Collecting copays

Visit copays can start from a visit or from a claim. The expected copay may come from the visit's eligibility check. If eligibility does not provide a clear copay, Ona can use the service type's default or show payer copay options for you to choose from.

When a claim belongs to a visit, Ona uses the visit copay workflow so the copay stays tied to that visit. A claim that is not tied to a visit uses the claim-only dialog instead.

How do I review the expected copay on a visit?

In the left sidebar, click Visits, then open the visit. Under Visit coverage, click Insurance to review the copay before you collect it.

Use the Eligibility (1) card to review Plan (2) to confirm which coverage the amount came from, Checked (3) to see when Ona last read the plan, and View eligibility details (4) to open the matching copay rows.

1. In Eligibility, review Plan to confirm which coverage the amount came from.
2. Review Checked to see when Ona last read the plan.
3. Select View eligibility details.
4. If Ona shows one matching copay amount, select Use.

If eligibility shows more than one possible copay row, choose the row that matches the visit. If it does not identify a single clear copay, Ona can use the service type's default or let you enter the amount later when you bill the copay.

After you accept a suggestion, that amount becomes the expected copay for the visit.

For more about the plan response, see Reading eligibility results.

How do I issue or update a copay invoice from a claim?

In the left sidebar, under Admin, click Claims, then open the claim. You may also see the same claim copay dialog on a patient's claims page. Use this route when you want to bill the patient before the payer rules on the claim.

Use Claims (1) to open the claims queue. Callout Open a claim (2) marks a claim row you can open from the queue.

With the copay dialog open:

1. In Copay to collect, enter the amount.
2. If the dialog shows Checking the plan for a copay…, wait for the suggestion to load.
3. If Ona shows one matching eligibility amount, select Use.
4. Select Issue invoice. If the claim already has a copay invoice, select Update invoice.

If Ona shows more than one possible copay row, choose the row that applies or enter the amount yourself.

After the invoice is ready, take payment from the invoice. The claim stays with the payer, and the remittance reconciles the payer's actual split later.

For taking payment from the invoice, see Invoicing patients and collecting payments and Payment links and charging a card on file.

Should I record a copay or bill the copay by invoice?

When a claim belongs to a visit, Ona opens the visit copay workflow instead of the claim-only dialog. Choose the route based on whether you already have the payment.

Use Record money already received (1) when the patient paid at the desk. Use Bill by invoice (2) when the patient still needs to pay by card or payment link. The table below explains when to pick each one and what happens.

Choice	Use it when	What happens
Record money already received	The patient paid at the desk or you are entering money already in hand.	The amount is held on the patient's account. This does not require an invoice or claim.
Bill by invoice	The patient still needs to pay by card or payment link.	Ona bills the copay through the visit's claim and opens the invoice when it is ready.

Billing by invoice depends on the visit having a claim that can be billed for the copay. If there is no claim to bill through, or the visit has already been invoiced without the copay, Ona stops the action instead of creating a conflicting bill.

For more about taking payment from an invoice, see Invoicing patients and collecting payments.

How do I open the invoice after billing a copay?

In the left sidebar, click Visits, then open the visit. Under Visit coverage, click Billing to open the visit invoice after you bill the copay.

Use the Invoice card (1) to review the visit invoice. If the visit does not have an invoice yet, Create draft invoice (2) may appear for team members who can create billing drafts when the visit is linked to a patient.

1. In the Invoice card, review Invoice, Total, Balance, Line items, and either Issued or Created.
2. If the invoice has a due date, review Due.
3. Select View invoice.

The invoice opens in a detail sheet.

What happens when the claim belongs to a visit?

From Claims, a patient's claims page, or a visit-linked claim flow, a claim that belongs to a visit uses the visit copay workflow instead of the claim-only dialog.

Use Copay amount (2) to enter the amount, Cancel (3) to close the dialog, and Issue invoice (4) to bill the copay by invoice.

That visit workflow gives you two routes: record money already received, or bill the copay by invoice. After you save the copay, Ona updates the visit copay, the patient's balance, and related billing or claim records. If you issue an invoice, Ona can open that invoice once it is ready.

What can't I do here?

In the claim copay dialog and the visit-linked copay workflow, copay collection is limited in these ways:

• Self-pay visits do not have a visit copay.
• A claim that is not tied to a visit can only issue or update an invoice. It cannot record money already received.
• You cannot bill a visit copay by invoice when there is no claim to bill through.
• You cannot bill a visit copay by invoice when the visit has already been invoiced without the copay.
• Ona blocks invalid copay amounts. In Copay to collect, enter a non-negative amount in dollars and cents.
• If you do not have permission to make billing changes, some copay actions are blocked.

Common questions

Where does a recorded copay go?

A recorded copay is held on the patient's account. Use this for money already in hand.

Where does the suggested copay amount come from?

Ona uses the visit's eligibility check when it can identify the copay. If eligibility does not provide one, Ona can use the service type's default.

Why did Ona show more than one possible copay?

Eligibility can return more than one payer copay row. When Ona cannot tell which one applies, choose the row that matches the visit or type the amount.

Can I collect a copay before the claim is decided?

Yes. You can bill the patient their copay before the payer rules on the claim. The remittance reconciles the payer's actual split later.

Why couldn't I issue the copay invoice?

Ona stops the invoice when the claim or visit is not billable for that copay, or when the amount is invalid.