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END-TO-END, WORK-FREE RCM

The RCM & Prior Auth solution for telemedicine & specialty clinicS

Stop managing fragmented black boxes. Foresight orchestrates everything from eligibilitY, TO CODING, prior authORIZATIONS, CLAIM SCRUBBING, DENIAL RECOVERY, AND ERA-to-bank reconciliation. customIZED for your SPECIALTY, payers and workflowS.

WE USE PREDICTABLE RULES AND surgical AI only where rules can't reach. PLUS Optional managed services when you want us to own the queue.

3 min to submission

92% 1-st pass rate

85% autohandled

3 min to submission 92% 1-st pass rate 85% autohandled

How it works

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    Custom, transparent Logic

    We build specialty and payer-specific rules. Every decision, from POS code to modifier to timely-filing window, is rule-driven and fully auditable

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    Proactive, not reactive

    We determine PA requirements, co-pays, service line and formulary rules upfront. Foresight compiles clinical evidence, solves gaps and contradictions, submits, and chases status

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    Smart Submissions

    Claims and PAs are scrubbed pre-submission against live payer policies (not just format), validating codes against actual clinical notes. We catch upcoding, undercoding, and errors. 90%+ of volume runs hands-free; exceptions land in a prioritized queue with suggestions, or we run the queue for you

We handle claims and PAs end-to-end

When something can't be automated, whoever owns the queue, your team or ours, sees exactly what's wrong, why, and how to fix it

  • Value-first queues: Highest-dollar items on top

  • UNIFIED Pipeline: every stuck claim OR PA in one view, across ALL payerS

  • One-click fixes: Problems come with suggested fixES

Operate with confidence

THE BEST DENIAL PREVENTION STRATEGY IS TO AVOID A DENIAL IN THE FIRST PLACE. WE CHECK THAT ALL DATA IS COMPLETE, FREE OF CONTRADICTIONS, AND MEETS PAYER CRITERIA BEFORE SUBMISSION

from the start to high-volume

Designed for digital health and specialty clinics managing complex workflows like GLP-1, SPRAVATO, TMS, infectious diseases, or addiction, WHETHER YOU’RE A Single clinic or A nation-wide group. We handle the nuance of recurring visits, authorization limits, and specific documentation requirements that generic RCM tools miss

custom for your practice

The era when only health systems could afford CLINICAL OPS SYSTEMS is over. We adapt our PLATFORM to deliver client-specific results accommodating your data, PAYERS, AND KPIS, EVERYTHING IS REPORTED LIVE AND FULLY AUDITABLE

FAQs

    • You have to track data across several systems and your EHR won’t show the data you need

    • Every denied claim costs you $48 on average to rework

    • 8% of your revenue disappears into billing complexity

    • Your best clinicians waste 2 hours daily on admin work

  • We use predictable, custom-built rules + AI only where needed to lift the workload of creating PAs or claims and submitting them off you. We integrate with all EHRs and submit claims and prior authorizations using clearinghouses, electronic prior auth APIs and prior authorization portals as needed for maximum coverage.

  • Other vendors promise AI magic. We deliver predictable revenue

    • Rules for what's certain (patient demographics, POS codes, time based E/M, etc.)

    • AI only where needed and when needed (e.g., ICD-10 and CPT codes)

    • Every decision traced and auditable

    • Submission and re-try playbooks per payer and clinical area

  • Our multi-step process greatly increases 1st-pass approvals. When something is denied

    • We scan denial reasons to transform them into targeted fixes

    • E.g., CARC 197 → Missing auth → Auto-attach from ePA system → Resubmit → PAID

    • See denial patterns by payer, provider, while Foresight continuously learns and improves from past performance

Tap your revenue recovery potential

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