How we use AI
Automated where work is repetitive, checked where it matters
Most billing work is repetitive, so we automate it: checking every code against the note, building and scrubbing claims, matching payments and tracking every unpaid claim. Our billing specialists review appeals, unusual claims and anything that needs judgment. We never upcode. Software never raises a code level or adds units.
Who does what
Software checks, matches and tracks. Our billing specialists handle what needs judgment. Your practice cares for patients and documents the care.
Software
- Checks each visit against the note and the insurance company's rules.
- Matches payments to visits.
- Tracks filing deadlines.
- Tracks visit limits and authorization dates.
- Gives every unpaid claim a next step and a date.
- Never raises a code, adds a unit or decides medical necessity.
A billing specialist
- Codes each visit from the signed note, with every code checked.
- Reviews everything the software flags.
- Reviews unusual claims and fixes rejected ones.
- Calls insurance companies when a claim stalls.
- Decides what to correct, appeal or recommend writing off.
- Reviews every appeal and corrected claim before it is sent.
- Answers your patients' billing calls.
Your practice
- Sees patients, documents the care and signs the notes.
- Collects insurance cards and copays, and requests authorizations.
- Approves refunds, and write-offs above the limit you set.
Claims go out under your National Provider Identifier (NPI)
Your NPI is on every claim. Medicare's enrollment form says: "Even if you use a billing agency/agent, you remain responsible for the accuracy of the claims submitted on your behalf."1 That is why we check every claim against the note before it goes out, and why we never upcode.
Who does what, part by part
Every part of the service: what software does in it, what our billing specialists do, what stays with your practice, and the rule we hold to.
The full scope, line by line| Part of billing | Software | Our billing specialists | Your practice | The rule |
|---|---|---|---|---|
| Coding and charge review | Software checks every code, unit and modifier against the signed note and the insurance company's written rules. For physical therapy, software also checks timed units, GP, KX and plan-of-care dates. | We code every visit from your clinician's signed note. When a note does not support a code, we ask your clinician to clarify. Our billing specialists review everything the software flags and make the judgment calls. | Sees patients, documents the care, signs the notes and answers our questions. | We never ask a clinician to change a signed note to get a claim paid. |
| Claim scrubbing and submission | Software builds and scrubs each claim and holds any claim that fails a check. Software tracks each payer's filing deadline. | Fixes and resends rejected claims, and bills secondary insurance after the primary pays. We track each insurance company's filing deadline and work claims before it passes. | Signs notes on time and gives correct patient and insurance details at intake. | Every claim has to pass every check before it goes out. |
| Payment posting | Software reads electronic remittances and matches each payment and adjustment to its visit. Software flags payments that differ from what the payer allowed before, take-backs and credit balances. | Works what does not match, and posts the paper checks and explanations of benefits (EOBs) you send. Works payments that differ from what the payer allowed before. If an insurance company overpaid you, we tell you in writing. | Forwards paper checks and EOBs, and approves refunds. | Software never moves money. Refunds need your approval, and write-offs above a limit you set need your approval. |
| Denials and appeals | Software sorts denials by reason and deadline. | Decides what to correct, appeal or recommend writing off. Our billing specialists call insurance companies. Software does not. | Supplies records or a clinician statement when asked, and approves write-offs above the limit you set. | Our billing specialists review every appeal and corrected claim before it is sent. |
| Accounts receivable (A/R) follow-up | Software gives every unpaid claim a next step and a date, and tracks claim status. | Works the list of unpaid claims and escalates what is stuck. Each contact with a payer is recorded on the claim. | Answers the questions only your practice can answer. | Nothing is written off without a reason. Write-offs above a limit you set need your approval. |
| Patient statements and calls | Software prepares statements from posted balances and tracks what was sent and paid. | Answers patients' billing questions, and sets up payment plans inside your policy. | Sets the financial policy for payment plans, discounts and collections, and collects copays at the visit. | No patient goes to collections without your approval. |
| Live dashboard and monthly summary | Software keeps your dashboard current as every claim moves, and assembles the numbers for your monthly summary. | 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. | Nothing is written off without a reason, and every write-off shows in your dashboard with its reason and who approved it. |
| Eligibility and benefits (automated check) | Checks coverage before scheduled visits: active coverage, plan dates, copay, coinsurance, deductible and visit limits where the payer returns them. | We look at unclear answers and tell your front desk. | Fixes insurance details at the front desk, talks to the patient, collects copays and decides whether to see the patient. | If a payer's answer is incomplete, it is flagged, never guessed. |
| Prior authorization (tracking) | Software 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. | Requests authorizations at the front desk, and writes plans of care and recertifications. | Requests stay with your front desk. |
What we promise
- Coding
We code every visit from your clinician's signed note. When a note does not support a code, we ask your clinician to clarify.
Every code, unit and modifier is checked against the note and the insurance company's written rules before the claim goes out.
- Upcoding
We never upcode. Software never raises a code level or adds units.
- Signed notes
We never ask a clinician to change a signed note to get a claim paid.
- Coverage
Software does not decide coverage or medical necessity.
It checks, flags and tracks. A billing specialist reviews every flag. Your clinicians document medical necessity.
- Appeals
Our billing specialists review every appeal and corrected claim before it is sent.
- Money
Software never moves money. Refunds need your approval, and write-offs above a limit you set need your approval.
- Overpayments
If an insurance company overpaid you, we tell you in writing.
- Failed checks
A failed check stops the claim and sends it to one of our billing specialists, not to the insurance company.
Why we never upcode
Insurers now look for claims that software pushed up. The Blue Cross Blue Shield Association says hospital AI coding tools added $942 million in spending over two years (as reported by TechCrunch, 2026-09-26).2 We use software to catch what is missing or unsupported, never to push a code up.
How we talk about AI, and about your data
Plainly. Automation handles the repetitive work, our specialists make the judgment calls, and every rule and industry number on this site links to its source. There is no official HIPAA certification.3 We sign a Business Associate Agreement before any patient data moves, and we follow the HIPAA Privacy, Security and Breach Notification Rules in how we handle your patients' information.
Questions about AI and responsibility
Software checks every code, unit and modifier against the signed note and the insurance company's written rules. Software reads electronic remittances and matches each payment and adjustment to its visit. Software gives every unpaid claim a next step and a date, and tracks claim status.
Our billing specialists review everything it flags and make the judgment calls.
A failed check stops the claim before it reaches the insurance company and sends it to one of our billing specialists.
We do. Mohenara codes every visit from your clinician's documentation and owns coding accuracy. Your clinicians document care; they do not choose codes.
Every code, unit and modifier is checked against the note and the insurance company's rules before the claim goes out. We never upcode. Software never raises a code level or adds units.
No. Our billing specialists call insurance companies. They pick up the phone whenever a claim needs a person.
Claims go out under your National Provider Identifier (NPI), and Medicare's enrollment form says you remain responsible for claims a billing agent sends for you.1
That is why we own coding accuracy: we code every visit from the documentation and check every code and unit against the note and the insurance company's rules before the claim goes out.
Next question: what happens to our patients' data?
How we protect your patients' information, from the business associate agreement to the day you leave.