Billing

Creating and Submitting Claims

Create claims manually or from appointments, run scrub checks, and submit to payers electronically.

7 min read·January 16, 2025

Overview

Claims in Onvelas can be created directly from completed appointments (recommended) or manually from the Claims screen. All claims go through a scrub check before submission to catch common errors.

Creating a Claim from an Appointment

  1. Open the completed appointment.
  2. Click Generate Claim.
  3. Review the pre-filled data: CPT code, units, rendering provider, diagnosis codes.
  4. Add or adjust service line items if needed.
  5. Click Save as Draft or Submit.

Creating a Claim Manually

  1. Go to Billing → Claims.
  2. Click New Claim.
  3. Select the patient, payer, and date of service.
  4. Add service lines: each line needs a CPT code, units, modifier (if required), and charge amount.
  5. Add diagnosis codes (ICD-10) — at least one primary diagnosis is required.
  6. Select the rendering provider and supervising provider (if applicable).
  7. Click Save.

Claim Scrub Checks

Before submission, Onvelas runs automated scrub checks. Common issues flagged include:

  • Missing or expired authorization
  • Invalid NPI or taxonomy code
  • Diagnosis code mismatch
  • Duplicate claim detection (same patient, payer, DOS, CPT)
  • Service date outside authorization dates
  • Units exceeding authorized amount

Claims with scrub errors are held in Draft status. Resolve all errors before submitting.

Submitting Claims

  1. From the Claims list, select one or more Draft claims (use checkboxes).
  2. Click Submit Selected or open a single claim and click Submit.
  3. Claims are sent via your configured clearinghouse (ClaimMD by default).
  4. Status updates to Submitted with the submission timestamp.

Tracking Claim Status

Use the Claims list quick-filter pills to view claims by status:

  • Draft — created but not submitted
  • Submitted — sent to payer, awaiting response
  • Denied — payer returned a denial; click to see reason codes
  • Paid — ERA received and payment posted
  • CH Rejected — clearinghouse rejected before reaching payer
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