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What we do

Complete billing, from signed note to paid claim

We code every visit, send and track every claim, post every payment, work every denial and unpaid claim, and bill your patients. Coverage is checked automatically before each visit and authorizations are tracked. You see every claim, live, in your dashboard.

Scope

The scope, line by line

Table 1Scope of the service
FunctionMarkMohenaraYour practicePage
Coding and charge reviewIncluded
  • Checks each visit's codes, units and modifiers against the signed note and the insurance company's written rules
  • For physical therapy, also timed units, GP, KX and plan-of-care dates
  • Codes every visit from the signed note
  • Reviews every flag
  • Sends your clinician the question and the reason
  • Sees patients, documents the care, signs the notes and answers our questions
Coding and charge review
Claim scrubbing and submissionIncluded
  • Builds and scrubs the claim; holds claims that fail a check
  • Tracks each payer's filing deadline
  • Fixes and resends rejected claims
  • Bills secondary insurance after the primary pays
  • Signs notes on time
  • Gives correct patient and insurance details at intake
Claims
Payment postingIncluded
  • Reads electronic remittances and matches each payment and adjustment to its visit
  • Flags payments that differ from what the payer allowed before, take-backs and credit balances
  • Works what does not match
  • Posts paper checks and EOBs you send
  • Tells you about overpayments in writing
  • Forwards paper checks and EOBs
  • Approves refunds
Payment posting
Denials and appealsIncluded
  • Sorts denials by reason and deadline
  • Decides whether to correct, appeal or recommend a write-off
  • Reviews every appeal before it is sent
  • Calls the payer
  • Supplies records or a clinician statement when asked
  • Approves write-offs above the limit you set
Follow-up and appeals
Accounts receivable (A/R) follow-upIncluded
  • Gives every unpaid claim a next step and a date; tracks claim status
  • Works the list
  • Calls insurance companies
  • Escalates what is stuck
  • Answers questions only the practice can answer
Follow-up and appeals
Patient statements and callsIncluded
  • Prepares statements from posted balances; tracks what was sent and paid
  • Answers your patients' billing questions
  • Sets up payment plans inside your policy
  • Sets the financial policy
  • Collects copays at the visit
  • Approves any collections referral
Patient statements and calls
Live dashboard and monthly summaryIncluded
  • Keeps your dashboard current as every claim moves
  • Writes your monthly summary: what changed, what is open and what we need from you
  • Sees every claim live, and makes the decisions the summary lists
Live dashboard
Eligibility and benefitsAutomated check only
  • Checks coverage before scheduled visits: active coverage, plan dates, copay, coinsurance, deductible and visit limits where the payer returns them
  • Looks at unclear answers and tells your front desk
  • Fixes insurance details, talks to the patient, collects copays, decides whether to see the patient
Before the visit
Prior authorizationTracking only
  • Tracks visits used against visits approved and the dates authorizations and recertifications end; warns before they run out
  • Checks each claim against the authorization on file
  • Requests authorizations at the front desk, and writes plans of care and recertifications
Before the visit
Credentialing and payer enrollmentNot included
  • Tells you when a denial points to an enrollment problem
  • Handles credentialing directly or through a credentialing service
See below

Tasks

Every task, and who does it

Open any row for the detail. Filter by mark.

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Coding and charge review

IncludedCoding and charge review

Claim scrubbing and submission

IncludedClaims

Payment posting

IncludedPayment posting

Denials and appeals

IncludedFollow-up and appeals

Accounts receivable (A/R) follow-up

IncludedFollow-up and appeals

Patient statements and calls

IncludedPatient statements and calls

Live dashboard and monthly summary

IncludedLive dashboard
  • IncludedLive dashboardEvery claim in real time, for your practice and for each patient
  • IncludedMonthly summaryMohenaraBilled, paid, still owed by age, every write-off, and what we need from you

Eligibility and benefits

Automated check onlyBefore the visit

Prior authorization

Tracking onlyBefore the visit

Credentialing and payer enrollment

Not includedSee below

Coding and charge reviewIncluded

Coding from your documentation

Mohenara codes every visit from your clinicians' signed notes

We do

Mohenara

  • Checks each visit's codes, units and modifiers against the signed note and the insurance company's written rules
  • For physical therapy, also timed units, GP, KX and plan-of-care dates
  • Codes every visit from the signed note
  • Reviews every flag
  • Sends your clinician the question and the reason

