Foresight helps psychiatry teams coordinate TMS treatment episodes, Spravato REMS requirements, payer authorization criteria, session counts, drug codes, observation documentation, and claim rules across payers.
A TMS or Spravato denial is rarely just a claim edit. The failure may have started weeks earlier in treatment-resistant depression evidence, rating-scale history, REMS enrollment, monitoring documentation, code transition handling, or auth/session-count tracking.
Verify benefit route, auth criteria, and payer-required depression history before scheduling a high-cost episode.
Surface missing rating scales, failed medication trials, REMS fields, or treatment-plan evidence before the session occurs.
Track authorized sessions, used sessions, motor-threshold events, observation time, and reauthorization triggers.
Route exceptions to the operator who can fix them, with the clinical and billing context already attached.
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 TRD/MDD diagnosis support, failed medication trials, rating-scale baseline and trend, auth dates, authorized session count, REMS setting status, observation documentation, discharge note, drug code, NDC, unit, and payer-required service code.
Flag session ledgers that do not match 90867/90868/90869 usage, Spravato dose and billable units that disagree, REMS monitoring missing from the billing record, or an auth approved under a retired or payer-specific drug code.
Evaluate treatment-resistant depression criteria, prior therapy expectations, rating-scale severity, induction/maintenance cadence, reauthorization triggers, REMS requirements, and site-of-care rules before high-cost visits are 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.