AI denial recovery for medical billing companies
The denials you write off still pay.
Mohenara is an AI-native denial recovery service for US billing companies. Our pipeline classifies each denial, drafts the correction or appeal, and routes judgment calls to your team. It runs under your brand, at a cost that makes small claims worth working again.
Built by RCM automation engineers · NVIDIA Inception member · Developed entirely on synthetic claims data · We sign BAAs
The problem
Below your threshold, working a denial loses money
Every billing company has a write-off threshold. Below it, working a denial costs more in labor than your percentage of the claim returns. Industry analyses consistently find that half to two-thirds of denied claims are never reworked at all, not because they cannot be overturned, but because the labor does not pencil.
Your write-off threshold
$150
Billing companies we have talked to run explicit thresholds anywhere from $10 to $750. Drag to yours.
Worked by hand
At $43 to $57 of labor per denial, anything under about $45 loses money before you touch your client's share. Everything from $10 to $150 sits in the write-off pile.
Worked through Mohenara
Pipeline cost in the low single dollars per denial moves the break-even down to roughly $3. The band between $3 and $150 stops being a write-off and starts being recovered revenue.
Labor cost sources: AHIMA-cited industry range of $25 to $181 per reworked claim; Premier Inc. 2023 survey, $57.23 average administrative cost per denied hospital claim.
How it works
A recovery line that runs behind your brand
Step 1
Send us the paper trail
835s, denial worklists, or an aged AR export. CO-16, CO-197, CO-29, timely filing, eligibility, the codes your team stopped chasing.
Step 2
The pipeline sorts and drafts
Each denial is classified by defect type and routed to a pipeline built for that denial group. Data fixes and proof retrieval run automatically. Corrected claims and appeal letters come out drafted, not templated.
Step 3
Your people gate judgment
Anything requiring clinical reasoning, signature authority, or payer-specific judgment stops for human review. Your staff approve in minutes instead of building from scratch.
Step 4
Resubmission under your name
Claims go back out through your existing channels and credentials. Your clients see your logo and your recovery numbers. We stay invisible.
The math
You keep about 7 cents of every recovered dollar. We built for that reality.
50 to 65%
of denied claims are never reworked, per industry analyses. Not because they cannot be overturned, but because the labor does not pencil.
$25 to $181
cost to rework a single denial (AHIMA-cited range; Premier's 2023 survey put the average at $57.23). On a percentage-of-collections contract, that math kills small claims before anyone reads them.
Your 7%
is the real budget for every recovery decision. Tools built for providers ignore this. Mohenara is priced and built around it.
Technology
Built on a synthetic claims testbed, not on your data
Before touching a single real claim, we built a 750-case synthetic testbed: full transaction chains from eligibility check to remittance, with planted, known defects. Every pipeline is scored against held-out cases before it ships. Denials are not one problem, so each denial group gets its own pipeline with deterministic checks plus bounded model judgment.
Security
Boring on purpose
We sign Business Associate Agreements. Development and evaluation run entirely on synthetic data, so no real patient data is involved in building the system. Production claim data stays on HIPAA-eligible AWS infrastructure under a BAA, encrypted in transit and at rest.
Pricing
Contingency only
We charge a percentage of what we actually recover. No recovery, no fee. No platform fees, no seats, no minimums.
We are onboarding a small number of design partners: billing companies who give us their write-off pile and help shape the product. Design partners get founder-level attention and preferential terms that persist.
Who we are
Built by people who automated RCM before it was a pitch deck
Mohenara was founded by Umer Jamil and Shoaib Ahmed. Shoaib spent 3 years as an automation engineer at CureMD, building internal tooling that keeps a large billing operation running. Umer previously led growth at Derek's Goods, a US e-commerce company. We work with independent US billing companies because that is where the work-or-write-off decision actually gets made.
FAQ
The questions we get
What do you need from us to start?
An aged AR export, denial worklist, or 835 files for the claims you have stopped working. That is enough for us to tell you what is recoverable under your threshold.
Do you compete with billing companies?
No. We only serve billing companies, white-label. Your clients stay yours, see your brand, and see your recovery numbers. We never contact providers directly.
Who actually does the work?
Per-denial-type pipelines do the classification, data fixes, and drafting. Humans gate every judgment step: clinical reasoning, signature authority, payer-specific calls. Nothing goes out the door on model output alone.
How is patient data handled?
Under a Business Associate Agreement, on HIPAA-eligible AWS infrastructure in US regions, encrypted in transit and at rest, with role-based access and audit logging. Client data is never used to train models. Details on the security page.
What does it cost?
A percentage of recovered revenue, agreed up front. If we recover nothing, you pay nothing.
What happens after I reach out?
A founder replies within one business day. The first call is 20 minutes: your aged AR, your write-off threshold, and whether the math works for your book. No demo theater.
Contact
Tell us your threshold. We'll tell you what's under it.
We start every conversation with your aged AR, not a demo. If you run a billing company and write off denials below a dollar figure, we would like to hear the number.
hello@mohenara.com · A founder replies within one business day.