For treatment-resistant depression, an authorization gap is a clinical interruption. Foresight assembles TMS and Spravato evidence before submission, tracks scores and authorized sessions, and keeps benefit routing and drug codes aligned with each payer.
Assemble drug, dose, start and end dates, response, and reason for discontinuation. Corroborate outside-prescriber trials with available fill history. Check the payer's trial-count, duration, class, current-episode, and psychotherapy requirements; a medication list alone does not establish an adequate trial.
Track baseline, mid-course, and end-of-course scores using scales the payer accepts, such as PHQ-9, MADRS, or HAM-D. Flag outdated baselines and missing response documentation before a continuation or repeat-course request is due.
Keep granted units and expiration dates beside the session ledger. Reconcile initial mapping, treatment sessions, and motor-threshold redeterminations with 90867/90868/90869 usage. Start reauthorization before either the unit limit or end date interrupts the scheduled course.
Distinguish medical buy-and-bill from pharmacy-supplied treatment. Check the authorization, expected drug supply, dose, billable units, and payer's current code requirements together. Surface an unconfirmed shipment or a drug-code change that requires a new authorization.
Keep REMS enrollment and the post-dose observation record with the billed session. Check contraindication screening, PDMP documentation where required, and payer requirements for concurrent oral antidepressant use. Clinical questions go to the treating clinician.
Confirm the benefit and gather prior trials, psychotherapy history, and a qualifying baseline score.
Compare the evidence with the current policy. Identify missing records and contradictions before drafting the packet.
Present the evidence and drafted answers for approval. Track submission, additional-information requests, and the determination.
Track sessions, drug supply, scores, and remaining authorization. Reconcile claims and payments while preparing any renewal.