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.
