What we do

Complete billing, and exactly what stays with you

Ten parts of billing. We run seven, check one automatically, track one, and leave one with you. Each is below, with who does what.

Scope

The scope, line by line

TABLE 1.Scope of the service
Function	Mark	Software	Your billing team	Your practice	Page
Charge review and coding checks	INCLUDED	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	Reviews every flag Sends your clinician the question and the reason Changes a code only with your clinician's approval	Your clinicians choose the codes, write and sign notes, answer questions and approve any change	Charge review
Claim scrubbing and submission	INCLUDED	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 Correct patient and insurance details at intake	Claims
Payment posting	INCLUDED	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	Posts 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 appeals	INCLUDED	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 its limit	Follow-up and appeals
Accounts receivable (A/R) follow-up	INCLUDED	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 calls	INCLUDED	Prepares statements from posted balances; tracks what was sent and paid	Answers your patients' billing questions Payment plans inside your policy	Sets the financial policy Collects copays at the visit Approves any collections referral	Patient statements and calls
Month-end reporting (plus dashboard)	Month-end reportINCLUDEDClient dashboardPLANNED	Assembles the numbers The client dashboard is planned and shown only as sample data	Writes the report: what changed, what is open, who owns each item	Reads the report and makes the decisions it lists	Month-end report
Eligibility and benefits	AUTOMATED 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 Does not call payers to verify benefits	Fixes insurance details, talks to the patient, collects copays, decides whether to see the patient	Before the visit
Prior authorization	TRACKING 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	Your front desk requests and submits authorizations; clinicians write plans of care and recertifications	Before the visit
Credentialing and payer enrollment	NOT INCLUDED	Nothing	Tells you when a denial points to an enrollment problem	Your practice or its credentialing service	See below

A coverage check is not a guarantee of payment.

Tasks

Every task, and who does it

Open any row for the detail. Filter by mark.

Charge review and coding checks

INCLUDEDCharge review

YOUR PRACTICECodes chosen, notes signedYouYour clinicians choose the codes and own the documentation
INCLUDEDCodes, units and modifiers checkedSoftware, checked by your billing teamAgainst the signed note and the payer's written rules
INCLUDEDDocumentation questionsYour billing teamSent to your clinician with the reason
YOUR PRACTICECode changesYouNothing changes without your clinician's approval

Claim scrubbing and submission

INCLUDEDClaims

INCLUDEDClaim scrubbingSoftwareRequired fields, payer IDs, code pairs, authorization dates, filing deadline
INCLUDEDSubmissionSoftwareSent through a clearinghouse
INCLUDEDDuplicate claims stoppedSoftwareDuplicates are blocked before they go out.
INCLUDEDRejections fixed and resentYour billing teamClearinghouse and payer rejections
INCLUDEDSecondary claimsYour billing teamSent after the primary pays

Payment posting

INCLUDEDPayment posting

INCLUDEDElectronic remittances postedSoftware, checked by your billing teamEach payment and adjustment matched to its visit
INCLUDEDPaper checks and explanations of benefits (EOBs)Your billing teamPosted when you send them
INCLUDEDUnmatched payments and take-backsYour billing teamFlagged and worked, not written off
INCLUDEDPayments that differ from what the payer allowed beforeSoftware, checked by your billing teamFlagged and worked with the payer
YOUR PRACTICERefundsYouWe prepare them; you approve; software never moves money

Denials and appeals

INCLUDEDFollow-up and appeals

INCLUDEDDenials sorted by reason and deadlineSoftware
INCLUDEDCorrections and appealsYour billing teamA person reviews every appeal before it is sent.
INCLUDEDClinical appealsYour billing teamSent to your clinician for review and signature
INCLUDEDWrite-off recommendationsYour billing teamIn writing; above your limit, only with your approval

Accounts receivable (A/R) follow-up

INCLUDEDFollow-up and appeals

INCLUDEDNext step and date on every unpaid claimSoftwareOrdered by filing deadline, amount and age
INCLUDEDPayer calls and status checksYour billing teamEach contact recorded on the claim

Patient statements and calls

INCLUDEDPatient statements and calls

INCLUDEDPatient statementsSoftware, checked by your billing teamAfter insurance has paid its share
INCLUDEDPatients' billing questionsYour billing teamBalances explained; payment plans inside your policy
YOUR PRACTICEFinancial policy and collections decisionsYouPayment plans, small balances, collections

Month-end reporting (plus dashboard)

Month-end reportINCLUDEDClient dashboardPLANNEDMonth-end report

INCLUDEDMonth-end reportYour billing teamBilled, paid, adjusted, still owed by age; open items with owners
PLANNEDClient dashboardShown on this site as a sample with synthetic data

Eligibility and benefits

AUTOMATED CHECK ONLYBefore the visit

AUTOMATED CHECK ONLYCoverage check before scheduled visitsSoftwareCoverage, plan dates, copay, coinsurance, deductible and visit limits as the payer returns them
AUTOMATED CHECK ONLYProblems to your front deskSoftware, checked by your billing teamInactive or changed coverage goes on your front desk's list before the visit
AUTOMATED CHECK ONLYUnclear answers stay unknownSoftwareAn incomplete answer from a payer is flagged, never guessed
NOT INCLUDEDCalling payers to verify benefitsThe check is electronic

Prior authorization

TRACKING ONLYBefore the visit

TRACKING ONLYAuthorization trackingSoftwareVisits used against visits approved, and the date each authorization ends
TRACKING ONLYRecertification datesSoftwarePlan-of-care and recertification dates, with a warning before they end
YOUR PRACTICEAuthorization requestsYouYour front desk decides when one is needed and requests it

Credentialing and payer enrollment

NOT INCLUDEDSee below

NOT INCLUDEDCredentialing and payer enrollmentYour practice or 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 2.Share of US billing companies that include each service in their core fee (2022)
Service	Billing companies (2022)	Mohenara
Claims submission	96%	Included
Claims follow-up	95%	Included
Appeals	86%	Included
Patient support	74%	Included: statements and calls
Medical coding	62%	Charge review and coding checks; your clinicians choose the codes
Verification of benefits	50%	Automated check before visits
Credentialing	25%	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 choose the codes and 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 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.

