On the CMS-1500 claim form, Box 6 tells the payer how the patient relates to the insured — the policy holder whose member ID appears in Box 1a. This guide explains what the box means and where Pabau takes the value from.
NOTE: This article is part of the US Insurance Billing Additional Resources series, which walks through every box of the CMS-1500. If you are new to claims in Pabau, start with Creating a US Professional (CMS 1500) Claim.
Box 6 — Patient relationship to insured
Box 6 carries four checkboxes — Self, Spouse, Child, and Other — and exactly one of them is marked. When the patient holds the policy themselves, the answer is Self; when they are covered under someone else's policy (a spouse's or a parent's, say), the box says so. It is required on every claim.
How Pabau fills it
The value lives in the Patient section of the claim editor, which is labeled with the CMS-1500 boxes it covers (2–5), as the Relationship to insured select. Each option carries its standard relationship code — Self (18), Spouse (01), Child (19) — and any other value travels as Other.
The value starts from the policy's policy-holder setup on the client card — whether the policy belongs to the patient or to Someone else — and you can correct it on the claim itself before validating or sending. Client policies live on the client card, in the Insurance tab of the left panel.
On the printed form (Export > Print), Pabau marks Self, Spouse, or Child to match the code, and any other relationship is marked as Other.
On the electronic claim: the relationship code (18, 01, 19, and so on) is sent to Claim.MD with the claim.
TIP: When the relationship is anything other than Self, the payer also needs to know who the insured is — fill in the Insured first name (if not the patient) and Insured last name fields in the claim's Insurance section, which cover CMS-1500 box 4.
To set up client policies and policy holders from scratch, see Insurance Guide Part 2: Client Insurance Setup in Pabau.