Completeness
Check for subscriber identifiers, active behavioral health benefit, rendering NPI/taxonomy, license type, supervision, diagnosis, procedure, pointer, treatment plan, time, modality, patient location, and prior auth where required.
Behavioral health
Psychology and psychiatry RCM needs provider, service, and telehealth logic on every claim.
Foresight helps behavioral health groups separate therapy, psychiatry, testing, medication management, collaborative care, and telehealth billing rules so claims match the provider type and documented service.
Provider logic
Why it matters
Mental health revenue leakage often looks simple until the payer checks provider taxonomy, license type, telehealth place of service, time documentation, psychotherapy add-ons, testing supervision, or collaborative-care consent and registry requirements.
Cleaner provider-specific billing
Fewer avoidable modifier and credentialing denials
Better support for mixed therapy and psychiatry groups
Workflow checks
Evidence to catch before work leaves the queue.
Operating workflow
Rules-first automation with human review where it counts.
- Provider type, taxonomy, rendering NPI, supervising relationship, and payer enrollment for psychologists, psychiatrists, PMHNPs, therapists, MFTs, and counselors
- Correct service family: diagnostic evaluation, psychotherapy, medication-management E/M, psychotherapy add-on, crisis, family/group therapy, testing, or care-management, with examples such as 90791/90792, 90832/90834/90837, 90833/90836/90838, and 99492/99493/99494
- Telehealth place-of-service, modifier, audio-only, state licensure, and payer carve-out rules
- Collaborative care and BHI requirements, including registry tracking, patient consent, behavioral care manager time, psychiatric consultant review, monthly minute thresholds, and 99484 versus CoCM routing
Classify the encounter from documentation before charge release instead of relying on appointment type alone.
Check provider-specific payer rules so a therapy claim is not sent under a medical taxonomy or an E/M claim under a non-E/M eligible clinician.
Validate time, modality, diagnosis, treatment plan, and add-on-code evidence before claim submission.
Route denials by root cause: credentialing, authorization, modifier/POS, diagnosis-service mismatch, or documentation.
Automation fit
Inspect the actual artifacts.
Foresight checks whether required evidence is present, whether records contradict each other, and whether the available facts look approvable under payer criteria before submission.
Contradictions
Catch appointment-type and note mismatches such as therapy booked but E/M documented, 90837 with only 45 minutes, add-on psychotherapy without a primary E/M service, or telehealth POS/modifier rules copied from another payer.
Payer approvability
Apply payer carve-outs, visit limits, credentialing constraints, telehealth rules, testing-supervision requirements, and CoCM/BHI consent, registry, consultant-review, and monthly-minute thresholds before claim release.
Common leakage points
The work Foresight is built to surface early.
90791/90792, psychotherapy, and E/M services treated as interchangeable
Telehealth modifiers or POS rules applied globally instead of by payer
Psychotherapy add-ons missing separately identifiable documentation
Testing or collaborative-care claims missing supervision, consent, registry, or time evidence
Workflow risk audit
Map the risk surface.
A useful audit scores concrete workflow gaps: missing evidence, contradictory records, payer criteria risk, and follow-through after submission.
Required evidence present
Whether the claim, PA, or appeal has the basic identifiers and clinical anchors needed before work leaves the queue.
Chart contradictions
Where the EHR, notes, questionnaire, inventory, pharmacy response, and billing record point to different answers.
Payer approvability
Whether the available evidence appears to satisfy payer criteria before the submission creates AR or appeal work.
Follow-through
Whether approvals, denials, paper EOBs, portal messages, corrected claims, and deposits resolve cleanly after submission.
Psych / psych
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