What we do / Follow-up and appealsIncluded
Every unpaid claim gets a next step and a date
We check claim status, call insurance companies, correct and resend claims, and file appeals, until each claim is paid or you decide to close it.
Who does what
Who does what with unpaid claims
Denials are one part of this work. We correct and resend each denied claim, or appeal it.
Mohenara
- Gives every unpaid claim a next step and a date, and tracks claim status.
- Sorts denials by reason and deadline.
- Calls insurance companies when a claim stalls.
- Decides whether to correct a claim, appeal it or recommend a write-off.
- Reviews every appeal and corrected claim before it is sent.
- Each contact with a payer is recorded on the claim.
Your practice
- You send records or a clinician statement when an appeal needs one.
- Your clinicians review and sign clinical appeals.
- You decide whether to close a claim that cannot be recovered.
Claims board
Being recovered68$3,932.09 openBilling specialist38 denials being corrected or appealed ($3,371.65) and 30 underpaid claims ($560.44: $254.18 short from the payer plus $306.26 patient share, billed once the payer fixes its payment).
Showing 3 per column
Total open: 619 claims, $43,003.11. Equals Open A/R.
Spaces: workstreams
As of Sep 28- Commercial PPO B: 97530 paid less than it allowed beforePayer reprocessingBilling specialist
Since the Aug 25 payment, PPO B paid 97530 about 15% less than it allowed on earlier claims (about $29.39 a unit instead of $34.58) on 43 claims (78 units), $404.59 short in total. Dispute sent Sep 2 for the first 16 claims, then as each new one arrived. 13 claims corrected on Sep 22 ($150.41 recovered). 30 still short ($254.18). Patient statements on these visits wait until the payment is corrected.
- Plans of care: recerts dueNeeds youYou (therapists); software tracks the dates
Pt 2150: certified through Sep 24, visit Sep 28 held, next visit Sep 30. Pt 2153: certified through Sep 18, next visit Oct 1. Pt 2180: certified through Oct 2, next visit Oct 6.
- Authorizations1 over, 1 running lowYou (front desk requests); software tracks visits used
Pt 2173 (Commercial HMO C): visit 15 on Sep 24 is past the 14 authorized; retro request needed. Pt 2294 (HMO C): 2 of 8 used, 9 scheduled; runs out at visit 8 on Oct 19. Pt 2280 (Medicare Advantage A): 3 of 12 used, 6 scheduled, covered.
- Payer E: over 30 daysWaiting on payerBilling specialist
15 claims over 30 days ($2,207.01, 6 patients), out of 50 open Payer E claims ($7,240.74).
- Medicare therapy threshold (KX)WatchingSoftware, checked by a billing specialist
Pt 2166: $3,329.84 this year on the claims we bill. KX on every line since Aug 26. Above $3,000, Medicare can select claims for targeted review; notes must show why skilled therapy is still needed.
- September patient statementsSentSoftware; calls by a billing specialist
4 runs (Sep 1: 16, Sep 8: 11, Sep 15: 17, Sep 22: 19) = 63 statements covering 105 balances, $3,430.73. 25 of those balances paid so far ($756.93).
- Denials being workedIn progressBilling specialist
38 claims, $3,371.65: missing information (CARC 16) 14, $1,318.74; coordination of benefits (22) 10, $859.02; authorization absent (197) 9, $801.58; visit limit reached (119) 4, $216.29; medical necessity (50) 1, $176.02.
Deadlines
Deadlines we work to
Each unpaid claim is worked against the insurance company's own clock. These are Medicare's, from the regulations and manuals.
| Deadline | What the rule says |
|---|---|
| Payment on a clean claim | Medicare cannot pay a clean electronic claim until 13 days after it receives it, and must pay or deny it within 30 days.1 |
| Medicare appeal (redetermination) | Medicare redetermination requests are due within 120 days of receiving the initial decision.2 |
| Medicare Advantage appeal (reconsideration) | Medicare Advantage reconsideration requests are due within 60 calendar days of receiving the plan's written decision.3 |
| Filing limit | Medicare claims must be filed within one calendar year of the date of service.4 |
- Small and awkward claims are worked like the rest, until they are paid or you decide to close them.
- We track each insurance company's filing deadline and work claims before it passes.
- Software never moves money. Refunds need your approval, and write-offs above a limit you set need your approval.
- Clinical appeals go to your clinician for review and signature.
Published data
What published data says
How often claims are denied on first submission across US practices. Every claim we fix before it goes out stays out of this number.
- Medical practices saw 7% to 8% of claims denied on first submission across the past four years.7% to 8%
Industry reference. Source: MGMA Stat, 2026-07-30.5
Questions
Questions about follow-up and appeals
Yes. Every unpaid claim gets a next step and a date, until it is paid or you decide to close it.
Nothing is written off without a reason. Write-offs above a limit you set need your approval.
Yes. We sort each denial by reason, then correct the claim or appeal it. Our billing specialists review every appeal and corrected claim before it is sent. We ask your clinician when an appeal needs clinical detail.