Limited Agency Authorization

You appoint Upstream as your limited agent solely to electronically transmit, submit, and status-check these transactions with payers, plans, and clearinghouses, and only for items you have reviewed and approved in the platform:

• prior authorization and pre-certification requests, and responses to related payer information requests;
• claims and claim corrections;
• appeals and reconsideration requests for denied claims or authorizations;
• eligibility, benefits, and authorization-status inquiries.

Transmission happens only after you approve the specific item in the approval queue. Upstream is a conduit for your approved instruction; it never originates a submission you have not approved.

You retain sole authority over, and responsibility for, all clinical, coding, medical-necessity, billing, and financial decisions. Nothing here delegates decision-making to Upstream. Your approval of an item in the platform is your own act. Upstream is responsible only for transmitting approved items accurately and securely as instructed.

Upstream has no authority to:

• make, change, or override any clinical, coding, medical-necessity, billing, or appeal decision;
• enter into, amend, or terminate any payer or network contract on your behalf;
• negotiate with, settle with, or bind you to any payer or third party;
• receive, hold, direct, or disburse your funds, remittances, or payments;
• act on any patient, payer, transaction, or program outside the list above;
• use or disclose PHI beyond what the Business Associate Agreement permits.

This Authorization begins when you accept it and continues until your Services Agreement ends or you revoke it. You can suspend or revoke it at any time, in writing or through the platform's controls. Revocation stops future transmissions going forward; it does not unwind transmissions already completed.

All handling of protected health information under this Authorization is governed by the Business Associate Agreement and the HIPAA Rules, including the minimum necessary standard. This Authorization does not expand what the BAA permits.