Export and individual FHIR resource APIs.
Configurable
Excludes cost sharing and remittance dollar amounts based on the provider relationship.
