Check the claim before it reaches the payer.
Build claims from encounter data, apply payer-specific edits, and submit through the appropriate clearinghouse or paper route.
Catch coding and documentation conflicts.
Validate codes, diagnosis-to-procedure linkage, duplicates, provider eligibility, and NCCI or add-on modifier rules. Surface the proposed correction with the finding.
Current payer policies. Optional clinic overrides.
Medical-necessity and reimbursement checks reflect each payer's current policies. Foresight refreshes them as policies change, and your clinic can override the defaults with its own rules.
Route each transaction by payer.
Use the clearinghouse that supports the payer and transaction. Generate and send paper claims where electronic submission is unavailable.
Give exceptions a next action.
Claims needing review arrive with the problem and suggested fix, prioritized by dollar value.