RCM Fox automates your entire prior authorization workflow — screening, payer calls, form submission, coding, claims, and REMS compliance. No human operator needed.
Your revenue specialists spend hours on phone calls and paperwork instead of getting patients into treatment.
Every new Spravato patient requires calling the payer to determine medical vs. pharmacy benefit. "I was on the phone for an hour just trying to get to the correct department."
Each payer has different forms, different portals, different criteria. Aetna uses fax. Cigna uses their portal. Florida Blue uses Lucet. CoverMyMeds for Spravato. Every one is different.
One clinic lost $100K in a few months from a single hire who kept missing prior authorizations. Wrong codes, missed deadlines, incomplete documentation.
Payer rules change every 6-12 months without notice. "Training is trial and error; you learn from denials." Your best person's knowledge walks out the door when they leave.
Patient arrives → system handles everything → clinic gets paid. You just monitor the dashboard.
Checks patient eligibility against every payer's exact criteria — diagnosis codes, PHQ-9 thresholds, medication failure history, contraindications. Instant results.
AI voice agent calls the payer, navigates the IVR, waits on hold, and asks: "Is Spravato covered under medical or pharmacy benefit?" Returns structured results in minutes.
Fills the correct PA form with all clinical data, routes to the right channel — Lucet portal, CoverMyMeds, fax, or FHIR API — and submits. No human touches the form.
Monitors PA status, processes decisions, codes each treatment session with the right CPT codes per payer, generates claims, and auto-refiles denials.
Built from real clinic SOPs. Every feature solves a problem we heard in the field.
Knows that Florida Blue needs 4 med failures (not 2), PHQ-9 ≥ 20 (not 18), and uses Lucet for behavioral health. Every payer's exact rules, always current.
Makes VOB and PA status calls to UHC, Aetna, Cigna, and more. Handles IVR navigation, hold times, and transfers. Extracts structured data from every call.
Auto-fills and submits through CoverMyMeds, Lucet, Cigna portal, UHC portal, fax, or the new FHIR PA API. One system, every channel.
Knows that Florida Blue switched to G-codes for Spravato. TMS mapping is 90867, sessions are 90868. Generates correct claims with auth numbers attached.
CARC 197 (no auth on file)? Auto-refiles with the authorization number. Detects patterns — "UHC denied 3 claims this month for the same reason."
Auto-enrolls Spravato patients in the Janssen REMS portal. Submits monitoring forms within 7 days of each session. Alerts when deadlines approach.
See every patient's pipeline stage, revenue at stake, PA status, and claim outcomes. Know exactly which patients are stuck and why.
Scrapes payer policy documents weekly, detects when criteria change, and auto-updates screening rules. No more surprise denials from policy changes.
One recovered TMS course ($7K) or Spravato course ($14K) pays for months of RCM Fox.
We're selecting 2 TMS or Spravato clinics to co-develop RCM Fox with. You get hands-on support, direct access to the founding team, and a permanent discount.
Apply for Design Partner →