Eligibility checks on demand
Run a real-time eligibility check and see active coverage status, co-pay, deductible, and out-of-pocket max in a single sheet on the patient record.
Insurance
Insurance handled before the visit.
Real-time eligibility and benefits verification, with coverage details surfaced on the chart so nobody guesses at co-pays or plan rules again.
- Eligibility checks
- Claim generation & submission
- Status pipeline tracking
- Denial & rejection workflow
Insurance is the workflow no clinician wants to touch, and the one that most determines whether the practice survives the year. “We'll check eligibility when you get here” has quietly cost the industry billions.
Ona verifies eligibility up front, surfaces coverage on the chart before the patient walks in, and routes claim generation, submission, and denial follow-up into a single queue your team can actually keep up with.
01 · Why it matters
The co-pay conversation should happen before the visit.
A meaningful share of visit revenue leaks to eligibility errors discovered after service. Most are preventable.
When the front desk guesses at coverage, patients get surprise bills and practices write off chunks of every month. Auditing the guess after the fact doesn't fix anything — it just assigns blame.
Checking eligibility up front flips the order. Before the visit, Ona confirms active coverage and surfaces exactly what the patient will owe. No surprises at the desk, no write-offs on Friday.
02 · What you get
Insurance handled, not endured.
Coverage on the chart
The most recent eligibility result sits on the patient record. No “is this covered?” mid-visit — the answer is already there.
Claim generation from the note
Codes from the signed note flow into a CMS-1500 draft with diagnoses and service lines pre-filled. Review, adjust, submit — without re-keying anything.
Status pipeline you can watch
Every claim moves through draft → submitted → acknowledged → accepted or denied. The list groups by status so nothing quietly ages in the wrong column.
Denials in a workable queue
Denied and rejected claims surface in the same list with reason details attached. Fix the issue on the draft, resubmit, and keep moving.
Patient responsibility, clean
After adjudication, what the patient owes vs. what insurance covered shows up as a balance on the billing record — visible to staff and patient alike.
03 · From booking to remit
The insurance lifecycle, demystified.
Eligibility runs before the visit
Check coverage from the patient record in a couple of clicks. Failures surface up front, not at the desk Monday morning.Coverage lives on the chart
The latest eligibility result stays with the patient. Clinicians and billing see the same record — no separate lookup, no stale info.Claim generated and submitted
After the visit, a draft claim is assembled from signed services and diagnoses. Review, submit, and watch it move through the status pipeline in one place.Remit posts, balance resolves
When the payer responds, the claim lands in Paid, Denied, or Rejected. Any patient responsibility becomes a balance on their billing record.
“We went from running eligibility on a 3-day lag to real-time. Our bad-debt line dropped by half in two quarters.”
04 · In practice
Coverage, in the rhythm of your clinic.
Primary care + urgent care
High volume, fewer surprises.
Check eligibility as patients book and again at check-in when something feels off. The latest result stays visible on the chart for the whole team.
Specialty practice
One list for the whole billing queue.
Drafts, submissions, acknowledgements, accepted, denied, paid — all in a single grouped list. No one has to remember which tab a claim lives in.
Out-of-network / superbill
Itemised claims patients can self-submit.
An itemised CMS-1500 with diagnoses and service lines generates from the note. Share it with the patient so they can submit to their payer without calling the office.
Multi-provider clinic
Rendering provider kept straight.
Rendering NPI and provider billing config live in settings and flow into every claim. Who saw the patient, under which plan, always matches.
FAQ
Common billing-team questions.
How does eligibility checking work?
Ona runs real-time eligibility checks against the major national and regional payers. If a payer isn't supported yet, our team can usually add it during onboarding.
How do claims get submitted?
Claims submit through an integrated clearinghouse and move through the status pipeline inside Ona. You don't need a separate login to see where each claim stands.
Does this replace our current billing service?
It can — the workflows are simple enough that many small practices run billing in-house on Ona. Higher-volume groups often keep their RCM partner and let them work inside the same claims queue.
Can we run a hybrid cash-pay + insurance workflow?
Yes — services can be marked cash-only, insurance-billed, or both. The billing record handles either path without forcing a choice up front.
What about Medicare / Medicaid?
Both supported for eligibility and claim submission. Some state-specific Medicaid rules are handled out of the box; others we configure during onboarding.
Ready when you are
Stop guessing at coverage.
Bring a real claim and a real denial to a fifteen-minute demo — we'll run both.