You do

  • Sees patients, documents the care, signs the notes and answers our questions

Coding and charge review

Coding and charge reviewIncluded

Codes, units and modifiers checked

Against the signed note and the payer's written rules

We do

Mohenara

  • Checks each visit's codes, units and modifiers against the signed note and the insurance company's written rules
  • For physical therapy, also timed units, GP, KX and plan-of-care dates
  • Codes every visit from the signed note
  • Reviews every flag
  • Sends your clinician the question and the reason

You do

  • Sees patients, documents the care, signs the notes and answers our questions

Coding and charge review

Coding and charge reviewIncluded

Documentation questions

Sent to your clinician with the reason

We do

Mohenara

  • Checks each visit's codes, units and modifiers against the signed note and the insurance company's written rules
  • For physical therapy, also timed units, GP, KX and plan-of-care dates
  • Codes every visit from the signed note
  • Reviews every flag
  • Sends your clinician the question and the reason

You do

  • Sees patients, documents the care, signs the notes and answers our questions

Coding and charge review

Coding and charge reviewYour practice

Signed notes

Your clinicians write and sign the notes, and clarify a note when we ask. We never ask a clinician to change a signed note to get a claim paid.

We do

Mohenara

  • Checks each visit's codes, units and modifiers against the signed note and the insurance company's written rules
  • For physical therapy, also timed units, GP, KX and plan-of-care dates
  • Codes every visit from the signed note
  • Reviews every flag
  • Sends your clinician the question and the reason

You do

  • Sees patients, documents the care, signs the notes and answers our questions

Coding and charge review

Claim scrubbing and submissionIncluded

Claim scrubbing

Required fields, payer IDs, code pairs, authorization dates, filing deadline

We do

Mohenara

  • Builds and scrubs the claim; holds claims that fail a check
  • Tracks each payer's filing deadline
  • Fixes and resends rejected claims
  • Bills secondary insurance after the primary pays

You do

  • Signs notes on time
  • Gives correct patient and insurance details at intake

Claims

Claim scrubbing and submissionIncluded

Submission

Sent through a clearinghouse

We do

Mohenara

  • Builds and scrubs the claim; holds claims that fail a check
  • Tracks each payer's filing deadline
  • Fixes and resends rejected claims
  • Bills secondary insurance after the primary pays

You do

  • Signs notes on time
  • Gives correct patient and insurance details at intake

Claims

Claim scrubbing and submissionIncluded

Duplicate claims stopped

Duplicates are blocked before they go out.

We do

Mohenara

  • Builds and scrubs the claim; holds claims that fail a check
  • Tracks each payer's filing deadline
  • Fixes and resends rejected claims
  • Bills secondary insurance after the primary pays

You do

  • Signs notes on time
  • Gives correct patient and insurance details at intake

Claims

Claim scrubbing and submissionIncluded

Rejections fixed and resent

Clearinghouse and payer rejections

We do

Mohenara

  • Builds and scrubs the claim; holds claims that fail a check
  • Tracks each payer's filing deadline
  • Fixes and resends rejected claims
  • Bills secondary insurance after the primary pays

You do

  • Signs notes on time
  • Gives correct patient and insurance details at intake

Claims

Claim scrubbing and submissionIncluded

Secondary claims

Sent after the primary pays

We do

Mohenara

  • Builds and scrubs the claim; holds claims that fail a check
  • Tracks each payer's filing deadline
  • Fixes and resends rejected claims
  • Bills secondary insurance after the primary pays

You do

  • Signs notes on time
  • Gives correct patient and insurance details at intake

Claims

Payment postingIncluded

Electronic remittances posted

Each payment and adjustment matched to its visit

We do

Mohenara

  • Reads electronic remittances and matches each payment and adjustment to its visit
  • Flags payments that differ from what the payer allowed before, take-backs and credit balances
  • Works what does not match
  • Posts paper checks and EOBs you send
  • Tells you about overpayments in writing

You do

  • Forwards paper checks and EOBs
  • Approves refunds

Payment posting

Payment postingIncluded

Paper checks and explanations of benefits (EOBs)

Posted when you send them

We do

Mohenara

  • Reads electronic remittances and matches each payment and adjustment to its visit
  • Flags payments that differ from what the payer allowed before, take-backs and credit balances
  • Works what does not match
  • Posts paper checks and EOBs you send
  • Tells you about overpayments in writing

