A shared operating path for high-burden specialty care.
Upstream starts with procedural workflows where payer requirements, missing evidence, review, submission, and follow-up need to stay connected.
Why one platform works across specialties
The drugs, procedures, and payer mix change by specialty. The operating contract remains useful where teams need sourced requirements, evidence readiness, human-approved action, capability-checked execution, and outcome reconciliation.
The specialties that feel this most.
High prior-authorization burden, payer-variable rules, and recurring denial management. These are target workflows for discovery and customer validation. Readiness depends on the procedure, payer source, EHR connection, and execution rail configured for a tenant.
Infusion
Biologic infusions, IVIG, and injectable specialty drugs.
Oncology
Chemotherapy, immunotherapy, and specialty oncology drugs.
Rheumatology
Biologics and step-therapy-heavy specialty drugs.
Gastroenterology
Biologics for IBD and Crohn disease, plus endoscopy.
Neurology
Infused neurology biologics, MS therapy, and Botox for migraine.
Cardiology
Advanced cardiac imaging and PCSK9 inhibitor therapy.
Orthopedics
Joint replacement, spine surgery, and injectables.
Pain Management
Injections, nerve blocks, and implantable devices.
Built first for interventional pain.
Interventional pain carries some of the heaviest prior-authorization load in specialty care. Each procedure rides payer-specific medical-necessity criteria that shift often, and new Medicare prior-authorization requirements are arriving for these exact procedures in several states. Upstream carries that case: the requirement in force today, the evidence attached, the submission staged for your approval.
- CPT-specific requirements, not a generic checklist.
- Available coverage-policy sources attached with effective dates and unknowns.
- Every prepared submission held for a person on your team to approve.
The people who carry the operational load.
If specialty care operations and the uncertainty around them land on your desk, this is built for you.
Practice administrators
You keep specialty care operations moving when everything else in the practice is already full.
Revenue cycle and billing managers
You need a clearer read on what is moving, what is stalled, and what needs attention next.
Prior authorization coordinators
You carry the detail work today. We help it arrive prepared so your judgment goes further.
Infusion and nursing managers
When specialty care operations slow down, the care plan feels it first. We help keep the path clearer.
Physician owners and managing partners
You need a steadier picture of payer friction without living inside the queue yourself.
Different procedures. The same care intelligence.
The clinical evidence and payer requirements differ by procedure. The control path can stay consistent: source the requirement, identify missing evidence, approve the exact action, select a supported rail, and reconcile the result.
The same hidden rules
These workflows often involve biologics, specialty drugs, or high-cost procedures with payer-specific requirements that can change.
The same requirement work
Clinical criteria, step-therapy proof, code alignment, functional baselines. The fields differ by procedure. The discipline does not.
The same loop
Signal to Brief to Action to Approval to Reconcile. Your team approves, and the case stays open until external evidence resolves the attempt.
The platform stays the same even when the payer path gets messy.
01
Benefits and eligibility
Use a configured Stedi connection to retrieve eligibility and benefit context. It is not the prior-auth submission rail.
02
Prior authorization
Prepare the request against available sourced requirements and keep unsupported facts explicit.
03
Denial management
Keep the requirement, approved payload, and payer evidence attached when the first answer is no or unknown.
04
Payer-policy monitoring
Record policy provenance and freshness so a stale or unavailable source does not look current.
05
Revenue intelligence
Use reconciled status and downstream evidence to understand where timing and friction are building.
The next specialties in the same mold.
Biologics, specialty drugs, high-cost procedures, step-therapy-heavy, payer-policy variable. These fit the operating model, but each remains a validation candidate until its sources, integrations, review path, and execution rail are verified.
- Radiation Oncology
- Ophthalmology (anti-VEGF)
- Allergy and Immunology
- Endocrinology
- Dermatology
- Nephrology and Dialysis
- Sleep Medicine
- Wound Care and Hyperbaric
- Physical Medicine and Rehab
- Urology
- Maternal-Fetal Medicine
See it on an infusion request.
One payer change, from the first signal to a clearer path through the work.
Bring a recent batch.
We will map the available payer source, evidence gaps, review decision, supported rail, and reconciliation path for one real workflow.