Insurance & claims

Insurance setup, enrollment, fee schedules, claims, ERAs and eligibility.

15 articles

Setting up insuranceTurn on insurance features, choose whether patients must add insurance during intake and card photos, and enter the billing provider and rendering NPI details used on claims.7 min read

Setting up your clearinghouseChoose the clearinghouse your organization uses for insurance transactions, connect Claim.MD when needed, and understand what changes when you switch clearinghouses.5 min read

Payer enrollmentSend payer enrollment requests from Insurance settings, choose whether the payer credentials the practice or one clinician, and complete clearinghouse tasks when action is required.7 min read

Fee schedulesSet global CPT fees, add payer-specific rates, manage self-pay cash rates, and import a fee schedule spreadsheet from Insurance settings.12 min read

Scrubbing claims with billing rulesSet claim-scrubbing checks, limits, reminders and custom billing rules before claims are submitted. Use payer-type and payer scopes when one group of claims needs different rules.7 min read

How claims move through OnaUnderstand the claim lifecycle in Ona, from draft claim data through submission, payer responses, payments, secondary claims and patient billing.8 min read

Working the claims queueUse the claims queue to find, filter, submit, review and follow up on insurance claims. Learn how payer statuses, workflow buckets, claim details, alerts, history and versions fit together.11 min read

Checking claim statusFind a claim, open its details, and review claim status, payer messages, alerts, payment information, attachments and history from the claims queue or a patient's claims page.6 min read

Correcting, resubmitting, and reverting claimsCorrect denied claims, resubmit claims when the action is available, and use claim history to review or revert saved claim versions from the claims queue.7 min read

Billing secondary insuranceCreate a secondary insurance claim from an adjudicated primary claim and handle missing or already filed secondary coverage from the claims queue.4 min read

Reviewing ERAs and remittances on claimsReview posted payer remittances from a claim, understand how the payer split the balance, export ERAs as CSV when needed, and create a secondary draft when another policy should be billed.9 min read

Managing prior authorizationsRecord scripts and prior authorizations from a visit’s eligibility details, track remaining visits, and see when an authorization issue affects eligibility.8 min read

From visit billing to superbill and claimCreate and review a superbill from a completed visit, then finalize, download, or void it. Start a draft claim from the visit’s Insurance page when the claim workflow is available.6 min read

Reading eligibility resultsOpen a visit's eligibility details, read the coverage verdict, review insurance and authorization information, and understand benefit rows and failed checks.10 min read

Claim statuses and bucketsUse claim statuses, buckets, and alerts to read the claims queue and prioritize follow-up work.5 min read

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