You do

  • Forwards paper checks and EOBs
  • Approves refunds

Payment posting

Payment postingIncluded

Unmatched payments and take-backs

Flagged and worked, not written off

We do

Mohenara

  • Reads electronic remittances and matches each payment and adjustment to its visit
  • Flags payments that differ from what the payer allowed before, take-backs and credit balances
  • Works what does not match
  • Posts paper checks and EOBs you send
  • Tells you about overpayments in writing

You do

  • Forwards paper checks and EOBs
  • Approves refunds

Payment posting

Payment postingIncluded

Payments that differ from what the payer allowed before

Flagged and worked with the payer

We do

Mohenara

  • Reads electronic remittances and matches each payment and adjustment to its visit
  • Flags payments that differ from what the payer allowed before, take-backs and credit balances
  • Works what does not match
  • Posts paper checks and EOBs you send
  • Tells you about overpayments in writing

You do

  • Forwards paper checks and EOBs
  • Approves refunds

Payment posting

Payment postingYour practice

Refunds

We prepare them; you approve; software never moves money

We do

Mohenara

  • Reads electronic remittances and matches each payment and adjustment to its visit
  • Flags payments that differ from what the payer allowed before, take-backs and credit balances
  • Works what does not match
  • Posts paper checks and EOBs you send
  • Tells you about overpayments in writing

You do

  • Forwards paper checks and EOBs
  • Approves refunds

Payment posting

Denials and appealsIncluded

Denials sorted by reason and deadline

We do

Mohenara

  • Sorts denials by reason and deadline
  • Decides whether to correct, appeal or recommend a write-off
  • Reviews every appeal before it is sent
  • Calls the payer

You do

  • Supplies records or a clinician statement when asked
  • Approves write-offs above the limit you set

Follow-up and appeals

Denials and appealsIncluded

Corrections and appeals

A billing specialist reviews every appeal before it is sent.

We do

Mohenara

  • Sorts denials by reason and deadline
  • Decides whether to correct, appeal or recommend a write-off
  • Reviews every appeal before it is sent
  • Calls the payer

You do

  • Supplies records or a clinician statement when asked
  • Approves write-offs above the limit you set

Follow-up and appeals

Denials and appealsIncluded

Clinical appeals

Sent to your clinician for review and signature

We do

Mohenara

  • Sorts denials by reason and deadline
  • Decides whether to correct, appeal or recommend a write-off
  • Reviews every appeal before it is sent
  • Calls the payer

You do

  • Supplies records or a clinician statement when asked
  • Approves write-offs above the limit you set

Follow-up and appeals

Denials and appealsIncluded

Write-off recommendations

In writing; above your limit, only with your approval

We do

Mohenara

  • Sorts denials by reason and deadline
  • Decides whether to correct, appeal or recommend a write-off
  • Reviews every appeal before it is sent
  • Calls the payer

You do

  • Supplies records or a clinician statement when asked
  • Approves write-offs above the limit you set

Follow-up and appeals

Accounts receivable (A/R) follow-upIncluded

Next step and date on every unpaid claim

Ordered by filing deadline, amount and age

We do

Mohenara

  • Gives every unpaid claim a next step and a date; tracks claim status
  • Works the list
  • Calls insurance companies
  • Escalates what is stuck

You do

  • Answers questions only the practice can answer

Follow-up and appeals

Accounts receivable (A/R) follow-upIncluded

Payer calls and status checks

Each contact recorded on the claim

We do

Mohenara

  • Gives every unpaid claim a next step and a date; tracks claim status
  • Works the list
  • Calls insurance companies
  • Escalates what is stuck

You do

  • Answers questions only the practice can answer

Follow-up and appeals

Patient statements and callsIncluded

Patient statements

After insurance has paid its share

We do

Mohenara

  • Prepares statements from posted balances; tracks what was sent and paid
  • Answers your patients' billing questions
  • Sets up payment plans inside your policy

You do

  • Sets the financial policy
  • Collects copays at the visit
  • Approves any collections referral

Patient statements and calls

Patient statements and callsIncluded

Patients' billing questions

Balances explained; payment plans inside your policy

We do

Mohenara

  • Prepares statements from posted balances; tracks what was sent and paid
  • Answers your patients' billing questions
  • Sets up payment plans inside your policy

You do

  • Sets the financial policy
  • Collects copays at the visit
  • Approves any collections referral

