Psychedelic therapy runs on two records: the one the state demands and the one HIPAA protects. Every system on the market keeps one and drops the other. Downstream keeps both — apart, walled off, and nobody's business but yours.
Downstream was built by Dr. Anne Metz, LPC, NMIT (Co), 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 learned to code in high school in a misguided attempt to meet boys. Who knew it would be useful?
Tech bros who like psychedelics are still tech bros
Downstream isn't out to disrupt healthcare. It's software designed by someone who has worked in a dozen EHRs and understands this care model, for the people doing the work. The mission is to make psychedelic therapy work for everyone — not just people who can pay cash for it. And it is the data-safe option, on purpose.
Health records attract people with bad ideas. Here is what Downstream will never do with yours.
Nothing in your record is scraped, mined, or used to train anything. Downstream hosts the record and cannot see inside it unless you invite us in.
Your data is not a revenue stream. We charge for software and for billing work. That is the entire business model.
The record is plain, dependable software: nothing on a chain, no chatbot in the chart, and nothing in your records ever used to train anything. Where software helps with billing paperwork — drafting a claim or a prior auth — it cites the rule behind every code, and a person approves it before it goes anywhere. AI will never make a care decision or talk to a patient.
Homegrown New Mexico software, owned by the clinician who built it. No one who needs to see a speedy return on their investment, no growth pushed at your data's expense, and no exit that hands your records to someone you never chose.
Your patients are not the product.
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 your state's program requires — New Mexico's Medical Psilocybin Program, Oregon psilocybin services, Colorado natural medicine — hosted under a BAA and kept apart from your clinical and payer records. It is live and in use in practices today.
New Mexico's 7.35.3 NMAC record with DOH submission packets. Oregon's OAR 333-333 service-center record with the quarterly aggregate report. Colorado's 4 CCR 755-1 facilitation record with the de-identified state report. Registration, chain of custody, adverse-event clocks, and the state reports are generated from the record, not assembled at the deadline.
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.
Each jurisdiction gets its own rulebook inside the same record: the fields, the checks, the reports, and even the words. New Mexico practices chart patients, Oregon service centers chart clients, Colorado practices chart participants. Nothing about your state's program is bolted on.
The 7.35.3 NMAC record: registration, site certification, chain of custody, and adverse events on the statutory two-calendar-day clock. The 7.35.3.8 patient application and the 7.35.3.13.C administration-day report are generated straight from the record.
Built for service centers, where Oregon requires every client record to live (OAR 333-333). Session records in mg psilocybin analyte with dose, duration, and ratio checks; OHA's own client forms included; 303 demographic data kept behind its own wall and leaving only as the quarterly aggregate report. The record also handles the destruction request the rules give clients after five years.
The facilitation record under 4 CCR 755-1, kept apart from the clinical one. Care under a clinician's own license during a session goes in a separate, linked clinical note. Adverse-event reporting tracks the 24-hour clock, and the de-identified state report is keyed to a random participant ID — no names, no contact details, no billing data. Colorado says natural medicine, not psilocybin, on purpose; as the state adds medicines, the record follows.
When the record flags a session — a dose over the cap, a missing form, a deadline coming due — the warning cites the rule it comes from, section number and all. You can look it up instead of taking our word for it, and nothing is ever blocked from being recorded.
Set up for FDA-approved psychedelic medicines, too. When they arrive, they'll chart on the clinical side and bill like any other treatment — in the same system, next to your state program. Healing centers will likely offer both; you won't need two record systems to do it.
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.
The program record is available for psilocybin service centers under OAR 333-333, where the state requires every client record to live. Clinicians providing preparation and integration under their own license can also ask us about billing and superbills.
The program record is available for healing centers and clinician practices under 4 CCR 755-1. Intake and psychotherapy under your own license bill as ordinary psychotherapy — ask us about billing and superbills alongside the record.
If your state is building a regulated access program, we're watching it too. Tell us where you practice and we'll let you know when the record supports it.
You'll talk to Anne, not a sales team.
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.
All three. 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. Oregon psilocybin services under OAR 333-333, built for service centers, including the quarterly aggregate report. Colorado natural medicine under 4 CCR 755-1, including the de-identified state report. Each practice's record uses its own state's fields, checks, reports, and terms.
Yes. An FDA-approved psychedelic medicine runs as ordinary medical care: charted on the clinical side of the record and billed through insurance like any other treatment, with prior authorizations and claims handled the same way. A practice offering both a state program and an FDA route keeps each in its lane in one system — the program record for the state, the clinical record for the payer. In New Mexico, if FDA approval opens coverage for the dosing day, turning that billing on is a settings change.
In Colorado, intake and psychotherapy under a clinician's own license bill as ordinary psychotherapy; natural medicine services themselves never go to a payer, and the record keeps the two apart so that line never blurs. In Oregon, facilitation sits outside insurance; clinicians providing preparation and integration under their own license can talk to us about billing and superbills. New Mexico billing launches in December 2026.
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.
Your data is never sold, scraped, mined, or used to train anything — that is permanent. The record itself is plain software with no AI in it and no blockchain. On the billing side, software drafts paperwork like claims and prior authorizations, citing the rule behind every code, and a person approves every one before it goes anywhere. If AI ever helps draft that paperwork, the same rules hold: trained on nothing of yours, reviewed by a person, and never near the chart or a care decision. Downstream charges for software and billing work; your patients are not the product.
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. Book a call to get a quote.
Pick a time that works, tell us where you practice and what you're interested in — record system, billing, superbills — and we'll take it from there.
Book a call