What Changes When the Clearing House Is Inside the EHR
What actually changes when the clearinghouse sits inside the EHR: who holds the contract, who starts payer enrollments, and where you work a rejection.
A clearinghouse inside the EHR changes who holds the contract, who starts payer enrollments, and where you work a rejection. The claim is built from the signed note and worked in the same queue as the chart. With Ona Clearing House there is no separate Stedi account to open, contract or pay for.
Quick answer:
- What changes: one vendor relationship instead of two, enrollments created in the same place you chart, and rejections worked next to the note they came from.
- What does not change: payers still set enrollment timelines, a denial is still a payer decision, and the codes on the claim are still your responsibility.
- You can also keep what you have: Ona connects to your own Claim.MD account with an API key, and your existing payer enrollments carry over.
What a clearinghouse actually does
A clearinghouse sits between your practice and the payers. It takes the claim your system builds, translates it into the format each payer expects, transmits it, and brings the response back. Almost every practice that bills electronically at volume works through one. That is the whole job, and it is the same job whoever performs it.
Because the job is identical everywhere, the question worth asking is not which clearinghouse is best. It is where the clearinghouse sits relative to the record you chart in, and which parts of the work land on your desk as a result.
Three arrangements exist in practice. You can hold a clearinghouse account of your own and work it in a separate portal beside your EHR. You can hold your own account and connect it to your EHR so the claims come back into the chart. Or your EHR vendor can hold the clearinghouse relationship for you, which is what Ona Clearing House is: Ona's clearinghouse product, running on Stedi as its partner, with no separate Stedi account to open or pay for.
The five things that actually change
1. One contract instead of two
With a separate clearinghouse you sign with them, get credentialed with them, manage a login with them, and reconcile a second invoice every month. With Ona Clearing House, Ona holds that relationship. The setup guide is blunt about it: Ona holds the relationship, you do not sign up separately or manage credentials.
This matters most at the two ends of a practice's life. A practice billing insurance for the first time has no clearinghouse to keep, and every account it does not have to open is a week it does not lose. A group consolidating several sites usually has several arrangements inherited from whoever set each one up, and folding them into one is the point of the exercise.
2. The claim is built from the note, not re-keyed from it
When the clearinghouse is outside, something has to carry the visit across: an export, an upload, or a person retyping codes. When it is inside, the chain is continuous. A signed note produces a completed visit, the visit produces a superbill frozen from it, and the superbill produces a CMS-1500 draft with the diagnoses and service lines already in place. Nothing is re-keyed, which removes an entire category of rejection before it happens.
Ona also runs billing rules over the claim before it goes out: units on every billable CPT code, a linked diagnosis on every line, a documentation note required before a visit can be billed, the Medicare 8-minute rule on timed codes, and filing-deadline warnings. Rules are set organization-wide and overridden per insurance type or payer. A rejection costs days of turnaround. A rule that catches the same problem before submission costs nothing.
3. Rejections are worked where the clinical record is
Claims in Ona move through seven statuses: draft, submitted, acknowledged, accepted, rejected, denied and paid. Those describe the payer's view. Alongside them sit eight workflow buckets your team controls, from untriaged through review, hold, payments, pending, settled, patient billing and closed, so what the payer thinks and what your biller is doing are two separate readings rather than one overloaded status field.
The distinction that saves the most time is rejected against denied. A rejection means the claim never got in the door, so you correct the data and resubmit. A denial means the payer looked and refused, so the route is appeal or patient billing. Ona keeps every version of a claim, so you can compare v1 against v3 and see exactly what the correction changed, and the History tab holds the timestamped clearinghouse exchange with the payer control numbers and the raw response behind it.
None of that is unique to having the clearinghouse inside. What is different is the distance: the note, the eligibility result and the rejection reason are one record apart instead of one system apart.
