Setting up insurance

This page is the foundation for everything insurance-related in Ona. Eligibility checks, claim submission, and payer enrollments all depend on it, and the clearinghouse page will refuse to create enrollments until it's complete.

Turn insurance on

Go to Settings → Insurance — "enable insurance features and set the billing provider details used on your claims".

The toggle at the top "activates real-time eligibility checks (270/271) and claim submission (837P)". Those are the X12 transaction types: 270 asks a payer about coverage, 271 is their answer, and 837P is a professional claim. Nothing insurance-related works until this is on.

Organization billing provider

These are the "Type 2 NPI and EIN used on the billing header of all claims".

• Billing NPI (Type 2) — your organization's NPI. Search by name looks it up if you don't have it to hand.
• Tax ID — choose EIN or SSN, then enter the number.
• Legal name — your registered entity name, e.g. "Acme Mental Health PLLC". This must match what the payer has on file, not your trading name.
• Phone
• Enrollment contact email (optional) — "used for payer enrollment and claim correspondence".
• Billing address — street, city, state, ZIP. The hint notes that ZIP+4 (9 digits, no dash) improves EDI matching, so use the full form if you know it.

Ona explains the distinction on the page: Type 2 NPI identifies your organization (clinic, PLLC, group) and appears on the billing header, Box 33 of the CMS-1500 form. EIN is required for payment processing.

Team rendering NPIs

Below the organization details, each team member gets a Rendering NPI — "Type 1 NPI per member for claim service lines".

Type 1 is the individual clinician's NPI, as distinct from the organization's Type 2. It identifies who actually delivered the care on each service line of a claim.

Ona validates these against the national registry. An NPI it can't find is flagged Not found in the NPPES registry beneath the field. Treat that as a real warning: a rendering NPI the payer can't match is a common cause of rejection, and it's far cheaper to fix here than to chase a rejected claim later.

What comes next

With insurance configured, two more pieces are needed before you can submit:

1. Clearinghouse — choose who transmits your claims. See Setting up your clearinghouse.
2. Billing Rules — decide what Ona checks before a claim goes out. See Billing rules and claim scrubbing.

Locations also carry claim data: each site has its own Facility NPI (Box 32a) and Taxonomy code (Box 32b) under Settings → Locations. Those identify where care was delivered, and are separate from the billing and rendering NPIs set here.