1up Payer-to-Payer Data Exchange API

Easily and securely exchange member data with other payers in a standardized format.

The current challenges of acquiring historical data

As you acquire new members, you need to know as much as possible about their clinical, claims, encounter, and prior authorization history. Historical data can inform care management, ensure continuity of care, create more targeted member experiences, and support operational priorities like risk adjustment and quality measures.

But, acquiring historical data from other payers is challenging, fraught with inefficient, manual processes and inconsistent data formats—leading to high administrative costs for your team. Similarly, it can be just as arduous to share your member data with other payers with whom you share concurrent or prior members.

1up Health makes it easy to exchange data with other payers

Designed to meet CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requirements and leveraging industry standards, the 1up Payer-to-Payer Data Exchange API lets you easily and securely exchange member data with other payers in a standardized format—eliminating manual processes and administrative costs.

Our FHIR®-based API allows you to share and receive health data with other payers for new and previous members who have opted into data sharing, excluding cost-sharing and remittance dollar amounts. Incorporating data from other payers gives you a complete view of your member base and supports more informed and efficient decision-making.

With the 1up Payer-to-Payer Data Exchange API, you can:

Meet Regulatory Requirements

Adhere to CMS-0057-F compliance requirements for Payer-to-Payer Data Exchange

Streamline Processes

Eliminate manual processes and reduce administrative burden related to exchanging data with other payers

Provide Better Member Care

Make more informed decisions about member care management, ensure continuity of care, and identify care gaps for your members

Improve Risk Adjustment

More accurately assess risk levels of new and active members with access to historical clinical and claims data

Enhance Quality Measurement & Reporting

Improve performance against key quality measures via improved care coordination and targeted interventions based on historical member data

How 1up Payer-to-Payer Data Exchange Works

Why 1up Payer-to-Payer Data Exchange

Secure

Accessible only to qualified payers with valid credentials and proper scope of permissions

Standardized

Adheres to the FHIR R4 standard for bulk export and individual FHIR resource APIs

Expansive

Accelerates data exchange with participating payers in 1up’s expansive network

Comprehensive

Combines internal and external member data for a more holistic member view

Data exchange among payers, specifically, sending patient data from a patient’s previous payer to their new one, is a powerful way to ensure that data follow patients through the health care system and improve care continuity. Electronic data exchange between payers will support payer operations and a patient’s coverage transition to a new payer efficiently and accurately.”
Centers for Medicare & Medicaid Services
Interoperability and Prior Authorization final rule

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