1upHealth, Inc.

A meaningful shift for healthcare IT. The U.S. Department of Health and Human Services (HHS) is renaming ASTP/ONC back to the Office of the National Coordinator for Health IT, reinforcing a clear signal: interoperable data and modern infrastructure are foundational to a true digital healthcare economy. But structure alone is not enough. Progress depends on an API-first approach that removes friction created by legacy systems, misaligned incentives, and regulatory complexity. This next chapter creates real opportunity across the ONC portfolio, from enabling patient-facing apps and unlocking EHR access to CMS payer APIs, to advancing electronic prior authorization, Bulk FHIR, and a stronger, privacy-forward TEFCA. The direction is clear. Now it is time to accelerate and we are continuing this conversation in real time. 1upHealth’s Inside the Beltway, the video series where Dr. Donald Rucker breaks down what is really happening in healthcare regulation, is going live for the first time. Dr. Rucker, former National Coordinator for Health IT at HHS, played a key role in advancing interoperability policy under the 21st Century Cures Act and helped shape the broader federal framework that informs regulations like CMS-0057 and CMS-0053. On May 5 from 1 to 2pm ET, join us for Inside the Beltway LIVE to understand what the latest CMS mandates actually require, where payers are falling short, and what comes next. Save your spot: https://lnkd.in/eSPyqpKj Read more: https://lnkd.in/eWkzq6Rg

CMS is changing how Medicare Advantage provider networks are displayed and the impact is immediate. Under CMS-4208-F2, Provider Directory FHIR APIs will power Plan Finder, turning provider data into a consumer-facing enrollment driver. Plans that cannot meet new requirements risk having their networks suppressed during the Annual Enrollment Period. That means beneficiaries may not see your network when choosing coverage. This blog breaks down what is changing, the biggest gaps we are seeing, and how plans can prepare ahead of the October 2026 go-live. Read more: https://lnkd.in/eXpez336

The March 1upDate is here, and it is a must-read if you are navigating CMS requirements, interoperability, and what comes next. Here is why it matters: We delivered Patient Access API reporting two weeks ahead of the CMS-0057-F deadline. That means faster access to required metrics, less manual work, and a smoother path to submission. CMS-4208-F2 is raising the stakes for provider directories. Accuracy is no longer just compliance. It directly impacts how your plan shows up in Medicare Plan Finder and how members choose coverage. The industry is shifting fast. From Bulk FHIR unlocking population-level insights to new debates around clinical data access, the foundation of interoperability is being tested and strengthened in real time. We are also looking ahead. New capabilities to unlock clinical data directly from EHRs are on the horizon, helping payers turn raw data into real intelligence. The takeaway is simple. The plans that act now will be the ones that stay visible, compliant, and competitive. Read the full March 1upDate below.

The fax machine had a long run. But healthcare is moving on. Becker's Healthcare just covered CMS’s push to phase out fax and mail for claims attachments, marking a clear shift toward digital, standardized exchange. This is more than modernization. It is a necessary step to reduce administrative burden, improve data quality, and accelerate decision-making across the payer ecosystem. At 1upHealth, this is exactly the future we are building toward. Clean, structured, API-driven data exchange that replaces manual processes and fragmented workflows with infrastructure that actually scales. As CMS advances these requirements, the opportunity is clear. Payers that invest now in standards-based interoperability will move faster, operate more efficiently, and deliver better member outcomes. Read the Becker’s article: https://lnkd.in/eHW9RZTK Explore the CMS fact sheet on CMS-0053-F: https://lnkd.in/eb8tpZXW

Missed our webinar on Payer-to-Payer (P2P) Data Exchange? The on-demand session is now available. 🎬 During the session, 1upHealth CPTO Mohammad Jouni and our Product & Account teams break down CMS-0057 obligations and share how our Payer-to-Payer Data Exchange solution simplifies compliance, unifies prior-payer data into a single member record, and drives measurable ROI. ▶️ Watch the full webinar here: https://bit.ly/4nuZEA7 #interoperability #payertopayer #cms57f #healthtech

Dr. Donald Rucker, Chief Strategy Officer, was recently featured in a Healthcare IT News article exploring how Bulk FHIR is unlocking population health insights. In the piece, Dr. Rucker shares a key takeaway from his HIMSS26 session: “What Bulk FHIR does is move the power of FHIR to a population of patients.” That shift is critical. Bulk FHIR enables organizations to extract large, standardized datasets across entire populations and stream that data into analytics platforms, supporting population-level analysis and more effective value-based care strategies. It also lays the groundwork for AI by making more complete, longitudinal data accessible at scale. This is where interoperability moves beyond compliance and starts driving real impact across cost, quality, and outcomes. 🗞️ Read the full article: https://lnkd.in/er3nJ4qS

Happy first day of Spring! And with CMS-0057 deadlines right around the corner, there is no better time for a reset. For too long, healthcare data has been stuck in silos, buried in PDFs, or trapped behind closed systems. Interoperability changes that. It clears out the clutter and makes room for clean, standardized, FHIR-first and API-driven data exchange that actually works for payers and the members they serve. We make it easy to acquire, manage, and use healthcare data. Let us help you build the kind of infrastructure your organization and members deserve. 🌱

Big milestone for our customers and our team. Patient Access API usage reporting is now fully delivered across our entire customer base, two weeks ahead of the March 31 CMS-0057 deadline. That means every 1up customer has the data they need for compliance, without last-minute scrambling or gaps in reporting. This wasn’t just a feature rollout. It required close partnership with each customer to ensure they were fully set up, had access to their metrics, and knew exactly how to use them. Our teams provided hands-on support to remove blockers and make sure no one was left behind. At the same time, customers are continuing to adopt the 1up Console, where these insights are centralized and reporting becomes even easier to manage over time. Execution matters. Deadlines matter. And delivering ahead of both is what our customers can expect from us 🚀 Request a Demo: https://lnkd.in/engxRtKu

We’d like to do a little throwback and highlight who you’re asking to fix interoperability. From tiny tots to big problem solvers, this team now helps payers and partners tackle messy data, complex requirements, and the reality of making interoperability actually work for you. Same people. Bigger problems. Smarter solutions. If interoperability is on your roadmap, you’re in the right place. Featuring: Andrew Boyd, Lindsay Parker, Kevin Kowalczyk, Rob Bradley, Olivia Cleworth

We were proud to recognize Emily Manning, CTO of Hamaspik Medicare Plans, as a 1upHealth Interoperability Trailblazer at HIMSS26. Emily and the Hamaspik Choice team continue to demonstrate what real interoperability leadership looks like. Their commitment to modern, standards-based data exchange goes beyond compliance and helps move the industry toward a more connected and efficient healthcare system. We are grateful for the strong partnership with Hamaspik Choice and honored to work alongside leaders like Emily who are pushing interoperability forward.