Transform prior authorization with real-time, FHIR®-powered automation.
Benefits
Your prior authorization process is painful, but it doesn’t have to be. With 1up Electronic Prior Authorization, you can replace manual processes and fragmented systems with an intelligent, FHIR-native workflow that works across EHRs, UM systems, and all lines of business.
Built for scale, adaptability, and regulatory confidence, 1up Electronic Prior Authorization simplifies how requests are submitted, reviewed, and returned—without disrupting the systems you already use.
Accelerates prior authorization by streamlining intake, instantly surfacing requirements, and quickly returning decisions.
Reduces Utilization Management (UM) workload by replacing labor-intensive intake channels (phone, fax) and follow-up with structured digital submissions and efficient review workflows.
Gives providers a clear, consistent, in-EHR process that simplifies submissions and minimizes administrative effort.
Ensures members receive timely care through faster reviews, fewer delays, and more predictability across service lines.
See how 1upHealth automates prior authorization, reduces provider friction, and helps your plan stay ahead of CMS-0057-F regulations, featuring a demo.
Compliance
Meet CMS-0057-F requirements with FHIR-based automation, without managing the technical complexity yourself.
FHIR-based CRD, DTR, and PAS APIs with secure OAuth2 authentication for automated, real-time prior authorization. Supports FHIR to X12 conversion.
Pre-built dashboards that track decision turnaround, approval patterns, and API usage to support CMS-mandated reporting.
Compliance
1up Electronic Prior Authorization does more than meet regulatory requirements. It enables automation, connectivity, and real-time intelligence across your ecosystem.
Faster decisions, fewer delaysÂ
Intelligent Routing Engine

Intelligent Routing Engine
Routes requests to the correct UM system automatically using configurable rules. Supports complex, multi-UM environments.
Fewer resubmissions, faster decisions
CRD Server
CRD Server
Surfaces coverage criteria directly in the EHR to prevent missing documentation and slowdowns.
Quicker adoption, cleaner intake
DTR Questionnaire
DTR Questionnaire
Provides a static FHIR questionnaire when UM vendors lack one, ensuring complete submissions.
reliable speed at scale
Optimized Performance
Optimized Performance
Delivers sub-five-second response times through a fast, scalable, enterprise-grade architecture.
Faster provider adoption
Provider Network
Provider Network
Allows providers to connect once via a one-to-many network, eliminating point-to-point payer integrations.
Simplified provider setup
Provider Registration 
& Onboarding
Provider Registration & Onboarding
Enables providers to onboard and obtain OAuth2 credentials without payer involvement via a secure, self-service portal.
Cleaner Cross-State Routing
BCBSA Interoperability Hub Connectivity
BCBSA Interoperability Hub Connectivity
Routes requests for Blues plans to the Association when home-and-host plans differ.
Faster outreach, better support
Real-Time Event Streams
Real-Time Event Streams
Provides a real-time stream of FHIR and non-FHIR events for status, analytics, and care management workflows.
An intelligent, real-time electronic prior authorization workflow built around provider EHR systems.
Provider initiates an order directly in their EHR. No new systems or workflow changes required.
The 1up API checks whether prior authorization is required based on payer rules.
If required, coverage details and questionnaires are returned to the EHR.
Providers complete documentation and submit the request electronically.
1up routes the request to the correct UM system and returns updates as they occur.
The provider’s EHR displays the status and final decision, along with reason codes.
1up sits between EHRs and UM systems, acting as a secure routing and orchestration layer. We use OAuth2, SMART on FHIR, and mTLS to connect with EHRs, while supporting FHIR APIs and custom mappings for UM systems.
Yes. 1up’s modular design supports selective adoption of CRD, DTR, or PAS and integrates with your current systems.
No. Providers self-register via the 1up Developer Portal and can begin testing immediately, reducing your onboarding burden.
1up supports asynchronous workflows using FHIR Subscriptions in PAS, delivering decisions automatically when available.
Routing and prior authorization rules are submitted as structured spreadsheets, ingested into the 1up Electronic Prior Authorization Metastore, and applied in real time.
We capture all CMS-mandated metrics – approval/denial rates, time-to-decision, appeals outcomes – and present them in dashboards and exports for public reporting.
Accelerate decisions. Reduce burden. Improve provider and member experience.
Stay ahead of CMS-0057-F with 1up Electronic Prior Authorization.
