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 — with predictable rules, surgical AI, and optional managed services.

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0min

To 1st submission

1st-pass rate

Auto-handled

Revenue · Orchestrated

From eligibility to ERA · one surface

Trusted by leading clinics and partners

01How it works

See results. Not surprises.

Foresight runs the cycle from the first eligibility check to the last dollar collected.

01 / CUSTOM

Custom, transparent logic

Custom rules built from your setup and your payer relationships — covering every part of the PA and RCM cycle.

Rules engineAuditable

02 / Proactive

Eligibility you can act on

A single check misses what’s carved out to a behavioral-health vendor or a second plan. Foresight runs eligibility across more than one source, catches the carve-out, and returns one confidence-scored answer — so “not covered” doesn’t become a surprise denial.

Multi-sourceCarve-outConfidence

03 / Smart

Smart submissions

Claims are scrubbed against each payer’s own rules, and the fixes get applied for you — per-payer taxonomy, place of service, modifiers, fee schedules. 90%+ run on autopilot; the rest surface in a prioritized queue with the fix attached.

Per-payer overridesScrubbing

The platform

The layer your EHR doesn’t have.

Prior auth, eligibility, claims, charge accuracy, denials, and the patient ledger — on top of the EHR you already use.

01Prior authorization 02Eligibility 03Claims 04Charge accuracy 05Provider billing & assignment 06Denials & AR analytics 07Patient ledger & payments +The full platform

Explore the platform

A promise

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.

02 · Denials

Turn denials from dead ends into dollars.

Most denials are decided before the claim is ever submitted. We read each payer’s own medical-necessity policy, check it against the claim and the chart, and catch what’s missing up front — with the rule cited and the fix in hand.

The payer’s own rules, codified.Each plan’s required documentation and coverage criteria, per service.
Cited, not guessed. Every requirement links back to the exact policy it came from.
Held, not denied.Anything uncertain surfaces for a quick human check before submission — not a denial weeks later.

Medical-necessity check

Outpatient mental-health visit$85.00

Blue Shield Promise · Medi-Cal

Evaluating

Evaluated from the claim, the payer’s own rules, and the evidence on file.

Medi-Cal behavioral-health referralRequired

Blue Shield Promise won’t pay an outpatient mental-health visit without its Medi-Cal Social Services & Mental Health Referral Form.

Blue Shield Promise · Behavioral Health Services Program

0 of 1 required documents satisfied

Caught before the claim goes out — not weeks later, after a denial.

$85 paid. Denial prevented, every step traced.

Blue Shield Promise · taxonomy 1041C0700X · LCSW

03 · Operate with confidence

The best denial prevention is to avoid a denial in the first place.

We check that data is complete, contradiction-free, and meets payer criteria before submission. Every flagged claim or PA shows exactly what's wrong and how to fix it.

Pre-submission scrubbing. Contradictions caught at the source, not the clearinghouse.

Solutions attached to problems. Every issue lands with an AI-suggested fix.

Tunable confidence. You decide where Foresight auto-submits and where work escalates for review.

The cost of the status quo

Fragmented RCM has a price.

to rework a single denied claim

of revenue lost to billing complexity

of clinician time on admin, every day

04 · Claims & PA

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.

Value-first queues. Highest-dollar items stay on top.

Pipeline visibility. See stuck items across PAs and claims instantly.

One-click fixes. Problems come with solutions attached.

05 · Scale

From the start, to high-volume care.

Designed for digital health and specialty clinics with complex workflows — GLP-1, TMS, infectious disease, addiction. Single clinic or nationwide telemedicine group.

Recurring visits. Authorization cadence rules, managed.

Specialty-grade documentation. Requirements that generic RCM tools miss.

06 · Custom for your practice

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.

Tailored toYour data model

Tuned forYour payer mix

ReportingLive · auditable

AnalyticsYour KPIs, your way

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.

BMI

≥ 30, or ≥ 27 with a weight-related comorbidity

Comorbidity

T2DM, HTN, dyslipidemia, or OSA documented

Lifestyle trial

3–6 months of diet & exercise on record

Reauthorization

≥ 5% weight loss at 3–6 months

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?

We use predictable, custom-built rules + AI only where needed to lift the workload of creating PAs or claims and moving them out the door. 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. For prior auth, the populated packet always lands with a clinician for review and sign-off before any submission goes out.

03Won’t AI make unpredictable decisions?

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.

04How does Foresight deal with denials?

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 and provider, while Foresight continuously learns and improves from past performance.

Tap your revenue recovery potential

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.

Book a demo Read case studies

What we'll review together

Claim sample size7 × days

Denial categories scannedCARC / RARC

Eligibility re-runs4 layers

Recoverable revenueSurfaced · live

BAA & security reviewDay one

End—to—end,work-free RCM