1upHealth

# Fix list: 1upHealth

From Anchor Terminal's listing at https://www.anchorterminal.com/tools/1uphealth, the October 2026 research run, assessed 14 October 2026. Grade D, 46.8 out of 100.

This is everything the published grade says the listing lacks, the biggest possible gain to the total first. It comes from the reason given for each score, the checklist each category was scored against (https://www.anchorterminal.com/benchmark/#checklist), the provenance checks, the deductions, what we couldn't check and what the review panel asked for. A fix counts at the next check, once it's public.

For a coding agent working on 1upHealth: work through the items below in the product, its docs and its public pages. Each category gives the reason for its score, with the points each checklist item earned, and the checklist itself, so the gap is the items that earned less than their points. Change the product, not the wording, and keep a note of what you changed and where it's published.

## 1. Agent ergonomics, 32 out of 100, up to 11.1 more on the total

Why it scored 32: FHIR search and bulk export, with no documented size controls (12 of 25). Pagination and filters follow FHIR without 1upHealth-specific documentation (8 of 20). Errors are barely documented (5 of 20). No idempotency or retry guidance, though the Patient Access API is read-only (3 of 20). No official SDK, and the authorisation code step needs a person or, per the FAQ, a scripted browser (4 of 15).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-ergonomics):

- 0 to 25, context cost. For MCP, the number and size of the tool definitions (25 for ten or fewer compact tools, 15 for 11 to 30, 5 for more than 30, plus up to 10 back for toolsets, dynamic loading or read-only subsets). For APIs, whether responses can be sized (field selection, limits, summaries).
- 20, pagination, filtering and output-size controls.
- 20, actionable, documented error responses, codes and messages an agent can recover from.
- 20, idempotency or safe retries, and for MCP the `readOnlyHint` and `destructiveHint` annotations.
- 15, sensible defaults, few required parameters, and official SDKs in at least two languages.

Models are read for tool use, structured output, prompt caching, context length, batch and SDKs. Frameworks for how much code and how many defaults a tool-calling agent with MCP needs.

## 2. Payments & pricing, 20 out of 100, up to 10 more on the total

Why it scored 20: Read with the hosted rubric. No x402, MPP or L402 (0). No published prices (0). Sandbox clients in the Dev Portal need a verified email and no card (20). Sign-up is in a browser, Patient Access testing needs an email to 1upHealth to sync the client, and production needs a vetting review (0).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-payments):

The published rubric, also on the [x402 page](https://www.anchorterminal.com/x402/).

- 40, a machine payment protocol (x402, MPP or L402) on the tool's own endpoints. 10 to 30 when it covers only some endpoints or only goes through a third party, and the note says which.
- 20, per-call or per-unit pricing published without a login. 10 for public plan-only pricing, 0 for "contact sales" or prices behind a login.
- 20, a free tier or trial that doesn't need a card.
- 20, autonomous onboarding, meaning an agent can get access without a person signing up in a browser (keyless use, x402, a programmatic key API).

Payment platforms and agent wallets rarely charge for their own API over a machine protocol, so the first line has steps for them, and the highest one that applies counts. 40 when x402, MPP or L402 runs on all their own endpoints, 30 when it runs on part of their own API, 25 when their merchants can accept one, 20 for running a facilitator, 15 for paying as a buyer, and 0 when the only protocol is their own. Merchant acceptance sits above a facilitator because the platform's own customers can charge agents through it, while a facilitator settles for sellers who wire up the protocol themselves. The counter-argument (a facilitator does more for the protocol as a whole) has a point. Each note says which step applied.

Open-source software you run yourself is scored on its hosted or paid option if it has one. A free, self-hosted package with nothing to buy gets 20, 20 and 20 for the last three lines, and 0 to 40 for the first only if it ships a payment protocol.

