{"templateId":"markdown","sharedDataIds":{"sidebar":"sidebar-sidebars.yaml"},"props":{"metadata":{"markdoc":{"tagList":["admonition"]},"type":"markdown"},"seo":{"title":"1up Payer-to-Payer","llmstxt":{"hide":false,"sections":[{"title":"Table of contents","includeFiles":["**/*"],"excludeFiles":[]}],"excludeFiles":[]}},"dynamicMarkdocComponents":[],"compilationErrors":[],"ast":{"$$mdtype":"Tag","name":"article","attributes":{},"children":[{"$$mdtype":"Tag","name":"Heading","attributes":{"level":1,"id":"1up-payer-to-payer","__idx":0},"children":["1up Payer-to-Payer"]},{"$$mdtype":"Tag","name":"Heading","attributes":{"level":2,"id":"overview-for-payers-partnered-with-1uphealth","__idx":1},"children":["Overview for payers partnered with 1upHealth"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Designed to meet CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requirements and leveraging industry standards, the 1up Payer-to-Payer Data Exchange API lets you easily and securely exchange member data with other payers in a standardized format—eliminating manual processes and administrative costs."]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Our FHIR®-based API allows you to share and receive health data with other payers for new and previous members who have opted into data sharing, excluding cost-sharing and remittance dollar amounts. Incorporating data from other payers gives you a complete view of your member base and supports more informed and efficient decision-making."]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Payers that are partnered with 1upHealth can use the templates provided under Member education to satisfy CMS's requirement for payers to provide plain language resources to members."]},{"$$mdtype":"Tag","name":"Heading","attributes":{"level":2,"id":"overview-for-external-payers","__idx":2},"children":["Overview for external payers"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["As a health plan who is not a 1up customer, you can make requests to 1up's Payer to Payer APIs to export data for members that have switched to your coverage, or have concurrent coverage with you."]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Payer organizations can query 1upHealth to receive member data from our partnered payer organizations. Payers must register on the ",{"$$mdtype":"Tag","name":"MarkdownLink","attributes":{"href":"https://developer.console.1up.health/1up-dev-portal"},"children":["1up Dev Portal"]}," and complete the identity verification process to query production data, but payers can perform test queries using a sandbox client before receiving access to production."]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["See ",{"$$mdtype":"Tag","name":"MarkdownLink","attributes":{"href":"/docs/payer-to-payer/payer-network"},"children":["Payer network"]}," for a list of our partnered payer organizations."]},{"$$mdtype":"Tag","name":"Heading","attributes":{"level":3,"id":"quick-start-member-match-and-bulk-export-with-a-sandbox-client","__idx":3},"children":["Quick-start ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["$member-match"]}," and bulk ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["$export"]}," with a sandbox client"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["You can test the process for creating a client, setting up access with client credentials and an authorization token, and requesting patient data with a sandbox client. The sandbox ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["tenant"]}," for this process is ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["bison"]},"."]},{"$$mdtype":"Tag","name":"ol","attributes":{},"children":[{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Access the ",{"$$mdtype":"Tag","name":"MarkdownLink","attributes":{"href":"https://developer.console.1up.health/1up-dev-portal"},"children":["1up Dev Portal"]}," login page."]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Register for the 1up Dev Portal, complete email verification, and login."]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Click Create a Client."]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Select Payer claims data (CMS Payer-to-payer access)."]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Enter a Client Name and click Create."]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Copy your new client ID and client secret from the clients table."]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Request an authorization token by pasting the following code into a terminal. Use the copied ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["client_id"]}," and ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["client_secret"]}," for this request."]},{"$$mdtype":"Tag","name":"CodeBlock","attributes":{"data-language":"curl","header":{"controls":{"copy":{}}},"source":"curl -i -X POST \\\n    https://gateway.1up.health/auth/realms/dev-portal/protocol/openid-connect/token \\\n    -H 'Content-Type: application/x-www-form-urlencoded' \\\n    -d 'client_id={your-id-here}' \\\n    -d 'client_secret={your-secret-here}' \\\n    -d grant_type=client_credentials \\\n    -d 'scope=member-match|read'\n","lang":"curl"},"children":[]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Copy the ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["access_token"]}," from the successful response. You will use this token for subsequent requests."]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Send a request for a specific member's data from a specific payer using the below request. The values listed in the request below are required, but additional data may be provided in the request."]},{"$$mdtype":"Tag","name":"Admonition","attributes":{"type":"info","name":"Required fields"},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Member match requests must contain exactly one each of the memberPatient, CoverageToMatch, and Consent parameters. The CoverageToLink parameter is optional."]