Your EHR has no field for chain of custody, and state program platforms were never built for HIPAA. Downstream keeps the program record in its own system, hosted under a BAA and apart from your clinical charts, and can bill insurance for the therapy around the dosing day.
Contact usDownstream was built by Dr. Anne Metz, a clinician who practices in Colorado's regulated access model and is preparing to work in New Mexico's Medical Psilocybin Program in 2027. She built it because she knows this work from the inside: the state report due on a deadline, the consent form you have to enter manually, the claim nobody knew how to code, and the superbills we should all be offering for prep and integration.
Tech bros who like psychedelics are still tech bros.
Downstream is homegrown New Mexico software. No venture capital, no data mining, no scraping. Each practice's record is walled off, and Downstream can't see inside it unless you invite us in.
A practice inside a state-regulated access program answers to two sets of rules at once. The state demands the program record. HIPAA governs the clinical one. Every system on the market was built for one or the other, so the gap gets filled with spreadsheets, scanned PDFs, and hours of admin work nobody pays you for. Downstream exists to hand those hours back.
They were built for clinical notes and insurance claims. They have no place for registration, site certification, chain of custody, adverse-event reporting on the state's two-day clock, or DOH submission packets, so program content ends up outside the record.
Record platforms built for state-regulated access programs track the program and nothing else. They don't meet HIPAA requirements for clinical notes and healthcare applications, so the clinical side of care can't live there.
One system that holds everything New Mexico's Medical Psilocybin Program requires, hosted under a BAA and kept apart from your clinical and payer records. It is live and in use in practices today.
Registration, site certification, chain of custody, and adverse-event reporting with the statutory two-calendar-day clock, all in one record. DOH submission packets, including the 7.35.3.8 patient application and the 7.35.3.13.C administration-day report, are generated from it.
Consent, screening, and prep forms go to patients through a secure portal with typed e-signature. No paper packets, no scanned PDFs to chase down.
The state and a payer need to see different things. The record keeps them separate by default: program content never reaches a claim, and everything works the same whether or not you bill insurance.
Each practice gets its own login and its own walled-off record, hosted on Google Cloud under a Google Workspace BAA. Downstream hosts it and has no access unless invited in. Telehealth sessions run through Zoom under a BAA.
Billing is optional and runs on top of the record. Screening, prep, and integration bill as ordinary psychotherapy under Medicaid and commercial plans today. The dosing day isn't billable until FDA approval. Billing launches in New Mexico in December 2026.
Prep sessions, dosing days, and integration visits all bill differently, and some of it can't go to insurance at all. We code to the legal guidance written for psilocybin therapy in New Mexico, and we can show our work on every claim.
Most clinicians in this field have never been paneled with a payer. Credentialing is months of forms and follow-up calls, so we start before your doors open. You send us one packet of documents and we take it from there: Medicaid enrollment, CAQH, plan applications, contracting.
Someone at your front desk uploads visit records to our portal. We check each patient's coverage, tell you in plain English if anything is missing, send the claims to the insurance company, track the payments, and follow up on anything that gets denied.
The software drafts claims. It doesn't send them. A billing specialist looks at every claim, prior auth, and appeal before it goes anywhere, and the system refuses outright to bill things that shouldn't be billed.
| Payer | Screening | Prep session (×2) | Integration session (×2, 60 min) | Insurance pays* |
|---|---|---|---|---|
| NM Medicaid (Turquoise Care) | $133 | $228 | $218 | $1,027 |
| BCBS New Mexico | $145 | $213 | $152 | $876 |
| Presbyterian Health Plan | $138 | $203 | $148 | $840 |
* One screening, two prep sessions, and two 60-minute integration sessions, billed with standard E/M and psychotherapy codes. These are provisional fee-schedule rates for illustration. Your actual rates get set in your payer contracts during credentialing. NM Medicaid figures reflect the state's 150%-of-Medicare minimum that took effect January 2025. The dosing day itself, administration and monitoring both, can't be billed to insurance before FDA approval. We route it to self-pay or the state Equity Fund and track it so it never ends up on a claim. If approval comes and coverage opens, turning monitoring billing on is a settings change, worth another $796 to $887 per dosing day at these rates.
Insurance revenue stacks on top of your cash model. Dosing days stay direct pay, and everything around them gets billed. Three credentialed clinicians doing twelve courses a month bring in roughly $10,000 to $12,000 a month that a cash-only clinic never sees, and it grows as your panel does. You pay a flat credentialing fee up front, then a percentage of what we actually collect.
Screening, prep, and integration go through the insurance a patient already has, Medicaid or commercial, the same way regular therapy does. They pay their normal copays. The dosing day is the one direct cost, and they know the exact amount before their first visit. And for anything paid out of pocket, we provide a coded superbill so patients can seek out-of-network reimbursement from their own plan.
Not sold on insurance? Plenty of practices aren't. We prepare coded superbills instead: your patients file with their own plan for out-of-network reimbursement, and you never sign a payer contract.
Psychedelic therapy can't just be for the wealthy. Most of this treatment can be covered by regular insurance — if the records are kept straight and you know how to bill it.
The program record is live for practices in New Mexico's Medical Psilocybin Program. Insurance billing and credentialing launch in December 2026 with a small group of founding clinics.
Working in Colorado or Oregon and interested in billing insurance or providing superbills? Contact us.
It is the electronic record a practice needs to operate inside New Mexico's Medical Psilocybin Program under 7.35.3 NMAC. It tracks registration, site certification, chain of custody, and adverse events on the two-calendar-day reporting clock, collects patient consent and screening forms by e-signature, and generates DOH submission packets from the record.
No. The program record works on its own. It works the same whether a practice bills insurance through Downstream, bills insurance itself, or does not bill insurance at all. Insurance billing and credentialing are separate, optional services that a practice can add to the record at any point.
Yes. Program and compliance data are kept separate from the clinical and payer-facing record by default. DOH submission packets are built from the program record. Program content never reaches an insurance claim; only the visit data required to bill a service correctly crosses over, and only when the practice bills through Downstream.
Downstream hosts it on Google Cloud under a Google Workspace BAA. Each practice gets its own login and its own walled-off record, and Downstream has no access to that record unless the practice invites it in. Telehealth sessions run through Zoom under a BAA, not Google Meet.
The program record supports New Mexico's Medical Psilocybin Program under 7.35.3 NMAC, including the 7.35.3.8 patient application and the 7.35.3.13.C administration-day report. Clinicians working in Colorado or Oregon who are interested in billing insurance or providing superbills can contact Downstream to discuss their practice.
Yes. A practice that does not want to panel with payers can hand patients a coded superbill for screening, prep, and integration visits, and patients submit it to their own plan for out-of-network reimbursement. Downstream prepares the superbill with the correct codes. No credentialing, no claims, no payer contracts.
Record system pricing is set per practice on an initial call. Billing is priced separately: a flat credentialing fee up front, then a percentage of what Downstream collects. A practice that uses only the record system pays no billing fees. Use the form below to set up a call and get a quote.
Tell us where you practice and what you're interested in, and we'll set up a call.