Patient statements and calls

Patient statements and callsYour practice

Financial policy and collections decisions

Payment plans, small balances, collections

We do

Mohenara

  • Prepares statements from posted balances; tracks what was sent and paid
  • Answers your patients' billing questions
  • Sets up payment plans inside your policy

You do

  • Sets the financial policy
  • Collects copays at the visit
  • Approves any collections referral

Patient statements and calls

Live dashboard and monthly summaryIncluded

Live dashboard

Every claim in real time, for your practice and for each patient

We do

Mohenara

  • Keeps your dashboard current as every claim moves
  • Writes your monthly summary: what changed, what is open and what we need from you

You do

  • Sees every claim live, and makes the decisions the summary lists

Live dashboard

Live dashboard and monthly summaryIncluded

Monthly summary

Billed, paid, still owed by age, every write-off, and what we need from you

We do

Mohenara

  • Keeps your dashboard current as every claim moves
  • Writes your monthly summary: what changed, what is open and what we need from you

You do

  • Sees every claim live, and makes the decisions the summary lists

Live dashboard

Eligibility and benefitsAutomated check only

Coverage check before scheduled visits

Coverage, plan dates, copay, coinsurance, deductible and visit limits as the payer returns them

We do

Mohenara

  • Checks coverage before scheduled visits: active coverage, plan dates, copay, coinsurance, deductible and visit limits where the payer returns them
  • Looks at unclear answers and tells your front desk

You do

  • Fixes insurance details, talks to the patient, collects copays, decides whether to see the patient

Before the visit

Eligibility and benefitsAutomated check only

Problems to your front desk

Inactive or changed coverage goes on your front desk's list before the visit

We do

Mohenara

  • Checks coverage before scheduled visits: active coverage, plan dates, copay, coinsurance, deductible and visit limits where the payer returns them
  • Looks at unclear answers and tells your front desk

You do

  • Fixes insurance details, talks to the patient, collects copays, decides whether to see the patient

Before the visit

Eligibility and benefitsAutomated check only

Unclear answers stay unknown

An incomplete answer from a payer is flagged, never guessed

We do

Mohenara

  • Checks coverage before scheduled visits: active coverage, plan dates, copay, coinsurance, deductible and visit limits where the payer returns them
  • Looks at unclear answers and tells your front desk

You do

  • Fixes insurance details, talks to the patient, collects copays, decides whether to see the patient

Before the visit

Eligibility and benefitsNot included

Calling payers to verify benefits

The coverage check is electronic, before every scheduled visit

We do

Mohenara

  • Checks coverage before scheduled visits: active coverage, plan dates, copay, coinsurance, deductible and visit limits where the payer returns them
  • Looks at unclear answers and tells your front desk

You do

  • Fixes insurance details, talks to the patient, collects copays, decides whether to see the patient

Before the visit

Prior authorizationTracking only

Authorization tracking

Visits used against visits approved, and the date each authorization ends

We do

Mohenara

  • Tracks visits used against visits approved and the dates authorizations and recertifications end; warns before they run out
  • Checks each claim against the authorization on file

You do

  • Requests authorizations at the front desk, and writes plans of care and recertifications

Before the visit

Prior authorizationTracking only

Recertification dates

Plan-of-care and recertification dates, with a warning before they end

We do

Mohenara

  • Tracks visits used against visits approved and the dates authorizations and recertifications end; warns before they run out
  • Checks each claim against the authorization on file

You do

  • Requests authorizations at the front desk, and writes plans of care and recertifications

Before the visit

Prior authorizationYour practice

Authorization requests

Your front desk decides when one is needed and requests it

We do

Mohenara

  • Tracks visits used against visits approved and the dates authorizations and recertifications end; warns before they run out
  • Checks each claim against the authorization on file

You do

  • Requests authorizations at the front desk, and writes plans of care and recertifications

Before the visit

Credentialing and payer enrollmentNot included

Credentialing and payer enrollment

Your practice or a credentialing service

We do

Mohenara

  • Tells you when a denial points to an enrollment problem

You do

  • Handles credentialing directly or through a credentialing service

Comparison

How our scope compares with billing companies

What US billing companies include in their core fee, from a 2022 industry survey, next to what we include.

Table 2Share of US billing companies that include each service in their core fee (2022)
ServiceBilling companies (2022)Mohenara
Claims submission96%Included
Claims follow-up95%Included
Appeals86%Included
Patient support74%Included: statements and calls
Medical coding62%Included: we code every visit from your clinicians' documentation
Verification of benefits50%Automated check before every scheduled visit
Credentialing25%Not included

Survey of 277 people at US medical billing companies, September to October 2022.1 The survey's labels are kept.

