The claims queue

The claims queue is where billing work happens day to day. Go to Claims in the left sidebar — "review and submit insurance claims".

Claims are grouped by status, each group showing a count. Every row carries the patient, a claim ID, the payer, the billed amount, and a date.

Switch between List and Board with the toggle in the top right. List suits working through claims in order; Board suits seeing where volume is piling up.

Claim statuses

Seven statuses track a claim's life with the payer:

• Draft — built but not sent. Still editable.
• Submitted — sent to the clearinghouse.
• Acknowledged — the payer confirms receipt. Not yet a decision.
• Accepted — the payer accepted it for adjudication.
• Rejected — bounced before adjudication, usually a format or data problem. Fix and resubmit.
• Denied — adjudicated and refused. A clinical or coverage decision, not a data error.
• Paid — payment issued.

The Rejected / Denied distinction is the one to internalise. A rejection means the claim never really got in the door — correct the data and send it again. A denial means the payer looked and said no, so the route is appeal or patient billing, not resubmission.

Alongside status, eight buckets track your own workflow: Untriaged, Review, Hold, Payments, Pending, Settled, Patient Billing, Closed. Status is what the payer thinks; bucket is what your billing team is doing about it.

You can also filter by patient, payer, and a service date range.

Submitting drafts

Each draft row has a ⋮ menu.

• Submit claim — sends this claim to the clearinghouse.
• Delete draft — removes it.

To send several at once, use Select and Submit at the top of the Draft group.

Submission is not reversible from Ona — once a claim reaches the clearinghouse it's out of your hands. Check the diagnosis codes, service lines, and payer before submitting, especially in a batch.

Reading a claim

Click a claim to open its detail panel.

The Details tab shows the claim as the payer sees it: status, patient, payer with payer ID, member ID, billed amount, created and submitted dates, and the Payer ICN — the payer's own control number, which is what you quote when calling them.

Diagnosis codes are listed with their ICD-10 codes and descriptions. Below that, fields are labelled with their CMS-1500 box numbers — Condition Related (Box 10), Referring Provider (Box 17), Signatures & Assignment — so a biller can map what's on screen to the paper form.

The arrows at the top step through versions, labelled e.g. Live · v3 of 3. Each correction and resubmission creates a version, so you can see exactly what changed between attempts.

Claim PDF downloads a CMS-1500 for printing or sending outside Ona.

Why a claim was rejected

Open the History tab.

History is the audit trail between Ona and the clearinghouse. Entries read like "Claim rejected via Claim.MD sync" and "Existing claim submitted via CLAIM_MD", each timestamped and tagged with the event type, e.g. CLAIM_MD_STATUS_UPDATE, alongside the payer control number and outcome.

View response opens the raw payer response. That's where the specific reason code lives — the thing you need to know what to fix before resubmitting.

Fixing rejections faster

Most rejections are preventable, and the queue links to the tools that prevent them. Manage billing rules in the filters panel opens the scrubbing rules that check claims before they go out. If the same rejection keeps recurring, add a rule rather than correcting each claim by hand. See Billing rules and claim scrubbing.