Member education

As part of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), payers must provide plain language resources to members at specific points of contact. 1upHealth provides template content for these resources which can be used as material on your website or in member communications. Engage the appropriate members of your organization for feedback, approval, and guidance on where these resources should be published.

The plain language resources must outline the following information:

  • The benefits of Payer-to-payer API data exchange.

  • The member's right to opt-in or withdraw consent.

  • How members can take action. A guide on how to opt-in or opt-out satisfies this requirement.

The above resources must be available to members:

  • when requesting member permission.

  • annually through regular beneficiary communications.

  • in an easily accessible location on the payer's public website.

Member opt-in process

1upHealth can integrate with your Identity Provider (IdP) so that members can begin the opt-in process signed in from your member portal. Once a member clicks on the link to opt-in, their Single Sign On (SSO) information is used to verify their identity for 1up so they don't need to login or create a second account to opt-in.

Members are redirected to 1up's opt-in site where they go through the following process:

  1. Review educational materials.

  2. Choose to opt-in. If they choose to opt-out then the process ends here and the user can navigate back to their payer portal.

  3. Search for and select previous health plans to request data from. Members can also manually enter a plan if they don't see it in the list.

  4. Authenticate their identity for the previous health plan using their previous member ID and the year their coverage with that plan ended.