1upHealth
1upHealth is a Boston-based healthcare data platform company that provides a FHIR-first interoperability platform for U.S. health plans, enabling CMS regulatory compliance and data exchange across Medicare, Medicaid, and commercial lines of business.
- Company typePrivate
- Founded2017
- HeadquartersBoston, United States
- Headcount101–250
- GTM typeB2B
- OfferingSoftware
What 1upHealth does
1upHealth is a Boston-based, privately held healthcare data platform company founded in 2017 that builds FHIR-first interoperability infrastructure for U.S. health plans operating across Medicare, Medicaid, and commercial lines of business. Its core offering, the 1up Platform, is a data lakehouse that ingests raw clinical, claims, and financial data, normalizes it within a unified longitudinal member record, and exposes it through FHIR R4 APIs. The platform supports six integrated sub-products — Electronic Prior Authorization, Payer-to-Payer Data Exchange, Provider Access, Patient Access, Provider Directory, and Formulary — that can be adopted independently and together address CMS-9115-F and CMS-0057-F regulatory requirements. Technical differentiation rests on a purpose-built lakehouse with proprietary identity resolution, deterministic member matching, FHIR-to-X12 conversion, and a one-to-many network covering over 500 U.S. health plan brands.
The company generates revenue through enterprise subscription agreements for the 1up Platform and its API products, with pricing tied to member volume and API usage, supplemented by professional services for implementation and ongoing customer success. Distribution is conducted exclusively via direct enterprise field sales to health plan executives and IT leadership, augmented by a structured channel partner program covering healthcare IT consultants, payer platform vendors, analytics firms, and government and public-sector organizations. Named customers include Aetna/CVS Health, Fallon Health, BlueCross BlueShield of Tennessee, Chinese Community Health Plan, Yamhill Community Care, and Advanced Health, with active engagement with the Blue Cross Blue Shield Association. KLAS Research named 1upHealth a Top Performer in its 2025 CMS Payer Interoperability Report, and the company holds SOC 2 Type II and HITRUST r2 certifications.
1upHealth was founded by Gajen Sunthara and is led by CEO Andrew Boyd, with a leadership team that includes former ONC National Coordinator Dr. Donald Rucker as Chief Strategy Officer. The company has raised approximately $75 million in cumulative venture funding across rounds from 2019 through a $40 million Series C led by Sixth Street Growth in April 2023. In May 2026 it became the first interoperability vendor to deploy all four CMS-0057-F APIs to all health plan customers, eight months ahead of the January 2027 regulatory deadline, and operates as a remote-first organization with headquarters in Boston, Massachusetts.
1upHealth firmographics
Firmographics- Name
- 1upHealth
- Legal name
- 1upHealth, Inc.
- Website
- https://1up.health
- Company type
- Private
- Founded year
- 2017
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- 1upHealth is a Boston-based healthcare data platform company that provides a FHIR-first interoperability platform for U.S. health plans, enabling CMS regulatory compliance and data exchange across Medicare, Medicaid, and commercial lines of business.
- Ownership category
- akta.pro rank
1upHealth industry classification
Industry- Product category
- Healthcare Data Interoperability Platform
- NAICS
- Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (51821)
- SIC
- Services-Prepackaged Software (7372), Services-Computer Programming, Data Processing, Etc. (7370)
- akta.pro primary industry
- FHIR/HL7 Data Repositories & Canonical Data Models (HLACAIAI)
- akta.pro secondary industries
- Interoperability Standards, Profiles & Implementation (HL7/FHIR/IHE) (HLACABAA), Real-World Data (RWD) Platforms & Clinical Data Curation (HLACAIAJ), Data Access, Sharing & Marketplace Platforms (incl. TEFCA/QHIN enablement) (HLACAIAL), Consent, Authorization & Data Sharing Governance (opt-in/opt-out, DS4P) (HLACABAG)
Keywords
Where 1upHealth is headquartered
LocationHeadquarters
- HQ city
- Boston
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
1upHealth business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Personnel, Technology or R&D, Marketing or Sales, Operations, Infrastructure
Revenue model
- Platform Subscription: Subscription-based access to the 1up Platform and its FHIR API products. Pricing likely based on member volume or API usage tiers. Enterprise agreements with dedicated implementation and customer success support.
- Professional Services: Implementation services including discovery, technical integration, testing, launch support, and ongoing customer success. Dedicated U.S.-based implementation managers and data engineers.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Annual | Enterprise Platform Subscription |
Go-to-market motion3 records
Distribution channels3 records
Marketing channels8 records
1upHealth product offering
Product offeringCore offering
1upHealth operates a FHIR-first healthcare data platform built on a data lakehouse architecture that ingests clinical, claims, and financial data, normalizes it within a unified model, and exposes it via FHIR R4 APIs and other formats for U.S. health plans. Its product suite includes the 1up Platform plus six integrated modules: Electronic Prior Authorization, Payer-to-Payer Data Exchange, Provider Access, Patient Access, Provider Directory, and Formulary, sold via enterprise subscriptions to Medicare, Medicaid, and commercial health plans for CMS regulatory compliance and interoperability.
