Frequently asked.

Yes. Foresight works with your existing EHR and writes results back. Your team can handle exceptions, or you can add managed services for follow-up and billing work. We agree which workflows and responsibilities move to Foresight during scoping.

Every PA packet, including a resubmission, requires clinician review and sign-off. AI drafts answers and gathers supporting evidence; it does not approve treatment.

For claims, you set the confidence thresholds for automatic submission. Missing evidence, uncertain coding, and unresolved payer requirements go to your team.

Foresight checks whether the clinical note supports the diagnosis and service, whether required fields agree, and whether the record meets the payer’s documentation criteria. Each finding includes its source and proposed next action.

We map your SOP and analyze de-identified samples: denied claims, stuck PAs, or your top denial reasons. In a live 30-minute session, we show what Foresight would prevent, fix automatically, and recover. No commitment; we will tell you if we do not find substantial recovery potential.

Rules handle explicit requirements and structured fields. AI extracts information from narrative notes when a rule or database field cannot supply the answer. Every result records its source; clinical ambiguities go to review.

Each claim or PA field records its source: database, rule, or AI extraction, with an AI confidence score where applicable. This audit trail helps you investigate payer questions and decide whether to correct or appeal a denial.

Foresight integrates with major EHRs including Healthie, Canvas, eClinicalWorks, and custom systems that expose standard APIs. During implementation, we map your fields and handle each EHR’s sync cadence, document formats, and webhooks.

We prefer structured fields for speed and reliability. When information lives in clinical notes, AI extracts diagnosis codes, procedure codes, and other relevant data with confidence scores.

During onboarding, we configure payer-specific rule packs tailored to your contracts and requirements. These include required modifiers, bundling rules, timely filing windows, prior authorization requirements, and credentialing checks. As we process claims, the system continuously learns from denials and adjusts rules to improve performance with each payer. You can also manually configure custom rules for unique payer relationships.

Foresight achieves a 92.1% first-pass rate, meaning 92 out of 100 claims are accepted on first submission without requiring corrections. PA first-pass rate is similarly high. This matters because rejected claims cost time and money to rework, delay payment, and hurt cash flow. A high first-pass rate means your revenue arrives faster and your staff spends less time fixing errors. Our pre-submission scrubbing catches formatting and content errors before they ever reach the clearinghouse.

Our denial rate is 4.8%, significantly below the industry average of 10-15%. We achieve this through payer-specific playbooks, pre-submission validation rules, and continuous learning from past denials. Every denied claim is analyzed to understand the CARC/RARC denial reason codes, and we automatically apply fixes when possible before resubmission.

Approximately 90% of claims are auto-handled without human intervention. Prior auths always pass through clinician review before submission — but the assembly is automated, so each PA usually takes a clinician seconds, not minutes. Across claims and PAs, your staff processes 6-7 times more work than with manual workflows; only items with low confidence scores, unusual patterns, or unresolved payer-specific requirements get extra attention in your queue.

Our average time-to-submit is 0.8 days (less than 1 business day) from when encounter data is available to when the claim is submitted to the payer. This is achieved through automated extraction, rules-based validation, and pre-submission scrubbing that eliminates delays. Compare this to the industry average of 3-5 days for manual processing.

Foresight analyzes CARC (Claim Adjustment Reason Code), RARC (Remittance Advice Remark Code), and PA denial reasons, then applies payer-specific playbooks. Resolvable coding errors, missing fields, and authorization attachments are fixed and claims resubmitted automatically. For example, CARC 197 triggers an ePA check to attach the missing authorization.

You see denial patterns by payer and provider; those patterns inform future prevention. A clinician signs off before every PA resubmission.

Foresight pulls encounter and medication/procedure data from your EHR, then answers payer questions using structured fields and AI extraction. Retrieval-augmented generation matches evidence and answers to the formulary and PA policies in force for your contract.

A clinician reviews the questions, drafted answers, and cited chart evidence before sign-off. Confidence flags help prioritize review; every packet requires approval before submission through electronic APIs or pre-filled portals.

We track the decision. After a denial, the retry playbook drafts the next packet—alternative drug, documentation, or appeal—and routes it through clinician review again.

Yes. Foresight connects to practice bank accounts through Plaid, matches payer ERAs to deposits, flags missing deposits, and tracks provider-level balance (PLB) adjustments through reconciliation. This closes the loop from remittance to bank settlement without manual spreadsheet reconciliation.

Yes. Foresight is designed with HIPAA compliance from the ground up. All PHI (Protected Health Information) is encrypted in transit using TLS 1.3+ and at rest using AES-256 encryption.

We maintain comprehensive audit logs of every access to patient data, including who accessed it, when, what they did, and from what IP address. We provide Business Associate Agreements (BAAs) for all customers and maintain compliance with all HIPAA Security Rule requirements.

Yes. Foresight completes regular penetration tests.

Other controls: row-level multi-tenant data isolation, Bedrock Guardrails with PHI/PII content controls on every LLM call, TLS 1.3+ in transit and AES-256 at rest, WAF in front of API Gateway, code-signed Lambda deployments, PHI rate limiting on API handlers, and comprehensive access logging. We provide a BAA and can share a security one-pager on request for your procurement team.

Revenue Cycle Management (RCM) covers the administrative and clinical work of collecting patient service revenue, from scheduling to final payment. It includes registration, insurance verification, charge capture, claim submission, payment posting, and denial management.

A prior authorization is approval from a health insurance company required before certain medications, procedures, or services can be provided. Without this approval, the insurance may deny coverage, leaving the patient responsible for the full cost. Prior authorizations are designed to control costs and ensure medical necessity, but they often create administrative burdens and delays in patient care.