End—to—end,
work-free RCMThe RCM & prior-auth platform for telemedicine & specialty clinics.
Stop managing fragmented black boxes. Foresight orchestrates everything from eligibility and prior auths to claims and denials — with predictable rules, surgical AI, and optional managed services.
See results. Not surprises.
From the first eligibility check to the last dollar collected — Foresight runs the cycle with predictable rules and surgical AI.
Custom, transparent logic
We don't just pull and submit data. We build custom rules derived from your specific setup and relationship with payers for maximum accuracy — handling all parts of the PA and RCM cycle.
Proactive, not reactive
We run dual-layer eligibility checks and determine PA requirements, co-pays, etc. instantly. If a PA is needed, Foresight auto-compiles clinical evidence, submits it, and chases the status — gating the prescription or claim until approval is secured.
Smart submissions
Claims and PAs are scrubbed against payer-specific rules — not just generic formatting. We fix errors programmatically and route to the correct payer automatically. 90%+ runs on autopilot; edge cases surface in a prioritized queue with AI-suggested fixes for your team or ours.
AI only used
where it’s safe
With tunable confidence scores, everything else stays rules-first and audit-ready. No black boxes. No surprises on your monthly revenue report.
Turn denials from dead ends into dollars.
We scan denial reasons and transform them into targeted fixes — traced, auditable, and resubmitted without human touch where we're confident enough.
- Rules for what's certain. Patient demographics, POS codes, time-based E/M.
- AI only where needed. ICD-10 and CPT coding, tunable confidence scores.
- Every decision traced. Submission and re-try playbooks per payer and clinical area.
The best denial prevention is to avoid a denial in the first place.
We check that all data is complete, free of contradictions, and meets payer criteria beforesubmission. Every flagged claim or PA shows exactly what's wrong and suggests how to fix it — with extracted data, confidence scores, and guardrails you can tune.
We handle claims and PAs end-to-end.
Full managed services, or automation + your team. When it's your team dealing with non-automatable tasks, we show them what, why, and how to fix it.
From the start, to high-volume care.
Designed for digital health and specialty clinics managing complex workflows — GLP-1, TMS, infectious diseases, addiction. Single clinic or nation-wide telemedicine group. We handle the nuance of recurring visits, authorization limits, and specific documentation requirements that generic RCM tools miss.
Clinical ops systems, no longer only for the largest health systems.
Every specialty comes with its own payer rulebook. Tap a practice to see the criteria Foresight tracks and documents end-to-end — so submissions go out complete the first time.
GLP-1 telemedicine
Wegovy, Zepbound, Saxenda, and Ozempic/Mounjaro off-label for weight. Most payers gate on BMI plus a documented lifestyle trial and comorbidities.
Frequently asked.
Short, honest answers. If we don't cover yours here, bring it to the demo — we'll walk you through the exact playbook.
01We already have a solution. Why change?
- 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.
02How is Foresight different?
03Won’t AI make unpredictable decisions?
- 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.
04How does Foresight deal with denials?
- 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 and provider, while Foresight continuously learns and improves from past performance.
Bring a week of claims.
We'll find the money.
Send us a sample. In under 30 minutes we'll show you the denial rate we'd have caught, the dollars recovered, and the playbook we'd run on day one.