--- title: Creating a US Professional (CMS 1500) Claim description: Work through a CMS-1500 claim in Pabau section by section, add a chart note with Attach Document, handle workers comp claims, then validate and send. --- [Skip to content](https://support.pabau.com/en/pabau2/creating-a-us-professional-cms-1500-claim#main-content) [![pabau logo white](https://support.pabau.com/hubfs/pabau%20logo%20white.svg)](https://support.pabau.com/en/pabau2?hsLang=en) Open main navigation Close main navigation - [Get Support](https://pabau.com/support-center/) [Get Support](https://pabau.com/support-center/) Pabau Knowledge Base - There are no suggestions because the search field is empty. 1. [Pabau Knowledge Base](https://support.pabau.com/en/pabau2?hsLang=en) 2. [Insurance Billing](https://support.pabau.com/en/pabau2/insurance-billing?hsLang=en) 3. [Insurance Billing (US)](https://support.pabau.com/en/pabau2/insurance-billing?hsLang=en#insurance-billing-us) # Creating a US Professional (CMS 1500) Claim Every invoice you issue to an insurer becomes a claim in Pabau, pre-filled from the visit. The claim screen is a working CMS-1500: the same boxes a paper form carries, laid out in sections you open one at a time, and checked against Claim.MD before anything leaves Pabau. **NOTE:** Insurance billing is available for practices in the United States. Claims go to payers electronically through the Claim.MD clearinghouse, using your own Claim.MD account. **Step 1: Open the Claim** 1. Go to **More → Claims**. Nothing needs creating first: an invoice issued to an insurer is already a claim. 2. Click **View** on the claim you want to work. ![The claims list with a claim row and its View button marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444163369161-01-claims-list.png) *Open a claim from More → Claims* **Step 2: Find Your Way Around the Claim** The top of the claim shows its status, the policy member ID (with an **Eligibility** button), the payer, the claim amount and the amount paid so far. Below that you can add a note for your team, and the **Appointment** field links the claim to the visit. 1. Click a section to open it. Each section names the CMS-1500 boxes it fills: **Patient**, **Insurance**, **Providers**, **Diagnoses**, **Condition dates**, **Additional claim information**, **Claim details**, and one section per charge line. ![The claim header tiles and the collapsible CMS-1500 sections, with the Patient section marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396715-02-sections.png) *Each section names the boxes it fills* Every field shows its box number, and the **?** beside it explains what goes there. At the bottom, **Claim.MD requests** logs every validation and submission for this claim. **Step 3: Check the Patient and Insurance Sections** These two sections fill themselves from the client record and the policy on file, so most of the time you are confirming rather than typing. - **Patient** (boxes 2–5): name, date of birth, sex, relationship to the insured, and address. Blank fields fall back to the client record. An address change applies to this claim only, unless you tick **Also update the client record**. - **Insurance** (boxes 1a, 4, 7, 11): **Member / policy number** and **Group number**, plus the insured's name, date of birth, sex, plan name and address when the client is not the policyholder. The payer comes from the insurer link in Setup. **TIP:** If **Relationship to insured** is anything other than Self, fill in the insured's details. Payers reject a dependent claim that carries no policyholder. **Step 4: Confirm the Providers** - **Rendering provider** (box 24J): the practitioner who saw the client. It is filled in from the visit when that practitioner has an NPI under **Setup → Claims → Claim.MD → Providers**; if they don't, the claim tells you so. See [How to set rendering and billing provider details for each practitioner](https://support.pabau.com/en/pabau2/how-to-set-rendering-and-billing-provider-details-for-each-practitioner?hsLang=en). - **Referring first name**, **Referring last name**, **Referring provider role** and **Referring NPI** (boxes 17 and 17b): only when the payer needs a referring, ordering or supervising provider on the claim. **Step 5: Add the Diagnoses and Charge Lines** The **Diagnoses** section holds the ICD-10 codes for the visit (box 21), labelled A to L. Each charge line then points at the diagnoses that justify it. Every charge line carries: - **Procedure (CPT/HCPCS)** and **Modifiers** (comma separated, up to four). - **Units**, **Charge** and **Place of service**, pre-filled from the service's billing code. - **Diagnosis pointers (A–D)**: which diagnoses this line is billed against. - **First date of service** and **Last date of