Bring specialty care operations into one prepared flow.
Upstream sees what payers are doing, knows what each one now requires, and prepares the work for your approval.
Prepared flow
Approval-gated- SignalDetected at the source
Aetna tightened the step-therapy rule for infliximab.
- BriefPlain language
What changed, who it touches, and the new documentation it asks for.
- ActionPrepared for you
A prior-auth packet, built to the new criteria, ready to send.
- ApprovalAlways a person
Your coordinator reviews and approves. Nothing moves until they do.
- OutcomeTracked + carried forward
Approved in two days. The pattern carries into the next case.
Built for the eight procedural specialties where prior authorization and payer change hit hardest.
The work is fragmented. The patient still feels it.
The work splinters across portals, spreadsheets, inboxes, and memory, and it drifts apart a little more with every handoff. Upstream brings it back into one flow, so the team stays clear and the patient stops feeling the gaps.
Signal to outcome. One path, every case.
From the first payer change to the tracked result. One flow for work that usually gets split across systems.
- 1
Signal
A change in payer behavior or a requirement worth acting on.
- 2
Brief
Plain language: what changed and what it means for the practice.
- 3
Action
The prepared work. An appeal, a submission, a verification.
- 4
Approval
A person on your team approves before anything executes.
- 5
Outcome
The tracked result, carried forward into the next case.
What Upstream solves.
Most tools wake up after a claim is denied. Upstream starts earlier, where the payer rules actually move.
Payer intelligence
Where we startWe read payer behavior at the source and tell you what each one now requires before you submit. The longer we watch, the sharper the read gets for every practice we serve.
Benefits and eligibility
Coverage and benefits verified with the payer context already in hand, so a case does not slip.
Prior authorization
Packets built around what the payer actually checks: criteria, proof, and code alignment.
Denial management
Appeals prepared and tracked by payer and procedure, still tied to the signal that started them.
Revenue intelligence
Approval pace, payer friction, and recovery kept clear enough for operators and finance to align.
One platform. Every procedural specialty.
The procedures and payers differ. The work underneath is the same: eligibility, prior auth, denial management, payer intelligence, and revenue intelligence. No specialty modules, no setup maze. One platform serves all eight.
Plain answers.
- What is Upstream?
- Upstream is the care intelligence platform for procedural specialty practices. We keep benefits and eligibility, prior authorization, denial management, payer intelligence, and revenue intelligence connected and under approval.
- Is this another dashboard?
- No. We prepare the work, carry it forward, and hand your team a clear next step. Your team still approves every action.
- How does Upstream keep our data safe?
- Protected health information stays encrypted and scoped to your practice. Every action waits for a human approval before it executes. We are HIPAA-aligned with the controls in place.
- Which specialties does Upstream serve?
- Procedural specialties with high prior-authorization burden: infusion, oncology, rheumatology, gastroenterology, neurology, cardiology, orthopedics, and pain management. One platform serves all of them.
Bring one recent case.
We will walk through how Upstream reads the payer context, prepares the work, and keeps the next step clear. No commitment.