How claims move through Ona

Claims live in Claims in the left sidebar for the whole organization and in a patient's chart for one patient: in the left sidebar, click Patients, click the patient's name, then click Claims. A claim is the insurance billing record for payer and member details, diagnoses, service lines, rendering, referring, supervising and ordering provider information, patient insurance and CMS-1500 fields. On submitted claims, the claim detail surface also shows a read-only attachments summary.

What is the claim lifecycle in Ona?

In Claims in the left sidebar, the claim lifecycle is the path from draft claim data to a payer or patient-billing outcome.

Use the Claims queue (1) to track claims through their lifecycle from one place instead of moving patient by patient.

The short version is: create or generate the draft, review the claim data, fix blocking alerts, submit it or handle it outside the clearinghouse, track the response, then resolve any remaining balance through secondary insurance or patient billing.

Claims can be connected to a visit. When they are, claim activity can show that the claim was assigned to the visit or synced from the visit chart. Claims also keep versions, so edits, submissions, resubmissions, reversions and snapshots can be reviewed later. After submission, the claim detail surface adds the claim history and a read-only attachments section alongside the rest of the submitted claim details.

When should I use the claims lifecycle view?

Use Claims in the left sidebar when you need to work payer claims from one place instead of searching patient by patient. The queue helps your billing team see each claim’s status, bucket and alerts so they can decide what needs action.

Use Patient Claims (1) to open the patient-specific claims tab, and use the Patient-scoped queue (2) when you want that patient's claim history instead of the organization-wide work queue.

Use the patient claims view when the question is about one patient’s claim history: in the left sidebar, click Patients, click the patient's name, then click Claims. That view is scoped to the patient, while Claims is the organization-wide work queue.

How does a claim become ready to send?

In Claims in the left sidebar, open the claim. Readiness is about the draft claim data and its alerts. The key items are payer and member details, diagnoses, service lines, NDC drug fields when a service line bills drugs, charges, place of service, rendering, referring, supervising and ordering provider information, signatures, prior authorization and other CMS-1500 details.

Before submission, Ona can show validation alerts grouped as errors, warnings and notes. Pre-submission errors block submission. Some alerts can take you directly to the affected field area, such as payer details, member ID, filing code, diagnoses, service lines, service line units or prior authorization.

Billing rules also contribute to the pre-submission check. See Scrubbing claims with billing rules for how those checks are managed.

The draft editor also includes attachments. You can upload documents or attach a signed visit note, then change or remove them before submission. After the claim is submitted, the claim detail view shows the attachments in read-only form.

How do claim statuses and buckets work?

In Claims in the left sidebar, open the claim. Status and bucket answer different questions.

Use Status groups (1) to see each claim’s processing state, Bucket filters (2) to narrow the queue by your team’s work label, and Claim rows (3) to open individual claims from the list.

Status is the claim’s processing state. Claim activity can show events such as Claim created, Submitted to payer, Acknowledged by payer, Accepted by payer, Rejected by clearinghouse, Denied by payer, ERA received and Payment received. See Claim statuses for the full status reference.

Bucket is how your team organizes the work. Buckets include Untriaged, Review, Hold, Open / Payments, Open / Pending, Open / Settled, Patient Billing and Closed. A claim can have a payer status and still need internal work, so use the bucket to keep the billing queue moving.

How does claim history record payer responses?

On the claim detail view, the claim history keeps payer, clearinghouse, system and team activity. History entries can include edits, submissions, payer updates, ERA events, invoice readiness, invoice not updated, card charge scheduled, copay returned to account, status updates, secondary filing and patient billing events.

Use the History tab (1) to open the claim history. Each Timeline entry (2) shows one event on the claim, and View snapshot (3) opens the version tied to that entry when one is available.

The important distinction is between a rejection and a denial. Rejected by clearinghouse means the claim did not get through cleanly. Denied by payer means the payer adjudicated the claim and refused some or all of it.

Claim details can also show payer messages, alerts, remittance information and the Box 22 value in the Sent as row. That row shows whether the claim was sent as a new claim, a resubmission or a correction, so you can see the wording that went out with the claim. When a claim has versions, you can view a snapshot tied to a history entry. Submitted claims also show attachments in this detail surface, but you can only read them there.

How do payments, secondary claims and patient billing fit in?

In Claims in the left sidebar, open the claim. Payment information appears in the claim detail view after an ERA or manual remittance. The claim can show billed, allowed, writeoff, denied, insurance paid and patient responsibility amounts.

If the patient has another policy and the primary claim leaves a balance, billing the secondary creates a new draft claim for the other payer and opens it for review. The patient is not invoiced until the secondary payer rules.

Some claims can be posted as self-pay instead of being sent to a clearinghouse. In that case, the patient owes the full claim amount, collected through the invoice.

When insurance is settled and the patient owes a balance, the claim can connect to patient billing. Patient invoices are separate from insurance claims: claims bill the payer, and invoices bill the patient. See Invoicing patients and collecting payments for the patient-payment workflow. On the submitted claim, the detail surface also shows the attachments that went with the claim.

What can't I do here?

In the claims queue, clinicians do not see Claims. Owners, admins and staff can use Claims when insurance features are turned on.

If insurance features are turned off for your organization, Claims and the patient claims view are not available.

A submitted claim is not edited like a draft. To continue work after submission, use the available claim actions, such as resubmitting, correcting a denial, billing secondary insurance, recording remittance or moving the balance to patient billing.

Common questions

What is the difference between a claim and an invoice?

On the claims page, a claim bills a payer. An invoice bills the patient. A visit can lead to both when insurance pays part of the balance and the patient owes the rest.

Why does a claim have both a status and a bucket?

On the claims page, status is the claim’s processing state. Bucket is your team’s work queue label, such as Review, Hold or Patient Billing.

Where do I see what changed on a claim?

On the claim detail view, review the history. It records edits, submissions, payer responses, ERA events, invoice readiness, invoice not updated, card charge scheduled, copay returned to account and linked snapshots when available.

What happens when I bill secondary insurance?

On the claims page, Ona creates a new draft claim for the other payer and opens it for review. The original balance is not invoiced to the patient until the second payer rules.

Can I still track a claim filed outside Ona?

Yes. Claims can be marked as filed by hand, and manual remittance can be recorded so the claim’s payment outcome is still reflected in Ona.