01Prior authorization

Prior authorization, assembled and defended.

Foresight gathers the evidence, drafts the medical-necessity case, submits it, and tracks it — reviewed and signed off by your clinician before it goes out.

Necessity engine
Each criterion is scored against the payer's own policy — approve, review, or deny, with the evidence behind every answer.
Medical-necessity engine

Scored against the payer's own rules

We load the payer's policy for the code, then read the chart criterion by criterion. Each answer resolves to true, false, or maybe — and a maybe routes to a person, never a guess.

Grounded. Every answer cites the chart line and policy clause behind it.
Auditable. The full evidence chain is saved with the decision, end to end.
Sign-off. The finished packet lands with your clinician for review before it's submitted.
Evidence & letters

The packet builds itself

Prior failed trials and step-therapy history — the top denial reason across the industry — are pulled from the chart and written into a medical-necessity letter, ready to send.

Medical-necessity letterDraftForesight
  • Step therapy4 failed antidepressant trials
  • SeverityPHQ-9 baseline documented
  • DiagnosisF33.2 recurrent MDD
Every span links to the chart line it came from.
A drafted medical-necessity letter with the evidence spans it draws from.
Submission & specialty depth

It tracks the course, not just the claim

We submit through the electronic PA path where a payer has one and fall back to fax where they don't — then chase status and file the appeal if it's denied. For recurring treatments we track the authorized course against what's delivered and flag reauth before it lapses.

Authorized course
A TMS course runs ~36 sessions; Spravato forks across the medical and pharmacy benefit — both are tracked.
See it on your claims

Bring a week of claims.
We'll show you the layer.

In under 30 minutes we'll walk this through on your data — what we'd catch, fix, and recover on day one.

This capability

AreaPrior authorization
Runs onYour EHR
ReviewTunable · audited