New Product Streamlines Prior Authorization to Improve Patient, Provider, and Payer Outcomes
BOSTON, MA / ACCESS Newswire / May 29, 2025 / 1upHealth, a leader in health data interoperability, today announced the launch of its 1up Prior Authorization solution. The solution is designed to ensure compliance with the CMS Interoperability and Prior Authorization final rule (CMS-0057) while delivering measurable ROI through reduced provider burden and lower administrative costs for payers. To accelerate adoption of electronic Prior Authorization (ePA), 1upHealth is also building strategic partnerships with Utilization Management (UM) and Prior Authorization (PA) policy vendors. These partnerships aim to simplify integration and speed up deployment for payer customers.
While PA programs are intended to manage costs, current processes are largely manual and create significant burdens across the healthcare system. For providers, this burden translates to less time spent on patient care; for payers, it drives up administrative costs and hinders member experience. According to the American Medical Association, 29% of physicians reported that PA led to serious adverse events for patients, and nearly 90% said it contributes to physician burnout. Separately, CAQH estimates that transitioning to ePA could save the industry at least $515M annually.
The 1up Prior Authorization solution digitizes and streamlines the PA process for health plans by managing complex integrations and providing real-time visibility, flexibility, and control at every stage. Built in accordance with Da Vinci FHIR Implementation Guides, the tool enables connectivity with all major EHRs, PA policy vendors, and utilization management systems. By simplifying prior authorization workflows, 1upHealth’s solution not only ensures regulatory compliance but also delivers measurable improvements for patients, providers, and payers.
“The CMS final rule not only set the stage for healthcare’s long overdue digital transformation, but it provided the kindling needed to solve one of the industry’s biggest pain points: prior authorization,” said Andrew Boyd, CEO of 1upHealth. “With 1upHealth’s latest releases, we’re taking away the complexity of the PA process while going beyond compliance to drive critical outcomes such as: reduced administrative costs and improved efficiency for payers; broader adoption and reduced burden for providers; and, most importantly, improved outcomes and higher satisfaction for patients.”
1upHealth is also building its ecosystem of PA partners, offering a comprehensive end-to-end ePA solution that integrates into a health plan’s existing technology stack. The 1up Prior Authorization solution connects to all industry EHRs, PA policy vendors, and UM vendors. Today, 1upHealth is integrated with EHR vendors Epic and Meditech; UM transformation provider Cohere Health; and prior authorization systems vendor Itiliti Health. Additional technology partners are actively testing and growing the ecosystem.
“Healthcare’s longstanding interoperability issues have made it frustratingly difficult to solve even the most basic challenges, such as ensuring patients receive the right care at the right time,” said Mohammad Jouni, Chief Product and Technology Officer of 1upHealth. “1upHealth is changing that by making it dramatically easier to access and integrate health data. This unlocks critical use cases like electronic prior authorization that not only improve clinical outcomes, but also streamline operations and eliminate the inefficiencies the industry has long accepted as inevitable. This is the foundational infrastructure healthcare has always needed but too often overlooked, and I’m proud that 1upHealth is leading the charge.”
1upHealth will host a webinar on June 4, titled “ePA in Action: Live Demo + Roadmap to CMS-0057 Compliance” to cover the ePA requirements and introduce its new solution. To learn more and register, visit this page.
About 1upHealth
Driven by a purpose of better healthcare for all through better data, 1upHealth is the national leader in health data interoperability and one of the fastest-growing health IT companies in the United States. Our modern data platform is built on a standards-based cloud architecture specifically designed for the healthcare industry, making it easy to acquire, manage, share, and compute data. From leading health plans and state Medicaid agencies to innovative digital health organizations and top-performing ACOs, over 90 health organizations rely on 1upHealth to seamlessly exchange data across the healthcare ecosystem to reduce risk, lower costs, and improve patient outcomes.
Media Contact
Elizabeth Grich
Aria Marketing for 1upHealth
egrich@ariamarketing.com
SOURCE: 1upHealth
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