4. Eligibility stops being a separate errand
Insurance settings in Ona activate real-time eligibility checks and claim submission together, which is to say 270 and 271 for coverage and 837P for a professional claim. A check asks the payer in real time whether the patient is covered, and the answer is stored on the record: a coverage badge on the patient header and in the Insurance column of the visits list, the parsed benefits underneath it, and a valid-until date so anyone can see how fresh the answer is. Eligibility returns active coverage status, co-pay, deductible and out-of-pocket max in a single sheet, before the visit rather than after the claim.
5. Enrollments are created in the same place you chart
This is the part that decides your go-live date, and it is the part buyers underestimate. Payer enrollments authorize your organization to transact with a specific payer through a specific clearinghouse. Most payers require them before they will accept your claims, and Ona's own guide calls enrollment the slowest part of getting billing live: payers often take two to six weeks, and some still want paper.
Two practical consequences follow. First, enrollments are gated on insurance setup, because they are built from your billing NPI, Tax ID and legal name, and the clearinghouse page refuses to create them until those exist. The ordered chain is insurance setup, then clearinghouse, then enrollments, then billing rules. Second, enrollments are clearinghouse-specific. Moving to a different clearinghouse means re-enrolling, weeks per payer, which is the single strongest argument for keeping the one you already have.
Every Ona Clearing House plan includes unlimited providers and unlimited payer enrollments. Adding a clinician or a payer changes what you have to wait for, not what you have to pay.
So why not just keep your current clearinghouse?
Often you should, and Ona is built to let you. If you already bill through Claim.MD, you connect your own Claim.MD account to Ona with an API key, keep your contract, and keep your enrollments. Ona's setup guide is explicit that existing payer enrollments carry over and that re-enrolling with a new clearinghouse takes weeks per payer. The claims still land in the claims queue beside the chart, and Claim.MD's status events appear in the claim history. You get the proximity without the migration.
Three cases separate cleanly.
Keep what you have if you are already submitting at volume through Claim.MD, your enrollments are live, and your rejection rate is under control. The work of re-enrolling buys you nothing that connecting the same account does not.
Let Ona hold it if you are turning insurance billing on for the first time, if the person who set up your current clearinghouse has left, or if you are consolidating several locations onto one record and want one contract and one renewal date instead of several.
Wait and check if you are tied to Waystar or Office Ally. Both are listed as coming soon in Ona's clearinghouse settings, which means they are not connections you can plan around today. Ask where they stand on the demo call rather than assuming.
One more thing worth saying plainly, because a buyer will work it out anyway: Ona Clearing House is not the cheapest way to move a claim. If cost per claim is the only number you are optimizing, a standalone clearinghouse account will usually win on that one number. What a plan buys instead is a known monthly figure that already contains your providers and your enrollments, sitting on the same invoice as the rest of your practice software. Both prices are published, on Ona's pricing page and on your current vendor's, so the comparison is yours to make with real numbers rather than promises.
How the options compare
Ranked by how much of the claim path sits inside the record you chart in. This is not a quality ranking and not a price ranking. Every statement was checked against the vendor's live pages in September 2026.
| Rank | Setup | Who holds the clearinghouse contract | Who starts payer enrollments | Where rejections get worked | Best fit |
|---|---|---|---|---|---|
| 1 | Ona Clearing House, running on Stedi | Ona. No separate account, contract, credentials or second bill | Created inside Ona once insurance setup is complete; unlimited providers and payer enrollments on every plan | The claims queue, beside the note the claim came from | Practices turning on insurance billing, or consolidating several sites onto one record |
| 2 | Your own Claim.MD account connected to Ona | You, directly with Claim.MD, connected to Ona with an API key | Already yours; existing enrollments carry over instead of being rebuilt | The claims queue, with Claim.MD status events in the claim history | Practices already submitting through Claim.MD that do not want to re-enroll |
| 3 | Waystar or Office Ally inside Ona | Listed as coming soon in Ona's clearinghouse settings | Not available in Ona today | Not available in Ona today | Practices tied to either one; confirm status before planning a switch |
| 4 | Availity Essentials portal beside your EHR | Availity, whose Essentials page describes a centralized provider portal covering eligibility, claim status, remittance and appeals | In the portal | A second system, with claims keyed or uploaded into it | Practices whose payer mix pushes them into the payer portal anyway |
| 5 | Stedi direct, through its API | You, directly with Stedi, which publishes per-transaction pricing with no monthly minimum and no per-provider fee | Through Stedi's transaction enrollment API | Whatever your team builds | Teams with engineers assembling their own billing stack |
Rows 4 and 5 are there because they are real choices, not strawmen. A portal beside the EHR is how a large number of practices bill today, and building directly on a clearinghouse API is the right answer for a team with developers. Both trade proximity for control.