Your practice

What stays with your practice

You

Your clinicians

  • Your clinicians see patients and document the care.
  • Your clinicians sign the notes.
  • Your clinicians answer our documentation questions.

You

Your front desk

  • Your front desk collects insurance cards and fixes insurance details.
  • Your front desk requests authorizations.
  • Your front desk collects copays at the visit.

You

You

  • You set the financial policy.
  • Software never moves money. Refunds need your approval, and write-offs above a limit you set need your approval.
  • You keep credentialing and payer enrollment current, or use a credentialing service.

Credentialing and authorization requests

Credentialing and payer enrollment stay with your practice or your credentialing service, as they do with most billing companies: in a 2022 survey of 277 people at US billing companies, 25% counted credentialing as part of their core service.1 Prior authorization requests stay with your front desk; we track visits used against visits approved and warn before an authorization or recertification date runs out.

One visit

One visit, from signed note to paid

Follow one visit through every step, with who did each one.

Claim record

Claim C-28941

Secondary plan

Pt 2137, Tue, Sep 8, 2026, Visit 15, PTA 1 (North), Medicare Part B + supplement

Open now $17.62

Checks before the claim went out

7 of 7 passed
  • 62 timed minutes = 4 units under Medicare's 8-minute rule (53 to 67 minutes).Software
  • GP on every line.Software
  • CQ on every line: a PTA furnished the visit. Medicare pays these lines at 85%.Software
  • KX not needed: $1,298.63 of therapy this year before this visit, under $2,480.Software
  • Plan of care certified Jul 15 through Sep 23; this visit is covered.Software
  • 97140 with 97530 on the same day: no Medicare code-pair edit since 2020, so no 59 or X modifier.Software
  • Units within Medicare's daily limits (MUE).Software

Timeline

Who did what, and when
  1. Fri Sep 4, 6:05 amSoftwareEligibility for the Sep 8 visit: Medicare Part B active, supplement on file.
  2. Tue Sep 8You (PTA 1)Visit 15; note signed the same day.
  3. Tue Sep 8, 7:40 pmSoftwareCharge review passed (checks above).
  4. Wed Sep 9, 5:30 pmSoftwareClaim sent to Medicare Part B.
  5. Thu Sep 10SoftwareAccepted by the payer (277CA).
  6. Fri Sep 25, 8:05 amSoftwareMedicare paid $69.08: payer adjustment (CARC 45) including the multiple procedure reduction (CARC 59); sequestration (CARC 253) $1.41; coinsurance $17.62; claim forwarded to the supplement plan (remark MA18).
  7. NextSoftwareWaiting on the supplement plan. If the supplement plan is late, a billing specialist follows up.

Outcome

Allowed$88.11Charges $331.00
Medicare paid$69.0880% less 2%
Sequestration$1.41CARC 253
Coinsurance$17.6220% of allowed
Payer adjustment$242.89CARC 45
Expected$86.70Open now $17.62

Split of the $88.11 allowed: Medicare paid $69.08; sequestration $1.41 (CARC 253); coinsurance $17.62, billed to the supplement plan by crossover; patient $0.00. Payer adjustment $242.89 (CARC 45, including the multiple procedure reduction) plus $1.41 (CARC 253). Expected $86.70.

Figure 1Claim records from your dashboardSee every view

In detail

Each part, in detail

Questions

Questions about scope

Coding and charge review, claim scrubbing and submission, payment posting, denials and appeals, accounts receivable (A/R) follow-up, patient statements and calls, a live dashboard and a monthly summary.

Coverage is checked automatically before every visit, and prior authorizations are tracked while your front desk requests them.

Credentialing and payer enrollment stay with your practice or your credentialing service. We bill under the enrollments you already have.

Your front desk requests them, and we track them: visits used against visits approved, and the dates authorizations and recertifications end. Your front desk is warned before they run out.

We check coverage electronically before every scheduled visit, including visit limits and deductibles, so no one waits on hold. Coverage problems go on your front desk's list before the visit, with the reason.

Collects insurance cards and keeps insurance details current, requests authorizations, and collects copays at the visit. Your clinicians document care. Mohenara does the rest.

Next question: what does it cost?

Pricing