Product overview
1upHealth offers a platform-plus-modules architecture centered on the 1up Platform, a FHIR-first data lakehouse built specifically for payer interoperability. The platform powers six integrated sub-products: 1up Electronic Prior Authorization (automates prior auth via FHIR APIs with intelligent routing), 1up Payer-to-Payer Data Exchange (bi-directional member data exchange between payers), 1up Provider Access (real-time data sharing with provider partners via EHRs and portals), 1up Patient Access (enables member-mediated data sharing with third-party apps), 1up Provider Directory (standards-based public API for in-network provider discovery), and 1up Formulary (public API for drug coverage and pricing information). All products run on the shared 1up Platform infrastructure and can be adopted independently or together.
Differentiator
Problem solved
Functional benefit
Products and services
- 1up Platform The core FHIR-first data platform built for payer interoperability, powered by a data lakehouse architecture that ingests clinical, claims, and financial data, normalizes it within a unified model, and delivers it in required formats via FHIR R4 APIs and other formats. Includes the 1up Console for payer team visibility and control and the 1up DevPortal for external payer, provider, and digital health developer access. Sold to U.S. health plans (Medicare, Medicaid, commercial) for CMS regulatory compliance and interoperability.
- 1up Electronic Prior Authorization FHIR-powered workflow that automates prior authorization decisions across EHRs, provider portals, UM systems, and all lines of business. Features intelligent routing, CRD server for coverage criteria surfacing, DTR questionnaire support, and sub-five-second response times, with FHIR to X12 conversion. Built for U.S. health plans to meet CMS-0057 electronic prior authorization requirements.
- 1up Payer-to-Payer Data Exchange FHIR-powered bi-directional data exchange between payers enabling automatic retrieval of member data from prior or concurrent payers. Supports five-year lookback period, member consent management, deterministic member matching, and longitudinal member profile unification. Covers over 500 U.S. health plan brands in the network.
- 1up Provider Access Enables secure FHIR-based sharing of clinical and claims data with provider partners through EHRs, existing portals, or a lightweight 1up-hosted interface. Manages attribution ingestion, member opt-out preferences, provider registration, and granular access controls with pre-built usage reporting for U.S. health plans.
- 1up Patient Access Enables members to securely access and share their health data with authorized third-party apps through FHIR-based APIs. Manages member authentication via IdP integration or secure email, third-party app onboarding, and patient-mediated consent, supporting clinical, claims, encounter, and prior authorization data for health plan compliance with CMS patient access requirements.
- 1up Provider Directory Centralized, CMS-compliant FHIR R4 directory for in-network provider data. Maps data per Da Vinci Plan Net Implementation Guide and publishes via public API, meeting CMS-9115-F and CMS-4208-F2 requirements including Medicare Plan Finder submission support for U.S. health plans.
- 1up Formulary Public CMS-compliant FHIR R4 API for drug coverage information. Maps formulary data per Da Vinci US Drug Formulary Implementation Guide, making covered medications, alternatives, tiers, restrictions, and pricing information accessible to member portals, provider systems, and third-party applications.
Quantifiable outcome
- Sub-five-second response times for electronic prior authorization
- +3 more outcomes
Companies that use 1upHealth
Customer profileNamed customers5 records
Segments3 records
Ideal customer profiles3 records
1upHealth technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Feature10 records
1upHealth partnerships and signals
Strategic signalPartnerships
Six partnerships are on record, tiered core and minor.
- InovaloncoreData and analytics platform company deeply embedded across the payer market. Partnership brings complementary capabilities and customer base that aligns with 1upHealth's payer interoperability focus.
- USTcoreGlobal technology and consulting firm with significant healthcare practice. Brings implementation depth and client relationships that help health plans move from contract to live faster.
- Chordline HealthcorePayer-focused company bringing domain expertise and trusted-advisor status that accelerates health plan adoption during major compliance initiatives.
- ZSminorManagement consulting and technology firm. Partner logo displayed on 1upHealth website indicating partnership relationship.
- Defacto HealthminorCo-authored blog content on provider directory endpoints. Defacto Health aggregates and scores provider-insurance relationship data from payers' Provider Directory APIs and machine-readable files.
- Blue Cross Blue Shield Associationcore1upHealth demonstrated electronic prior authorization flowing live through BCBSA Data Hub with real data, real systems, working in real time at eSolution Xchange.
Scale indicators6 records
Recent moves6 records
Expansion highlights6 records
1upHealth competitors and assessment
Company assessmentDirect peers
- Particle Health: Particle Health operates a healthcare data API platform focused on payer-to-payer and clinical data exchange for health plans, providers, and digital health apps. It competes directly with 1upHealth in the FHIR-first interoperability layer for U.S. payers.