}]},{"$$mdtype":"Tag","name":"CodeBlock","attributes":{"data-language":"curl","header":{"controls":{"copy":{}}},"source":"curl --location 'https://gateway.1up.health/v1/bison/member-match-sandbox/$member-match' \\\n--header 'Content-Type: application/json' \\\n--header 'Authorization: Bearer {access_token}' \\\n--data '{\n\"resourceType\": \"Parameters\",\n\"id\": \"member-match-in\",\n\"parameter\": [\n    {\n    \"name\": \"MemberPatient\",\n        \"resource\": {\n        \"name\": [\n            {\n                \"given\": [\"Jay\"],\n                \"family\": \"Young\"\n            }\n            ],\n        \"birthDate\": \"2001-03-11\"\n        }\n    },\n{\n    \"name\" : \"CoverageToMatch\",\n    \"resource\" : {\n        \"identifier\" : [\n        {\n            \"value\" : \"17148123-47da-43a0-8401-8d5d1368db02\"\n        }\n        ]\n    }\n    }\n    ,\n    {\n    \"name\": \"Consent\",\n    \"resource\": {\n        \"resourceType\": \"Consent\",\n        \"id\": \"consent123\",\n        \"status\": \"active\",\n        \"policy\": [\n    {\n    \"uri\": \"http://hl7.org/fhir/us/davinci-hrex/StructureDefinition-hrex-consent.html#regular\"\n    }\n],\n\"provision\": {\n    \"type\": \"permit\",\n    \"period\": {\n    \"start\": \"2022-01-01\",\n    \"end\": \"2035-01-31\"\n    }\n}\n    }\n    }\n]\n}\n","lang":"curl"},"children":[]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Copy the groupId value from the successful response."]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Send a request to bulk export the member's data using the groupId value."]},{"$$mdtype":"Tag","name":"CodeBlock","attributes":{"data-language":"curl","header":{"controls":{"copy":{}}},"source":"curl --location 'https://gateway.1up.health/v1/bison/bulk-data/r4/Group/{groupId}/$export' \\\n--header 'Authorization: Bearer {access_token}'\n","lang":"curl"},"children":[]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Copy the job ID from the end of the text value in the successful response. The job ID from the example below is the number ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["44bb133a-2033-4ba1-a29d-f50abb99e538"]},"."]},{"$$mdtype":"Tag","name":"CodeBlock","attributes":{"data-language":"json","header":{"controls":{"copy":{}}},"source":"{\n    \"resourceType\": \"OperationOutcome\",\n    \"id\": \"j7dl66lqv6\",\n    \"issue\": [\n        {\n            \"severity\": \"information\",\n            \"code\": \"informational\",\n            \"details\": {\n                \"text\": \"Asynchronous export running. Track job at https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/job/44bb133a-2033-4ba1-a29d-f50abb99e538\"\n            }\n        }\n    ]\n}\n","lang":"json"},"children":[]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Send a request to check on the status of the bulk export and return the URLs necessary for receiving the member data."]},{"$$mdtype":"Tag","name":"CodeBlock","attributes":{"data-language":"curl","header":{"controls":{"copy":{}}},"source":"curl --location 'https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/job/{job-id}' \\\n--header 'Authorization: Bearer {access_token}'\n","lang":"curl"},"children":[]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Copy the url ending in .ndjson for one of the batches. From the example below, ",{"$$mdtype":"Tag","name":"code","attributes":{},"children":["https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/file/Specimen_2ae9a36c.ndjson"]}," is one of the URLs out of 6 batches."]},{"$$mdtype":"Tag","name":"CodeBlock","attributes":{"data-language":"json","header":{"controls":{"copy":{}}},"source":"{\n    \"id\": \"44bb133a-2033-4ba1-a29d-f50abb99e538\",\n    \"transactionTime\": \"2026-01-05T16:08:38.956Z\",\n    \"request\": \"https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/Group/cmk1cuald0005l701sdo7gs8c/$export\",\n    \"requiresAccessToken\": true,\n    \"status\": \"Successful\",\n    \"resourceCount\": 31,\n    \"batches\": {\n        \"running\": 0,\n        \"complete\": 6,\n        \"failed\": 0,\n        \"total\": 6\n    },\n    \"lastUpdated\": \"2026-01-05T16:08:51.646Z\",\n    \"output\": [\n        {\n            \"type\": \"Specimen\",\n            \"url\": \"https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/file/Specimen_2ae9a36c.ndjson\"\n        },\n        {\n            \"type\": \"Coverage\",\n            \"url\": \"https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/file/Coverage_ff99b57c.ndjson\"\n        },\n        {\n            \"type\": \"Patient\",\n            \"url\": \"https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/file/Patient_797bccd4.ndjson\"\n        },\n        {\n            \"type\": \"ExplanationOfBenefit\",\n            \"url\": \"https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/file/ExplanationOfBenefit_f53222ae.ndjson\"\n        },\n        {\n            \"type\": \"Encounter\",\n            \"url\": \"https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/file/Encounter_edd3675f.ndjson\"\n        },\n        {\n            \"type\": \"Observation\",\n            \"url\": \"https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/file/Observation_ac712cd2.ndjson\"\n        }\n    ]\n}\n","lang":"json"},"children":[]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Send a request to receive the requested member data from one of the batches. The data is returned as Newline Delimited JSON (NDJSON)."]},{"$$mdtype":"Tag","name":"CodeBlock","attributes":{"data-language":"curl","header":{"controls":{"copy":{}}},"source":"curl --location 'https://gateway.1upcoredev.com/v1/bison/bulk-data/r4/$export/file/{url-ending-in-.ndjson}' \\\n--header 'Authorization: Bearer {access_token}'\n","lang":"curl"},"children":[]}]},{"$$mdtype":"Tag","name":"li","attributes":{},"children":[{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Send requests for each of the remaining batches."]}]}]}]},"headings":[{"value":"1up Payer-to-Payer","id":"1up-payer-to-payer","depth":1},{"value":"Overview for payers partnered with 1upHealth","id":"overview-for-payers-partnered-with-1uphealth","depth":2},{"value":"Overview for external payers","id":"overview-for-external-payers","depth":2},{"value":"Quick-start $member-match and bulk $export with a sandbox client","id":"quick-start-member-match-and-bulk-export-with-a-sandbox-client","depth":3}],"frontmatter":{"seo":{"title":"1up Payer-to-Payer"}},"lastModified":"2026-05-19T19:48:43.000Z","pagePropGetterError":{"message":"","name":""}},"slug":"/docs/payer-to-payer","userData":{"isAuthenticated":false,"teams":["anonymous"]},"isPublic":true}