Unlock historical member data with FHIR®-powered data exchange.
Benefits
Too often, new members arrive with little historical context. With 1up Payer-to-Payer Data Exchange, you don’t have to start blind. Member data is automatically retrieved from previous or concurrent payers, validated, and unified – so onboarding starts with real insights, not assumptions.
Built for scale, flexibility, and CMS-0057-F compliance, 1up supports the full payer-to-payer data exchange workflow. Everything is handled in one place – from member consent and managed payer connectivity to unified member profiles, real-time activation, and usage reporting. As a result, your teams can act sooner and with more confidence.
Gives your care teams immediate visibility into member history, utilization, and potential care gaps from day one.
Enables smoother enrollment and quicker program placement by reducing delays caused by missing information and manual follow-ups.
Powers more personalized member outreach and timely, relevant interactions by activating member data across member services and engagement workflows.
Improves risk accuracy, quality performance, and decision-making with access to more complete member information.
See how 1up unifies historical data into a single, longitudinal member record for smoother onboarding and better member experiences, featuring a demo.
Compliance
Provides everything you need to meet CMS-0057-F payer-to-payer data exchange requirements.
FHIR-based APIs with secure OAuth2 authorization for bi-directional data exchange between payers, supporting the five-year lookback period requirement.
Flexible opt-in workflows, including 1up-hosted and payer-hosted experiences, to capture, track, and audit member consent across lines of business.
Deterministic, FHIR-based member matching that accurately identifies members across payers to ensure clean, reliable data exchange.
Customizable, policy-based controls to exclude cost, remittance, sensitive, and/or non-required data from payer-to-payer sharing.
Compliance
1up Payer-to-Payer Data Exchange goes beyond meeting requirements to enable faster onboarding, stronger data continuity, and more data-driven risk decisions.
Lower integration costs
Payer-to-Payer Network
Payer-to-Payer Network
Simplifies connectivity to prior and concurrent payers with an expansive one-to-many payer network.
Reduced operational burden
Payer Registration & Onboarding
Payer Registration & Onboarding
Enables requesting payers to onboard and obtain OAuth2 credentials via a secure, self-service portal and 1up vetting process.
Better insights
Longitudinal Member Profile
Longitudinal Member Profile
Unifies prior-payer data with existing member information, creating a single, unified profile with source metadata.
Better member experiences
Real-Time Event Streams
Real-Time Event Streams
Integrates with care management, risk, quality, and member services systems to deliver acquired data directly into existing workflows.
Operational transparency
Payer-to-Payer Usage Reporting
Payer-to-Payer Usage Reporting
Provides visibility into inbound and outbound data exchange activity through pre-built dashboards and exportable reports.
Lower implementation risk
Modular Deployment
Modular Deployment
Enables modular adoption of 1up’s network and consent services while continuing to store and manage data on existing systems.
A single, automated workflow for securely receiving and sharing member data between prior and concurrent payers.
Members provide consent and identify prior or concurrent health plans during enrollment or outreach.
1up sends or receives compliant payer-to-payer data requests on your behalf using standard FHIR APIs.
Verified payers securely share approved member data through the 1up Payer-to-Payer network, excluding cost and remittance information.
Incoming data is validated, tagged with its source, and unified into a longitudinal member profile.
Unified data is immediately available across downstream systems, with complete visibility into activity through the 1up Console.
1up supports flexible opt-in workflows, including payer-hosted or a configurable 1up-hosted consent experience. Consent status is tracked, logged, and auditable, with full visibility in the 1up Console. Once consent is captured, 1up automatically initiates payer-to-payer requests and manages retrieval end-to-end.
1up uses deterministic matching based on member identifiers and the FHIR $member-match operation to accurately identify members across plans. The platform validates matches before retrieval and is designed to support enhanced identity management capabilities as matching needs evolve.
Members can choose from over 500 U.S. health plan brands across Medicare, Medicaid, and commercial plans, including national, regional, and Blues. If a plan isn’t listed, members can enter it manually, and 1upHealth will update the directory as needed.
Yes. 1up is modular, so you can use network connectivity, consent management, or data retrieval while continuing to store and manage data in your own systems, on-premise or in the cloud.
Retrieved data is validated, normalized, and unified into a single longitudinal member record. Plans can access the data through FHIR APIs, bulk exports, dashboards, or downstream integrations that support care management, quality programs, analytics, and member engagement. This data is also made available via other CMS-0057-F Access APIs, including Patient Access APIs and Provider Access APIs.
No. After providing consent, members take no further action. 1up manages data requests, retries, validation, provenance tracking, and downstream availability automatically, with operational visibility provided through the 1up Console.
Stop starting from zero. Unlock member insights earlier. Activate data on Day 1 for care management, risk adjustment, and quality initiatives. Stay ahead of CMS-0057-F requirements with 1up Payer-to-Payer Data Exchange.
