Upstream

Care Intelligence Platform for Healthcare Revenue Operations

Identify payer risk earlier. Reduce avoidable denials. Protect reimbursement.

Upstream gives healthcare revenue teams earlier visibility into payer behavior changes and a safer way to act on them.

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Maintainers: this README is intentionally buyer-facing. Technical implementation details live in docs/DEVELOPER_GUIDE.md.

Why Upstream

Healthcare billing teams often discover payer issues 30-60 days after they begin to impact cash flow. By the time traditional reporting catches up, avoidable denials, rework, and margin pressure have already compounded.

Upstream is built to move teams from reactive recovery to earlier operational intervention.

What Upstream Delivers

Earlier Risk Visibility: Detect denial drift, payment slowdowns, and authorization risk before monthly close cycles
Priority-Based Worklists: Focus teams on the highest-impact issues first
Operational Safety: Confidence-tier routing keeps higher-risk actions human-reviewed
Vertical-Specific Intelligence: Purpose-built logic for real healthcare reimbursement workflows

How It Works

Ingest Connect claim, authorization, and operational data through APIs, uploads, and webhook pipelines.
Detect Run DriftWatch, DenialScope, DelayGuard, and vertical-specific checks to surface meaningful payer changes.
Prioritize Score and route work by confidence and expected business impact.
Execute Safely Enable automation for low-risk tasks and escalate high-impact decisions to operators.

Business Outcomes

Role	Primary Value
Revenue Cycle Directors	Earlier warning before losses compound
Billing Managers	Clear daily priorities and faster triage
RCM Analysts	Root-cause visibility across payers and service lines
CFO / Finance Leaders	Better visibility into reimbursement risk and margin protection

Healthcare Domain-Specific Intelligence

Most platforms give you generic dashboards. Upstream gives you workflows that match how revenue teams actually operate in each care setting.

Upstream currently supports seven healthcare verticals:

ABA Therapy: Authorization lifecycle intelligence, CPT-specific risk, and unit exhaustion visibility
Skilled Nursing Facility (SNF-MA): PDPM and MA payment variance detection with stay-level risk context
Dialysis: MA reimbursement drift and add-on payment signal tracking
PT/OT: 8-minute rule and threshold-aware risk detection before preventable denials
Imaging: Prior-auth and utilization-management rule intelligence tied to payer behavior
Dental: PPO economics signals, downcoding/bundling patterns, and contract risk visibility
Home Health: PDGM, Face-to-Face, and NOA timing intelligence to reduce avoidable leakage

Why this matters:

Faster time to useful action: Teams spend less time interpreting and more time fixing
Higher signal quality: Vertical-aware baselines reduce false alarms and alert fatigue
Better financial outcomes: You catch high-impact issues while there is still time to intervene

Platform Capabilities

Detection Engines

DriftWatch: Denial-rate drift and statistical significance monitoring
DenialScope: Dollar-weighted denial impact analysis
DelayGuard: Payment timing deterioration tracking
Authorization Tracking: Expiration and unit-consumption risk monitoring
Pre-Submission Scoring: Risk scoring before claim submission

Intelligent Execution Model

Tier 1 (Auto-Execute): High confidence, low impact
Tier 2 (Queue Review): Medium confidence or medium impact
Tier 3 (Escalate): Lower confidence or high-impact decisions

Trust, Security & Compliance

Upstream is engineered for healthcare operating environments:

Multi-tenant isolation controls
PHI encryption at rest and audit logging
Security headers, CORS controls, and endpoint rate limiting
Signed webhook verification contracts
Operational hardening guidance and incident readiness runbooks

For details:

Product Status

Production — live as of 2026-04-23

Environment	URL	Hosting
Marketing site	`upstream.cx`	Vercel
Customer app (React SPA)	`app.upstream.cx`	Vercel
REST API (backend)	`api.upstream.cx`	GCP Cloud Run
Sandbox API	`sandbox.api.upstream.cx`	GCP Cloud Run

Who Upstream Is For

Healthcare organizations with 1-25 locations that want earlier payer signal detection, stronger revenue discipline, and safer execution workflows.

Documentation

Buyer / Operator Resources

Technical Resources

Developer Guide
Documentation Index
API Examples
Deployment Guide (GCP Cloud Run)
Deploy Runbook — migrations, frontend (Vercel), backend (Cloud Run). Run deploy scripts from the project root (e.g. cd ~/Projects/upstream).
Production Checklist — pre-deploy gates: ./scripts/deploy-gate.sh (lint + build + optional critical tests)
Contributing

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