Reviewing ERAs and remittances on claims

Use Claims to review remittances across the practice. For one patient’s claims, in the left sidebar, click Patients, then click the patient's name. In the patient sidebar, click Claims. Open a claim to see its payment summary, service lines, messages, remittances and history.

How do I review a remittance on a claim?

Open a claim from Claims to confirm how the payer adjudicated it and what work remains. The claim details panel shows the payer’s amounts at both the claim and service-line level.

1. In the left sidebar, click Claims.
2. Select the claim you want to review.
3. In Payment Summary, compare Billed, Allowed, Insurance paid, Writeoff, Denied and Patient owes.
4. Review each service line for Allowed, Paid, Denied and Writeoff and Adjustments.
5. Check Messages for payer or clearinghouse messages tied to the claim.
6. Open History to confirm events such as ERA received or Payment received.

After the remittance is posted, the claim shows what insurance paid, what was written off, what was denied, and what may still be owed by the patient or another payer.

How do I read Payment Summary?

Open a claim from Claims to understand the claim balance before you invoice the patient or bill another payer.

Field	What it means
Billed	The total charge on the claim.
Allowed	The amount the payer allowed, when the payer returns it.
Writeoff	The contractual adjustment shown as a writeoff.
Denied	The amount still open with the payer because it was denied.
Insurance paid	The amount paid by insurance.
Collected at visit	A copay collected before adjudication, shown as an estimate.
Patient owes	The patient responsibility after adjudication, unless a secondary payer is still pending.

If a secondary claim is pending, the primary payer’s patient responsibility is not the patient’s final balance. The second payer still needs to rule.

How do I review line-level adjustments?

Open a claim from Claims when the total does not explain what happened. Each line can show its own payment, denial and adjustment information.

1. In the left sidebar, click Claims.
2. Select the claim.
3. Find the service line you want to review.
4. Compare the line charge with Allowed, Paid, Denied and Writeoff.
5. Review Adjustments for the group-code pair, label and amount.

Denied line amounts are shown separately from writeoffs, so you can tell the difference between a contractual reduction and a refused charge.

How do I create a secondary claim from a remaining balance?

Open an adjudicated claim from Claims. When the claim opens Bill this balance to the secondary payer?, Ona creates a new draft claim for the other payer instead of resubmitting the primary claim.

1. Review the patient, primary payer and balance in Bill this balance to the secondary payer?.
2. Select Create secondary claim.
3. Open the new draft and set the filing code before submitting it.

Ona creates a draft secondary claim, closes the dialog, opens the new draft, and shows Secondary claim created. The original claim is closed, and the patient is not invoiced until the second payer rules.

If the patient does not have a second insurance policy on file, the dialog shows No second insurance on file. Add the secondary coverage to the patient record, then bill the balance again. If the balance was already billed to another payer, the dialog shows Secondary already filed and may offer View secondary claim.

How do I use claim history while reviewing remittances?

Open a claim from Claims to audit what happened to the claim and when. History entries include claim edits, submissions, payer status updates, ERAs and payment events.

1. Look for events such as Submitted to payer, ERA received, Payment received, Denied by payer or Secondary claim filed.
2. Select View snapshot on an event when you need to compare the claim version linked to that event.

History gives you a timeline for remittance review and follow-up, without changing the claim.

What can't I do here?

In the left sidebar, click Claims. Remittance review and follow-up are limited in these ways:

• Owners, admins and staff use the operational claims workspace. Members who are only clinicians do not use the full claims queue.
• If insurance billing is turned off, Claims is not available and patient claim tabs redirect back to the patient record.
• You cannot create a secondary claim when the claim is not adjudicated, when it is already a secondary, when there is no secondary policy on file, or when the secondary was already filed.
• A pending secondary claim means the patient balance is not final yet.
• Manual remittance date fields validate inline, and incomplete or invalid paid date and claim received date entries block saving.
• Pre-submission validation errors block claim submission until they are fixed.

Common questions

Where do I see what insurance paid?

Open a claim from Claims. Review Payment Summary. Insurance paid shows the paid amount, and each service line can also show Paid.

Where do I see what the patient owes?

Open a claim from Claims. Review Patient owes in Payment Summary. If a secondary payer is pending, the primary payer’s patient responsibility is not treated as the final patient balance.

How do I know whether a charge was denied or written off?

Open a claim from Claims. Use Payment Summary and the service lines. Denied is shown separately from Writeoff, and denied line amounts are labeled as denied rather than contractual writeoffs.

What happens after I create a secondary claim?

Open a claim from Claims. Ona creates a new draft secondary claim and opens it. Set the filing code, review the draft, then submit it when it is ready.

Where can I see the remittance timeline?

Open a claim from Claims. Select History. Events such as ERA received, Payment received and payer decisions appear in the timeline.