CMS Rule for Health Plans - CPCDS to FHIR



1upHealth’s FHIR API Platform is the first true implementation of the ONC’s intent for healthcare interoperability.
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1upHealth solution for CPCDS CARIN Blue Button 2.0 (CARIN BB) to FHIR Transformation


1up has pre-built FHIR data adapters including those based on the CARIN Alliance Payer FHIR Profile which offers consensus-based mappings of claims data to FHIR. We can help you transform your existing clinical and claims information (X12 EDI, proprietary formats, etc.) to FHIR Release 4.0.1 (R4), including support for the required discrete data elements (called FHIR resources) such as ExplanationOfBenefit (claims), Coverage, Patient (demographic information), Encounters, etc.


Supported CPCDS CARIN BB Profiles

Payers are required to make a patient’s claims and encounter data available via the Patient Access API. To facilitate this, we support ingesting CSVs based on the CARIN Alliance Blue Button® Framework and Common Payer Consumer Data Set (CPCDS) IG (Currently in Development).

  • Coverage CSV to FHIR
  • EOB Inpatient Facility to FHIR
  • EOB Outpatient Facility to FHIR
  • EOB Professional Non Physician to FHIR
  • EOB Pharmacy
  • Patient to FHIR
  • Practitioner to FHIR
  • PractitionerRole to FHIR
  • Organization to FHIR
  • Location to FHIR
For each profile we can assist in the mapping from proprietary format (e.g., database extracts, direct JDBC/ODBC connection to source systems) to FHIR, or ingest via CSVs based on the CARIN BB IG.


Why 1upHealth


1upHealth is well positioned to support health plans in meeting the CMS requirements for the July 2021 deadline.

Direct Payer Experience

We have direct experience through our work with as one of the first approved Blue Button 2.0 apps, with health plans supporting millions of health plan members and the Da Vinci Project through workgroups and connectathons.

Extensive Clinical Data Network

We've worked with 100s of health systems across the US in meeting Meaningful Use 3 (MU3) requirements. We’ve now connected to 10,000+ hospital and health centers, allowing patients to authorize access to their EHR medical records with 3rd party applications.

We are FHIR Experts

Our team is comprised of leading FHIR experts who have presented alongside CMS and ONC leaders like Don Rucker, had led HL7 standard balloting, and participate in numerous FHIR connectathons

Proven Platform for Regulation

Because our award-winning FHIR solution is already in production, we can ensure timely deployment and meeting the requirements of the new rules.