- Health Gorilla: Health Gorilla is a Clinical Data Network and interoperability platform operating as a QHIN under TEFCA, exchanging clinical records across payers, providers, and HIEs. It is a direct competitor to 1upHealth in FHIR-based clinical data exchange for U.S. payers and providers.
- Zus Health: Zus Health offers a FHIR-native shared clinical data platform used by digital health builders, payers, and providers to assemble longitudinal patient records. It overlaps with 1upHealth in the payer and digital health developer segment for FHIR data aggregation.
- Avaneer Health: Avaneer Health is a payer-led interoperability network built on FHIR and blockchain, founded by a consortium of large U.S. health plans. It is a direct competitor to 1upHealth in payer-to-payer data exchange and provider data sharing.
Emerging players
- Redox: Redox provides a healthcare API platform for integrating EHR and clinical systems, used heavily by digital health developers and increasingly by payers. It is comparable to 1upHealth's 1up DevPortal and integration layer, though Redox is more developer-focused than payer-focused.
- Myndshft Technologies: Myndshft provides automated prior authorization and benefits verification workflows using FHIR standards. It is an emerging competitor to 1upHealth's 1up Electronic Prior Authorization sub-product, focused specifically on PA automation for payers and providers.
Broad incumbents
- Change Healthcare (Optum): Change Healthcare (now part of Optum/UnitedHealth Group) operates one of the largest U.S. healthcare data exchange and clearinghouse networks, including FHIR-based APIs. It is a broad incumbent with overlapping capabilities to 1upHealth's payer interoperability platform.
- Edifecs: Edifecs provides healthcare data integration, interoperability, and compliance solutions to payers and providers, with deep X12 and FHIR capabilities. It competes with 1upHealth in payer-side interoperability and CMS compliance workflows.
- Epic Systems: Epic's Payer Platform and Cosmos network enable FHIR-based data exchange between Epic providers and payers. Epic is a broad incumbent competing indirectly with 1upHealth by offering payers native interoperability tools through Epic provider relationships.
Others
- Inovalon: Inovalon is a cloud-based healthcare data analytics and payer platform that 1upHealth lists as a strategic partner. It is comparable as a payer-focused data infrastructure vendor and represents both an integration partner and an adjacent competitor in payer analytics and data exchange.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
1upHealth social profiles
Digital presence1upHealth compliance and trust
Trust signalCompliance4 records
1upHealth financial estimates
Financial estimateRevenue estimate
Valuation estimate
1upHealth leadership team
Management profileNumber of profiles
Profiles1 record
1upHealth funding detail
Funding detailFunding overview
Funding rounds5 records
Investors7 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
1upHealth M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about 1upHealth
What does 1upHealth do?
1upHealth operates a FHIR-first healthcare data platform built on a data lakehouse architecture that ingests clinical, claims, and financial data, normalizes it within a unified model, and exposes it via FHIR R4 APIs and other formats for U.S. health plans. Its product suite includes the 1up Platform plus six integrated modules: Electronic Prior Authorization, Payer-to-Payer Data Exchange, Provider Access, Patient Access, Provider Directory, and Formulary, sold via enterprise subscriptions to Medicare, Medicaid, and commercial health plans for CMS regulatory compliance and interoperability.
Is 1upHealth a public or private company?
1upHealth is a private company. It is classified as venture growth investor backed and is currently operating.
When was 1upHealth founded?
1upHealth was founded in 2017. It employs 101 to 250 people.
Where is 1upHealth based?
1upHealth is headquartered in Boston, United States, in the North America region.
How does 1upHealth make money?
Two revenue lines are on record. Platform Subscription is the primary driver. The others are professional Services.
Who are 1upHealth's main competitors?
Direct peers on record are Particle Health, Health Gorilla, Zus Health and Avaneer Health. Emerging players are Redox and Myndshft Technologies. Broad incumbents are Change Healthcare (Optum), Edifecs and Epic Systems. Inovalon is listed as an others.
Does 1upHealth have an API?
Yes. 1upHealth offers FHIR-based APIs for healthcare interoperability including Patient Access API, Payer-to-Payer Data Exchange API, Provider Access API, and Electronic Prior Authorization API (CRD, DTR, PAS). APIs support OAuth2 authentication, SMART on FHIR framework, and FHIR to X12 conversion. The platform provides public-facing APIs for Provider Directory and Formulary that require no authorization. Data formats supported include X12 (837, 278), FHIR bundles, and custom flat files or CSV formats. Developer documentation is at docs.1up.health.
What industry is 1upHealth in?
1upHealth's product category is Healthcare Data Interoperability Platform. Its primary akta.pro industry code is HLACAIAI, FHIR/HL7 Data Repositories & Canonical Data Models, with a secondary code of HLACABAA, Interoperability Standards, Profiles & Implementation (HL7/FHIR/IHE). Its NAICS code is 51821 and its SIC code is 7372.