End—to—end,
work-free RCM
The 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 using predictable rules, surgical AI, and optional managed services.
See results, not surprises.
Foresight runs the cycle from eligibility to patient statements.
Custom, transparent logic
Custom rules built from your setup and your payer relationships — covering every part of the PA and RCM cycle.
Eligibility you can act on
Foresight runs eligibility across more than one source, catches the carve-outs a single check misses, and returns one confidence-scored answer.
Smart submissions
Claims are scrubbed against each payer’s own rules and fixed for you. 90%+ run on autopilot; the rest surface in a prioritized queue with the fix attached.
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.
Reduce denials, speed up approvals.
We catch likely denials before claims & PAs are submitted by scrubbing against payer policies, the chart, and catching what’s missing up front.
- Codified payer rules. Each plan’s required documentation and coverage criteria, per service.
- Traceable. Every requirement links back to the exact policy it came from.
- Safety holds. Anything uncertain is notified so a human expert can check before submission rather than get a denial weeks later.
The plan won’t pay this visit without its Medi-Cal Social Services & Mental Health Referral Form.
The best denial strategy is to avoid the denial in the first place.
We check that data is complete, contradiction-free, and meets payer criteria before submission.
Fragmented RCM has a price.
We handle claims and PAs end-to-end.
Full managed services, or automation plus your team.
Tired of reading data? Just ask.
Your claims, prior auths, denials and work queue — answered as a table or a chart, right where you’re working.
- Live data. Read the moment you ask, not from last night’s export.
- Ask a follow-up. “Break that down by payer” refines the answer instead of starting over.
- Read-only. It answers questions. It never changes a claim, an auth, or a queue item.
- Yours only. Your organization’s data, and every look-up logged.
From the start, to high-volume care.
Designed for digital health and specialty clinics with complex workflows — weight management, interventional psychiatry, infectious diseases, addiction medicine. Single clinic or nationwide telemedicine group.
Clinical automation for everyone.
Wegovy, Zepbound, Saxenda, and Ozempic/Mounjaro off-label for weight. Most payers gate on BMI plus a documented lifestyle trial and comorbidities.
Frequently asked.
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.
Tell us your issues.
We'll tell you if and how we can help.
We'll tell you if we're the right partners for your issues and priorities in the first meeting, and will help whichever way we can.
What we'll review together
- 01# of claims / PAs
- 02Denial rates and reasons
- 03Eligibility issues
- 04A/R buckets
- 05Budget and priorities