Payer enrollment

Payer enrollment is managed in Settings → Insurance. In the left sidebar, click Settings (at the bottom). In the settings menu, under Insurance, click Insurance. Use it when a payer requires registration before the clearinghouse can send a transaction for your practice.

How do I send a payer enrollment request?

In the left sidebar, click Settings (at the bottom). In the settings menu, under Insurance, click Insurance to start an enrollment for a payer that requires one. The enrollment request tells the clearinghouse which billing identity the payer should credential.

1. Turn on Insurance if it is off.
2. Open the enrollment dialog for the payer and transaction you want to enroll.
3. Review the explanation at the top of Enroll with. It tells you how the payer handles this enrollment and whether a Medicare PTAN is required.
4. Under Who this payer credentials, choose The practice or One clinician.
5. Complete the required identity fields.
6. Select Send enrollment request.

The request appears as pending. It becomes active once the payer accepts it. If the payer needs anything signed or completed, those steps appear on the enrollment row.

How do I choose between the practice and one clinician?

In the left sidebar, click Settings (at the bottom). In the settings menu, under Insurance, click Insurance. Choose the credentialed identity based on how the payer recognizes your billing relationship. The choice controls which NPI is sent with the enrollment.

Choice	Use it when	What it sends
The practice	The payer credentials the organization as a group.	Group billing NPI and tax ID. It covers every clinician.
One clinician	The payer credentials an individual provider, often for Medicaid or Medicare.	The clinician's rendering NPI, plus the tax ID and legal name registered with the payer.

For The practice, enter Billing NPI. The dialog may prefill practice billing details from your insurance settings, but you should check that they match what the payer expects.

For One clinician, choose Clinician. The clinician must already have a rendering NPI on file before you can send the request.

For either choice, enter Tax ID type, Tax ID the payer pays, and Name registered with the payer. If Medicare PTAN appears, the payer requires it before the request can be sent.

For claim-related enrollments, this choice can also affect claims. A practice enrollment bills claims to that payer as the selected practice identity. An individual enrollment bills claims for that clinician to that payer under the clinician's own NPI instead of the practice's.

How do I complete payer enrollment tasks?

In the left sidebar, click Settings (at the bottom). In the settings menu, under Insurance, click Insurance. Use View tasks when an enrollment needs more work before it can go live. Tasks are clearinghouse work items, and the task window shows the instructions for each one.

1. Find the enrollment that has tasks.
2. Select View tasks.
3. Read each task's instructions. Links in the instructions open outside Ona.
4. Complete the requested work with the payer or clearinghouse.
5. Enter any task details shown, such as a tracking number from a payer portal.
6. Select Mark as done when that button is available for a task your practice completed.

Ona notifies the clearinghouse when you mark a task done. Tasks labeled Handled by the clearinghouse do not have Mark as done because your practice does not complete them in Ona. If a task asks for details, Mark as done stays disabled until every field has a value. If the task says This task needs a document uploaded — complete it in the Stedi portal., complete that task in the Stedi portal instead. Instructions are also sent by email to your enrollment contact.

What can't I do here?

In the left sidebar, click Settings (at the bottom). In the settings menu, under Insurance, click Insurance. Payer enrollment is limited in these ways:

• Staff and clinicians cannot manage organization-wide payer enrollment.
• You cannot send an enrollment request while Ona is still checking what the payer requires.
• You cannot send an enrollment request if the payer already accepts that transaction without enrollment.
• You cannot send an enrollment request if the payer does not support that transaction.
• You cannot enroll The practice without a valid 10-digit Billing NPI.
• You cannot send the request without a 9-digit tax ID and Name registered with the payer.
• You cannot enroll One clinician until you choose a clinician with a rendering NPI on file.
• You cannot skip Medicare PTAN when the payer requires it.
• You cannot mark tasks labeled Handled by the clearinghouse as done.
• You cannot mark a task as done until all required task fields have a value.
• You cannot complete a document upload task in Ona; complete it in the Stedi portal.
• If Mark as done fails, complete any earlier required tasks first. The clearinghouse can reject task updates that are out of order.

Common questions

What happens after I send an enrollment request?

The clearinghouse sends the request to the payer using the identity shown in the dialog. The enrollment appears as pending and becomes active once the payer accepts it.

Will a practice enrollment cover all clinicians?

Yes. The practice uses the group NPI and tax ID and covers every clinician for that payer enrollment.

Why is a clinician missing an NPI in the clinician list?

That clinician does not have a rendering NPI on file. Add the rendering NPI before sending an individual enrollment.

Why is Send enrollment request disabled?

Send enrollment request is disabled while Ona checks the payer's requirements, while the request is being sent, when the payer already accepts the transaction without enrollment, or when the payer does not support that transaction. If required details are missing or invalid, selecting Send enrollment request shows what to fix.

Why is Mark as done disabled?

Mark as done is disabled while another task is being completed or when the task has fields that still need values. If the task needs a document uploaded, complete it in the Stedi portal instead.

Who receives enrollment task instructions?

The task window says instructions are also sent by email to your enrollment contact.