Upload a claim. See the risk. Act before denial.
Upstream turns claim upload into a care intelligence review, then routes the work through prior auth, denials, appeals, recovery, and specialty packs.
Developer API, MCP, and OSS tools are available for teams that want to build on the same signals.
Works with your EHR and PMS
Plus 20+ more via API.
HOW IT WORKS
Claim review is the front door. Care intelligence carries the rest.
Three steps from upload to prior auth, denials, appeals, recovery, and specialty-specific action.
Review
Upload a claim or 835 file. Upstream runs a claim intelligence review across coding, modifiers, payer history, and auth status.
Route
Findings move into the right lane: prior auth, denials, appeals, recovery, or the specialty pack rules for your care setting.
Recover
Your team sees the next action, evidence, deadline, and projected recovery in one care intelligence flow.
How a single claim flows through care intelligence
Live detection stream
6 engines active · 1,247 claims processed today
90-SECOND OVERVIEW
See the claim review flow.
Three steps from upload to care intelligence. Watch the walkthrough or review your own claim.
upstream.cx / command-center
Drop a claim or 835 file.
No EHR access, no VPN, no IT tickets. Upstream parses the file and runs the claim intelligence review.
PROOF
What operators find in the first 90 days
Early customers share what changed when detection moved from reactive to preventative.
We spotted a UnitedHealthcare denial pattern shift 38 days early and ran a targeted appeal campaign. We recovered claims we'd already mentally written off. Upstream paid for itself in the first 90 days.
Director of Revenue Cycle
Regional SNF Operator · 14 facilities · Medicare Advantage
Before Upstream, we were losing 6-8% of authorized ABA units to expiration every month. In 60 days, that dropped to under 1%. At our volume, that's $340K annually that just stops leaking.
VP of Finance & Compliance
ABA Therapy Group · 240 clinicians · 12 states
Our billing team was manually checking authorization expirations in a spreadsheet. Upstream replaced that entirely. AuthGuard fires 30 days out, we reauth before the claim ever gets touched. Zero expired auths in Q1.
Director of Operations
SNF Operator · 8 facilities · Ohio & Indiana
Compliance & security
Who We Serve
Built for every care setting.
Solo practices to multi-site operators. Your specialty, your payers, your workflow.
Built for clinical operations
Billing teams at small practices work late. They chase prior auths. They appeal denials one by one. They spot the payer shift only after the third week of kicked claims.
Upstream watches payer behavior across the network. When a pattern starts to shift, you see it early. The fix is in your hand before the claims go out.
Your clinicians get back to patients. Your billing team gets back their Thursday afternoons. That is the point.
See every payer shift. Before it reaches your team.
Payer policies shift quietly. Upstream gives your team early warning so you can adjust before the claims go out.