## 3. Reliability, 52 out of 100, up to 9.6 more on the total

Why it scored 52: Read with the hosted lines. status.1up.health is a Statuspage site with no components listed, so history can't be tied to an API (12 of 20). No incident since the AWS outage of 20 October 2025, but with no components this says little (20 of 30). No rate limits found (0). No 429, backoff or retry guidance found (0). A 99 per cent SLA with credits in Exhibit A of the terms (10). Patient Access, Provider Access and Payer-to-Payer are generally available. Patient Connect was sunset on 30 September 2026 and is not graded (10).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-reliability):

Hosted APIs, MCP servers, models and platforms.

- 20, a public status page with component history (Statuspage, Instatus, BetterStack or the vendor's own).
- 0 to 30, the incident record for the last 90 days on that page. 30 for a clean record or trivial incidents only, 20 for minor incidents only, 10 for one major outage (an hour or more of a core API down, or errors across the board), 0 for several. 5 when there's no history we could read, and the note says so.
- 15, rate limits documented with numbers.
- 15, documented 429 or overload handling (Retry-After, backoff guidance), and idempotency keys or safe-retry guidance where writes are involved.
- 10, an SLA published for any paid tier.
- 10, the surface agents use is generally available, not beta or preview.

Local packages, SDKs, frameworks and stdio MCP servers.

- 20, installs from an official package with supported runtimes stated.
- 25, a public CI and test suite, passing on the default branch.
- 0 to 25, open crash or regression issues relative to activity (25 for few and handled, 0 for many, old and unanswered).
- 15, semver discipline and breaking changes called out in a changelog.
- 15, version 1.0 or later, or declared stable.

Protocols are read from their reference implementations, the public facilitators or servers, spec stability and test vectors.

## 4. Schema & documentation, 50 out of 100, up to 8.1 more on the total

Why it scored 50: A FHIR CapabilityStatement at each server's /metadata and the CARIN, US Core and Da Vinci implementation guides define the resources, with no OpenAPI (12 of 25). llms.txt indexes 34 Markdown pages (10). Pages say which resources every payer returns and how to test, with little on parameters (8 of 20). Inputs follow the FHIR standard with nothing documented beyond it (6 of 15). curl examples, and the only error example is an HTML 400 page (6 of 15). Release notes are numbered by year and month but undated (8 of 15).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-schema):

APIs and MCP servers.

- 25, a machine-readable contract (a public OpenAPI file or similar; for MCP, typed JSON Schema inputs on every tool).
- 10, llms.txt or Markdown docs served for agents.
- 0 to 20, descriptions that say what a tool is for, when to use it and when not to, read from the tool definitions in the source or the API reference.
- 0 to 15, typed inputs with enums, constraints and required fields, and no free-form JSON blobs.
- 0 to 15, examples and documented error responses.
- 15, versioning and a public changelog.

Models are read from the API reference, the OpenAPI file, llms.txt, the structured-output and tool-use docs and the model cards. Frameworks from docs a model can follow, typed interfaces, examples and the API reference.

## 5. Security & auth, 63 out of 100, up to 6.5 more on the total

Why it scored 63: OAuth 2.0 with authorisation code for member consent, client credentials with scopes for bulk data, 15-minute tokens and secret regeneration. Secrets are posted in the request body (25 of 30). Patient Access is read-only data the member authorised, and bulk scopes are read and search (14 of 20). Claims and clinical records from payers, with no prompt-injection guidance (4 of 15). 1upHealth monitors app activity, with no audit log documented for developers (5 of 15). HITRUST, SOC 2 Type 2 and CSA STAR on a SafeBase trust centre, a bug bounty contact by email, no security.txt (15 of 20).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-security):

- 0 to 30, the credential model. 30 for OAuth 2.1 with scopes, or scoped and revocable keys with rotation. 20 for plain revocable API keys. 10 for one all-powerful key. 10 off when a secret can travel in a URL query string as a documented option.
- 0 to 20, read-only or least-privilege modes, and confirmation or approval for destructive actions.
- 0 to 15, prompt-injection posture where the tool returns untrusted content (documented mitigations or guidance). A tool that returns no untrusted content gets 10.
- 0 to 15, audit logs or per-call visibility for the operator.
- 0 to 20, a security programme. security.txt or a disclosure policy, a bug bounty, SOC 2 or ISO 27001, advisories handled in public.

