One care intelligence platform. Five connected capabilities.
Each capability hands its context to the next, so a case keeps its history from the first coverage check to the tracked result. One shared network keeps all five getting sharper.
What is the Upstream platform?
The Upstream platform is the care intelligence platform for healthcare specialty practices. It turns payer intelligence into benefits and eligibility checks, prior-authorization work, denial management, and revenue intelligence. The shared non-PHI network makes every lane sharper. The work still runs only under a human approval.
The five capabilities
See the policy move while there is still time to act.
Payers change the rules and rarely announce it. We read payer behavior at the source and detect when it shifts. The change surfaces early enough for a team to adjust the work before confusion spreads through the queue.
- Monitoring of published payer policy and observed behavior, not guesswork.
- Early warning when a rule moves in a way that touches your procedures.
- Lead time to adjust submissions instead of discovering the problem at the end.
Verify coverage before the rest of the work stacks up.
Benefits and eligibility are where fragmented work often starts. We verify the coverage state, the benefit path, and the payer context up front so teams can stay clear on what belongs in the next step.
- Coverage and benefit checks run before downstream work begins.
- The payer context follows the case into prior authorization and denial management.
- Teams stop discovering eligibility trouble at the worst possible moment.
Prepare the request the way the payer will actually review it.
Most prior authorization friction starts before the submit button. We know what the payer actually verifies: clinical criteria, step-therapy proof, ICD-10 and CPT alignment, and functional baselines. We check it up front so the request goes out matching what the payer expects.
- Requirement checks run before submission, not after avoidable rework.
- Clinical criteria, step-therapy evidence, and code alignment verified.
- Functional baselines confirmed so the file is complete the first time.
Run the appeal and follow-up work with the payer context intact.
A setback should not reset the case to zero. We carry the payer context, the supporting rationale, and the prepared work into denial management so the response stays specific to what that payer actually asked for.
- Appeal and follow-up work starts from the payer signal, not from scratch.
- Prepared denial-management work stays approval-gated and fully auditable.
- Each tracked outcome sharpens the next case and the next recommendation.
See what is slipping before it shows up in the numbers.
Approvals have a rhythm: which ones land, which slip, and when. We surface approval-rate trajectory, payer friction, and cash-flow timing by payer and procedure so operators and finance can stay oriented together.
- Approval-rate trajectory you can take into a payer conversation.
- Expected exposure surfaced by payer and procedure.
- Cash-flow timing so finance can plan, not react.
The network that keeps the platform getting better.
Anonymized, non-PHI payer behavior across every practice we serve becomes a shared signal. It sharpens the platform internally and also powers the external Upstream Data surface for builders who want requirements, benchmarks, and submission-pattern scoring.
- Benchmarks by payer and procedure that a single office cannot see alone.
- A developer surface for teams building closer to specialty care operations.
- A non-PHI asset that compounds even when a practice starts with one narrow workflow.
The rules are about to open up. We already read them.
The CMS Interoperability and Prior Authorization rule requires payers to expose their documentation requirements through standardized APIs by 2027. We are built to read that direction as it arrives. Until then, we bridge the gap so teams can work from the same clarity now instead of waiting for the deadline.
We run the work. You get the outcome.
The work runs through one system, and every step waits for your approval first. The practice gets a clear path through the work, not one more dashboard to keep open.
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.