The indication, benefit, and continuation rules must agree. Foresight checks the chart against the patient's plan, collects missing evidence at intake, and prepares initial and renewal requests for clinician sign-off.
Match the documented indication to the requested drug and benefit. Keep obesity, diabetes, cardiovascular, and sleep-apnea criteria distinct. Check the PBM, formulary, exclusions, and step therapy before drafting a request that the plan will not cover.
Use dated height, weight, and BMI records, with the comorbidities required for that indication. Reconcile diagnoses, BMI Z-codes, labs, and questionnaire answers so the evidence supports the same request throughout.
Collect the lifestyle-program history, previous therapies, response, and contraindication screening required by the payer. Missing evidence becomes a specific intake question before the clinician reviews the PA.
Track the authorization end date alongside baseline and current weight, adherence, and treatment response. Apply continuation criteria to the longitudinal record; an initial-authorization checklist is not sufficient for every renewal.
Verify the plan and indication. Collect the BMI timeline, comorbidity history, and prior-treatment evidence before the visit.
Check the formulary and clinical criteria. Flag missing evidence or conflicts between the chart and requested therapy.
Present the drafted answers and supporting chart evidence. Submit only after clinician approval.
Track the payer response, route denials for review, and collect continuation evidence before authorization expires.