What we do / Before the visitAutomated check only
Coverage checked before the patient arrives
Coverage is checked automatically before every scheduled visit, and visits are counted against each authorization. Problems go to your front desk before the patient does. Your front desk requests authorizations; we track them.
Coverage: automated check. Authorizations: tracked. See the full scope
Who does what
Who does what before the visit
Mohenara
- Checks coverage automatically before scheduled visits: active coverage, plan dates, copay, coinsurance, deductible and visit limits where the payer returns them.
- Tracks visits used against visits approved and the dates authorizations and recertifications end, and warns before they run out.
- Checks each claim against the authorization on file.
Your practice
- Your front desk fixes insurance details, talks to the patient, collects copays and decides whether to see the patient.
- Your front desk decides when an authorization is needed, then requests and submits it.
- Your clinicians write plans of care and recertifications.
Needs you
Now: 8 items; 9 visits held, $884.03
Showing 3 of 8: front desk| Item | Who | Patient | What is needed | Why | Held | Due | Status |
|---|---|---|---|---|---|---|---|
| 1 | You: Front desk | Pt 2259, Commercial PPO A, PT 2 | A copy of the new insurance card | Eligibility check before the Sep 23 visit: coverage ended Sep 22. No visit scheduled; please call the patient. | 3 visits (Sep 23, 25, 28), $282.64 | As soon as possible | Needs you |
| 2 | You: Front desk | Pt 2186, Payer E, PT 1 | Payer approval for visits after the Sep 21 re-evaluation | The payer approves visits in blocks; visits 11 and 12 are held until it does. | 2 visits (Sep 23, 28), $238.42 | Before the Sep 30 visit | Needs you |
| 3 | You: Front desk | Pt 2173, Commercial HMO C, PT 1 | Ask the plan for a retro authorization for 1 visit | Visit 15 on Sep 24 is past the 14 authorized. | 1 visit, $63.08 | This week | Needs you |
| Item | Who | Patient | What | By |
|---|---|---|---|---|
| 9 | You: PT 1 | Pt 2153, Medicare Part B | Recertification: plan certified through Sep 18; visits resume Oct 1 | Oct 1 |
| 10 | You: PT 4 | Pt 2180, Medicare Part B | Recertification: plan certified through Oct 2; visits Oct 6 and Oct 9 | Oct 5 |
| 11 | You: PT 3 | Pt 2166, Medicare Part B | Above $3,000 this year with KX on every line: make sure each note shows why skilled therapy is still needed | Next visit, Oct 1 |
| 12 | You: Front desk | Pt 2294, Commercial HMO C | Request more visits: 2 of 8 used, 9 scheduled; runs out at visit 8 | Oct 16 |
What we check
What the automated check reads
The check reads what the insurance company returns electronically before a scheduled visit.
| Field | What it tells your front desk |
|---|---|
| Coverage active | Whether the plan on file covers the patient on the visit date. |
| Plan dates | When the plan started, and when it ends if the insurance company reports an end date. |
| Copay, coinsurance and deductible | The patient's share as the insurance company reports it, so your front desk can collect the copay at the visit. |
| Visit limits | Visits allowed and visits used this year, where the insurance company returns them. |
- An answer the payer leaves incomplete stays unknown, never zero.
What the rules say
Why coverage is checked before the visit
Deductibles shift what patients owe, and some plans ration visits or require approval first.
- 34% of covered workers have a deductible of $2,000 or more for single coverage (2025).34%
Source: KFF, 20251
- Since 2026, Medicare Advantage plans must decide standard prior authorization requests within 7 calendar days.7 days
Source: CMS, 2024-012
- Example: physical therapyOriginal Medicare has no yearly visit limit for outpatient therapy and no prior authorization for it.No cap
Source: Medicare.gov, read 2026-09-29; CMS, read 2026-09-293,4
Questions
Questions about before the visit
Coverage problems go on your front desk's list before the visit, with the reason. Your front desk decides whether to see the patient, and can talk to them about coverage first.
A coverage check is not a guarantee of payment.
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.