Not included, said plainly

Credentialing and payer enrollment are not part of the service. 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. For context: in a 2022 survey of 277 people at US billing companies, 25% counted credentialing as part of their core service.¹

One visit

One visit, from signed note to paid

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

Client dashboardSample clinic · Physical therapy · 2 locations

SAMPLE DATAFictional clinic. Synthetic numbers.Updated Mon Sep 28, 6:00 pm

Claim record

Sample clinic

Sample view with synthetic data. The client dashboard is planned; this shows what it will track.

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

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

Timeline

Who did what, and when

Fri Sep 4, 6:05 amSoftwareEligibility for the Sep 8 visit: Medicare Part B active, supplement on file.
Tue Sep 8You (PTA 1)Visit 15; note signed the same day.
Tue Sep 8, 7:40 pmSoftwareCharge review passed (checks above).
Wed Sep 9, 5:30 pmSoftwareClaim sent to Medicare Part B.
Thu Sep 10SoftwareAccepted by the payer (277CA).
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).
NextSoftwareWaiting on the supplement plan. If the supplement plan is late, your billing team 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.

FIG. 1Sample claim records. Synthetic data. Example: a fictional physical therapy clinic.See every view

Client dashboardSample clinic · Physical therapy · 2 locations

SAMPLE DATAFictional clinic. Synthetic numbers.Updated Mon Sep 28, 6:00 pm

Claim record

Sample clinic

Sample view with synthetic data. The client dashboard is planned; this shows what it will track.

Claim C-28884

Being recovered

Pt 2125 · Mon, Aug 17, 2026 · Visit 9 · PT 3 (South) · Medicare Part B + supplement

Open now $106.48

Checks before the claim went out

6 of 6 passed

Passed: 54 timed minutes = 4 units under Medicare's 8-minute rule (53 to 67 minutes).Software
Passed: GP on every line.Software
Passed: No CQ: a physical therapist furnished the visit.Software
Passed: KX not needed: $874.50 of therapy this year before this visit, under $2,480.Software
Passed: Plan of care certified Jul 20 through Oct 17; this visit is covered.Software
Passed: Units within Medicare's daily limits (MUE).Software

Timeline

Who did what, and when

Fri Aug 14, 6:05 amSoftwareEligibility for the Aug 17 visit: Medicare Part B active, supplement on file.
Mon Aug 17You (PT 3)Visit 9; note signed the same day.
Mon Aug 17, 7:40 pmSoftwareCharge review passed (checks above).
Tue Aug 18, 5:30 pmSoftwareClaim sent to Medicare Part B.
Wed Aug 19SoftwareAccepted by the payer (277CA).
Tue Sep 8, 8:05 amSoftwareMedicare denied the claim: missing information (CARC 16). The referring physician's NPI on the claim did not match Medicare's records.
Thu Sep 10Your billing teamConfirmed the referring physician's NPI with your front desk.
Thu Sep 17Your billing teamCorrected claim sent to Medicare Part B.
NextYour billing teamWaiting on the decision on the corrected claim. If Medicare is late, your billing team follows up.

Expected outcome

Allowed$108.22Charges $330.00

Medicare share$84.8480% less 2%

Sequestration$1.74CARC 253

Coinsurance$21.6420% of allowed

Payer adjustment$221.78CARC 45

Expected$106.48Open now $106.48

Expected split of the $108.22 allowed once Medicare pays the corrected claim: Medicare $84.84; sequestration $1.74 (CARC 253); coinsurance $21.64 to the supplement plan. Expected $106.48.

FIG. 3Sample claim records. Synthetic data. Example: a fictional physical therapy clinic.See every view

In detail

Each part, in detail

INCLUDED
Charge review
Your clinicians code. We check every claim first.
AUTOMATED CHECK · TRACKING ONLY
Before the visit
Coverage checked, authorizations tracked.
INCLUDED
Claims
Checked, sent and tracked.
INCLUDED
Payment posting
Every payment matched to its visit.
INCLUDED
Follow-up and appeals
A next step and a date for every unpaid claim.
INCLUDED
Patient statements and calls
Clear bills and a person to answer.
INCLUDED
Month-end report
Your month in writing.

Questions

Questions about scope

Charge review and coding checks, claim scrubbing and submission, payment posting, denials and appeals, accounts receivable (A/R) follow-up, patient statements and calls, and a month-end report. Eligibility is an automated check before visits. Prior authorizations are tracked, not requested. Credentialing is not included.

No. Credentialing and payer enrollment are not part of the service. Your practice or a credentialing service keeps them current.

No. Your front desk requests them. We track visits used against visits approved and the dates authorizations and recertifications end, and warn your front desk before they run out.

No. An automated coverage check runs before scheduled visits. Coverage problems go on your front desk's list before the visit, with the reason. A coverage check is not a guarantee of payment.

Collects insurance cards and fixes insurance details, requests authorizations, and collects copays at the visit.

Next question: what does it cost?

Pricing

Complete billing, and exactly what stays with you

Your clinicians

Your front desk

You

Not included, said plainly

Charge review

Before the visit

Claims

Payment posting

Follow-up and appeals

Patient statements and calls

Month-end report

What is included?+

Do you do credentialing?+

Do you request prior authorizations?+

Do you verify benefits by phone?+

What does my front desk still do?+

Notes