Where this sits in the wider platform
Ona is a general ambulatory platform, and its own FAQ puts the range plainly: Ona scales from solo clinics to enterprise systems. The clearinghouse product follows the same shape. A solo clinician on the smallest plan and a multi-location group on a quoted volume use the same claims queue, the same billing rules and the same enrollment flow, with unlimited providers on every tier so growth changes the volume line and nothing else.
It is also optional in the truest sense. Cash-pay practices do not need a clearinghouse plan at all, and Ona's pricing page says so. Billing and invoicing works without one: invoices generated from the signed note, payment plans, superbills a patient can submit themselves, and card, Apple Pay, Google Pay or HSA and FSA payments. Practices that bill both ways mark services as cash-only, insurance-billed or both.
If your question is narrower and specifically about coverage checks and claim tracking rather than the clearinghouse relationship, the companion piece on real-time eligibility and claims software covers that ground. For the platform as a whole, including where it falls short today, read the honest review of Ona.
Frequently asked questions
Do I need a separate clearinghouse account to bill insurance from Ona?
Not if you use Ona Clearing House. It runs on Stedi, Ona's clearinghouse partner, and Ona holds that relationship, so there is no separate account to open, no second contract to sign, no credentials to manage and no second bill to reconcile. If you would rather bring your own account, Ona also connects to Claim.MD.
Can I keep my current clearinghouse?
If it is Claim.MD, yes. Ona connects to your own Claim.MD account with an API key, you keep that contract, and your existing payer enrollments carry over rather than being rebuilt. Waystar and Office Ally are listed as coming soon in Ona's clearinghouse settings, so check where they stand before you plan around them.
Who starts payer enrollments, and how long do they take?
Enrollments are created inside Ona, on the clearinghouse page, once insurance setup is complete, because they are built from your billing NPI, Tax ID and legal name. The waiting is the payer's. Ona's own setup guide says payers often take two to six weeks and some still require paper forms. Every Ona Clearing House plan includes unlimited providers and payer enrollments.
What does Ona Clearing House cost?
Plans start at $69 per month for 100 claims, 100 ERAs and 200 eligibility checks, and run to $1,099 per month for 2,500 claims. Every plan includes unlimited providers and payer enrollments, annual billing takes 10% off, and higher claim volumes are quoted individually.
Do cash-pay practices need a clearinghouse plan?
No. Ona's pricing page states that cash-pay practices do not need one. Invoices from the signed note, payment plans, superbills for patient self-submission, and card, Apple Pay, Google Pay and HSA or FSA payments all work without a clearinghouse plan.
What is the difference between a rejected claim and a denied claim?
A rejection means the claim never got in the door, usually a format or data problem, so you correct it and send it again. A denial means the payer adjudicated the claim and refused it, so the route is appeal or patient billing rather than resubmission. Both land in the same queue in Ona with the payer's reason attached, and every version of the claim is kept so you can compare what changed.
Next step
Bring your two hardest claims from last month, one rejected and one denied, and watch them run: note to superbill, scrub, submit, and the payer response landing back on the chart. Then ask the one question that decides your timeline, which is which of your payers need enrollments and how long yours will take. Book a 15-minute demo, or start the 14-day free trial with full access and no credit card.
Written by
Ona Health team