Foresight helps interventional psychiatry teams document failed medication trials the way payers audit them, capture rating scales on a reauthorization-ready cadence, track delivered sessions against authorized counts, and keep Spravato REMS, benefit routing, and drug codes straight across payers.
Insufficient documentation of prior medication trials is the most common TMS denial cause. Beyond that, payers disagree on almost everything: which rating scales qualify, how long an adequate trial runs, whether a psychotherapy trial is required, and how long an authorization lasts. Winning packets match each payer's counting rules before submission, not on appeal.
Structure medication trials as a table — drug, dates, dose, outcome — and corroborate outside-prescriber trials with pharmacy fill history at intake.
Capture a qualifying baseline scale before the PA and schedule mid-course and end-of-course rescores, so reauthorizations never wait on a missing score.
Record authorization end dates and granted units as structured fields the moment a determination arrives, and start reauth work ahead of each boundary.
Route each Spravato patient down the correct benefit rail, and flag any session where the auth or the drug shipment is unconfirmed.
Foresight checks whether required evidence is present, whether records contradict each other, and whether the available facts look approvable under payer criteria before submission.
Verify each medication trial carries drug, dates, dose reached, and discontinuation reason; check rating-scale baseline recency, psychotherapy-trial evidence where the payer requires it, contraindication screening, PDMP checks, REMS enrollment, and observation documentation before the packet is drafted.
Flag trial histories that conflict with pharmacy fill data, session ledgers that do not match 90867/90868/90869 usage, Spravato units that disagree with the documented dose, monotherapy patients routed to a payer that still requires a concurrent oral antidepressant, or an auth issued under a retired drug code.
Apply each payer's counting rules — adequate-trial duration and class requirements, accepted rating scales, current-episode and recency windows, psychotherapy-trial expectations, and improvement thresholds for repeat courses — before a high-cost episode is scheduled.
A useful audit scores concrete workflow gaps: missing evidence, contradictory records, payer criteria risk, and follow-through after submission.
Whether the claim, PA, or appeal has the basic identifiers and clinical anchors needed before work leaves the queue.
Where the EHR, notes, questionnaire, inventory, pharmacy response, and billing record point to different answers.
Whether the available evidence appears to satisfy payer criteria before the submission creates AR or appeal work.
Whether approvals, denials, paper EOBs, portal messages, corrected claims, and deposits resolve cleanly after submission.