Eligibility before every visit
Checks run when a patient books, when their insurance changes, and for visits in the next 48 hours. The verdict, copay, deductible, and out-of-pocket left sit on the patient and the visit.
Insurance & Claims
Insurance eligibility and claims software, built into your EHR
Ona's insurance billing checks eligibility when a patient books and again before the visit, keeps each visit's draft claim in sync with the chart, and submits professional claims through Ona Clearing House or your own Claim.MD account. Remittances post back to the claim and the patient's invoice, so denials, corrections and balances are worked in one queue.
- Eligibility before every visit
- Claims synced to the chart
- Claim scrubbing rules
- ERAs that post themselves
Ona Insurance is the revenue-cycle layer inside Ona, the AI-native practice management platform that combines a CRM, EHR, and RCM. It checks insurance eligibility before the visit, builds each visit's claim from the chart, and works the claim through submission, payer response, and remittance, so coverage, claims, and patient balances sit on the same record.
It's for US practices that bill insurance — primary care, behavioral health, physical therapy, women's health, and similar specialties — including hybrid clinics that run cash-pay and insurance side by side. Claims go out through Ona Clearing House, with no separate clearinghouse account to open, or through your own Claim.MD account.
01 · Why it matters
The copay conversation should happen before the visit.
Coverage problems found after the visit become write-offs and surprise bills. Most can be caught before the patient arrives.
When the front desk guesses at coverage, patients get surprise bills and practices write off what the payer won't pay. When claims are keyed into a separate tool, a missing diagnosis or a wrong unit count only shows up weeks later as a denial.
Ona flips the order. Coverage is checked before the visit, the claim is built from what was charted, and billing rules flag the problem before the claim leaves. By the time the remittance arrives, the patient's invoice already knows what they owe.
02 · What you get
Insurance handled, not endured.
Card scan and clean intake
Add photos of the card and Scan and fill reads them into the form. Require insurance and card photos at intake, and keep patients to a whitelist of the payers you bill.
Claims that follow the chart
Each insured visit's draft claim rebuilds as diagnoses, procedures, services, and referrals change, priced from your fee schedule, with the rendering provider's NPI filled in.
Scrubbing before submission
Billing rules can check units, diagnoses on every line, timely filing, and Medicare's 8-minute rule. Add payer overrides and custom rules that block, autofix, warn, or move a claim to a work bucket.
Denials worked in one place
Payer reasons come back as alerts with their adjustment codes. Correct a denied claim as a linked replacement, resubmit, ask the payer for status, or bill the balance to a secondary payer.
ERAs that post themselves
Remittances post to the claim with allowed, paid, write-off, and denied amounts, and the patient's invoice re-prices to what they actually owe.
03 · How it works
From booking to remittance.
Set up once
Turn on insurance, add your billing NPI, EIN, and each clinician's rendering NPI, choose Ona Clearing House or Claim.MD, and send payer enrollments from Settings → Insurance.Coverage is checked before the visit
Ona checks eligibility when the patient books and again in the 48 hours before the visit. For payers without electronic checks, Ona shows Verify with payer, and you record the call as a benefits verification.The claim builds from the chart
Diagnoses, procedures, and services charted on the visit flow into its draft claim, which rebuilds as the chart changes. Billing rules flag what would bounce, and an alert jumps to the field to fix.Submit and track
Submit one claim, or a batch with Select and Submit. Acknowledgements, acceptances, rejections, and denials land in the claim's history, and with Ona Clearing House, Check status asks the payer directly.The remittance settles the balance
The ERA posts paid, allowed, and denied amounts to each line. Bill the rest to a secondary payer, or let the patient's invoice re-price to what they owe.
04 · In practice
Coverage, in the rhythm of your clinic.
Primary care
Coverage checked twice, without anyone asking.
Eligibility runs at booking and again in the 48 hours before the visit, and the Needs Verification widget lists the next two weeks' insured visits with an unconfirmed copay or a coverage problem.
Physical therapy
Units and authorizations under control.
Turn on scrubbing for the 8-minute rule and the Medicare 60-unit monthly cap, and each script or prior authorization counts used, scheduled, and remaining visits.
Behavioral health
Copays settled before the session.
Set the copay from the eligibility check or a payer call, collect it at check-in, and let the remittance reconcile it with what the payer decided.
In-house billing team
One queue for the whole team.
Work claims as a list by status or a board by bucket — Review, Hold, Patient Billing, and more — with every edit, submission, and payer response in the claim's history.
FAQ
Common billing-team questions.
Does Ona do real-time insurance eligibility?
Yes. Ona runs electronic eligibility checks through your clearinghouse when a patient books, when their insurance changes, and in the 48 hours before the visit, and staff can recheck at any time. The result shows the verdict, copay, deductible, out-of-pocket, and the payer's benefit rows. For payers that don't support electronic checks, Ona shows Verify with payer so you can record a phone or portal verification.
Is this insurance claims software, or just eligibility?
Both. Ona keeps a draft claim for each insured visit in sync with the chart, scrubs it with your billing rules, submits it, and tracks it through Submitted, Acknowledged, Accepted, Rejected, Denied, and Paid. Denied claims can be corrected as a linked replacement, resubmitted, or billed to a secondary payer.
Which clearinghouse does Ona use?
Ona Clearing House, which runs on Stedi: claims, ERAs, eligibility checks, and payer enrollments all happen inside Ona, with no separate account to open. Plans start at $69 a month for 100 claims, 100 ERAs, and 200 eligibility checks. Practices with their own Claim.MD account can connect it with an API key instead.
Does Ona post ERAs automatically?
Yes. With Ona Clearing House, remittances post to the matching claim as they arrive; with Claim.MD, Ona syncs them. You can also upload an 835 file or enter an EOB by hand. Each claim shows billed, allowed, paid, write-off, and denied amounts, and the patient's invoice re-prices to what they owe.
Does Ona support Medicare and Medicaid claims?
Yes, through the clearinghouse like any other payer. Billing rules can be scoped to Medicare or Medicaid as a payer type, Medicare checks such as the 8-minute rule and the 60-unit monthly cap are built in, and payer enrollment asks for a Medicare PTAN when the payer requires one.
Does Ona submit claims automatically?
No. Ona drafts and updates the claim, and your team reviews and submits it, one at a time or in a batch with Select and Submit. A claim with a blocking error can't be submitted until it's fixed.
Does Ona support institutional (UB-04) claims?
Not today. Ona submits professional claims (CMS-1500 / 837P), and every claim can be downloaded as a CMS-1500 PDF.
Does this replace our current billing service?
It can. Practices run their insurance billing in-house on Ona, or give their billing partner a staff seat so they work the same Claims queue.
Ready when you are
Stop guessing at coverage.
Bring a real claim and a real denial to a fifteen-minute demo, and we'll walk through both in Ona.