Models are read for retention, whether API data trains models (and whether that's off by default), zero-retention options and certifications. Frameworks for telemetry defaults, approval hooks, guardrails and sandboxing.

## 6. Maintenance & community, 37 out of 100, up to 5.5 more on the total

Why it scored 37: Release 26.09.2 is the latest, numbered for September 2026 but undated (20 of 30). Releases 26.08.2, 26.09 and 26.09.2 fall in the last 90 days by their numbers, without dates (10 of 20). A support portal that needs registration, with no public response record (7 of 15). No official SDK found (0 of 15). Nothing public to judge package health (0 of 10).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-maintenance):

- 0 to 30, time since the last release, or the last published model or API change for a closed service. 30 within 30 days, 20 within 90, 10 within 180, 0 older.
- 20, at least three releases or dated changelog entries in the last 90 days.
- 0 to 25, responsiveness. Issues and pull requests answered on GitHub (the open issues and how recent the replies are). For closed services, a public changelog and a support or community channel that answers, 0 to 15.
- 15, presence in the official MCP registry under a verified namespace (MCP servers), or current official SDKs (APIs and models).
- 10, package health, current dependencies and CI.

Models are read for deprecation notice periods and model churn rather than release counts.

## 7. Transparency & trust, 72 out of 100, up to 2.5 more on the total

Made of editorial 61, provenance 82.

Why it scored 72: Closed service under Terms of Service effective 1 August 2024 (15 of 30). The privacy policy (June 2026) gives retention periods for logs and deletion, keeps data in the US and leaves PHI to BAAs (22 of 30). Patient Connect's sunset was announced with a date, 30 September 2026, with no general deprecation policy (12 of 20). The trust centre lists AWS as a sub-processor and the policy states US-only processing (12 of 20).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-transparency):

- 0 to 30, source availability and licence clarity. 30 for open source under an OSI licence, 15 for closed with clear terms, 0 for unclear terms.
- 0 to 30, data handling and retention statements that agree with each other (privacy policy, DPA, retention periods, subprocessors).
- 0 to 20, a deprecation policy or notices with dates.
- 0 to 20, telemetry disclosed with an opt-out (local software), or subprocessors and data locations disclosed (hosted).

The other half of Transparency and trust is the provenance score, computed from checked facts (below). The category score is the mean of the two.

Provenance checks not met in full (half of this category, computed from checked facts):

- Domain age: 1up.health, registered 2017-07-20 (9 years) (11 of 15)
- Terms of service: read, states 5 of the 7 things a reader expects, and has 1 clause that costs points (6.3 of 10)
- security.txt: not found (0 of 10)

## What we couldn't check

What we couldn't read counted as absent. Publishing it on a page a plain HTTP fetch can read (not only in a browser) lets the next check count it.

- Release dates are not published, so recency is inferred from version numbers
- No rate limits were found in the documentation
- unchecked: the full sub-processor list behind the trust centre's 'View more' link

## Weaknesses

- No rate limits, 429 handling or error formats documented
- Release notes are undated
- The status page lists no components
- Patient Connect, the patient-mediated exchange across health systems, was sunset on 30 September 2026

## What costs an agent a turn today

The notes we give agents before they call it. Each one is a workaround an agent shouldn't need.

- Hand the Patient Access sign-in to the member, who must authorise in the health plan's auth app
- Exchange the authorisation code within five minutes, and refresh before the 15-minute token expires
- Email payer-patient-access@1up.health with the client ID to get the app synced to the demo environment
- Expect only claims and coverage resources from some payers, and read /r4/metadata first

## When it's done

Send what changed and where it's published as a dispute (https://www.anchorterminal.com/builders/#disputes, or `POST https://www.anchorterminal.com/api/v1/contact` with `"kind": "dispute"`). Disputes are answered in public, and the listing is checked again by the same checklist. Paying for an audit or a listing claim changes nothing here.