service**. ![A charge line with procedure code, units, charge, place of service, diagnosis pointers and dates of service](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444163369161-03-charge-line.png) *One charge line (box 24)* Timed codes and home or mobile visits have their own guides: [How to bill timed codes in units](https://support.pabau.com/en/pabau2/how-to-bill-timed-codes-in-units?hsLang=en) and [How to set the place of service for home visits, mobile and telehealth claims](https://support.pabau.com/en/pabau2/how-to-set-the-place-of-service-for-home-visits-mobile-and-telehealth?hsLang=en). **IMPORTANT:** ICD-10 codes are checked against the date of service, so a code that was valid last year can be refused this year. If Claim.MD names a code, use the more specific version it suggests rather than sending the same one again. **Step 6: Fill In the Claim Details** **Claim details** covers boxes 10, 12, 13, 22, 23 and 27, the situational fields only some claims need. **Condition dates** (boxes 14, 16, 18 and 19) holds the dates of the illness or injury, time off work and hospital stays. - **Accept assignment** (box 27): whether you accept the payer's allowed amount as full payment. - **Release of information** and **Signature on file** (boxes 12 and 13): filled in from the client's policy. - **Prior authorization number** (box 23): filled in from the authorization chosen when the visit was booked. If an authorization covers the visit but this box is empty, the claim warns you and offers **Assign case**. - **Resubmission code (box 22)** and **Original reference no. (payer ICN)**: paper resubmissions only. Electronic corrections set these themselves. ![The Claim details section with Signature on file and Prior authorization number marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396715-03-claim-details.png) *Claim details (boxes 10, 12, 13, 22, 23, 27)* **Step 7: Workers' Comp and Auto Claims** Workers' comp and auto claims are billed to the carrier handling the injury rather than the client's health plan, so a few boxes change: - **Member / policy number** and **Group number**: Claim.MD's guidance is **999999999** in box 1a with the carrier's claim number for the injury in box 11. Federal workers' comp is the exception: the Department of Labor (FECA) wants its OWCP case number in box 1a *and* again in box 11, not 999999999. State programs and some carriers have their own rules too, so follow the carrier's instructions. - Under **Claim details**, set **Employment related** to Yes for workers' comp, or **Auto accident** to Yes for a motor accident, and enter the **Accident / injury date**. The claim cannot be sent without that date. - For an auto accident, add the **Auto accident state** (box 10b). On a workers' comp claim Pabau reminds you that the payer usually wants the treatment note. See the next step. **Step 8: Send a Chart Note With the Claim** Some payers, and most workers' comp carriers, won't settle without the clinical note behind the visit. You can send it with the claim: 1. Click **Attach Document** in the bar at the bottom of the claim. 2. Tick **Send a chart note with this claim**. 3. Pick the document from the PDFs on the client's record, or click **Upload a PDF**. If you pick nothing, Pabau sends the newest PDF on the visit's insurance case. 4. Check the **Attachment type** (usually **Support data for claim (OZ)**), then send the claim as normal. ![The Attach Document panel with the chart note checkbox, a PDF and the attachment type marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396715-04-attach-document.png) *Choose the note to send* Claim.MD may hold the claim (**On hold**) until the document arrives; once it lands, the claim goes on to the payer by itself, with no second submission. **NOTE:** Pabau warns you if Claim.MD lists the payer as not taking electronic attachments, or as needing an attachment enrollment first. In those cases send the note by the payer's own route. More detail, including other document types, in [How to send a chart note or other document with a claim](https://support.pabau.com/en/pabau2/how-to-send-a-chart-note-or-other-document-with-a-claim?hsLang=en). **Step 9: Validate, Then Send** 1. Click **Validate with Claim.MD**. It checks the claim without sending it; anything wrong comes back onto the field that caused it, with a plain-English explanation for the common cases. 2. Click **Send Invoice to Claim.MD**. The claim moves to **Submitted** (or **On hold** while an attachment is delivered). ![The claim header with Validate with Claim.MD and Send Invoice to Claim.MD marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444163369161-02-claim-workspace.png) *Validate, then send* **What's Next?** - [Insurance Guide Part 4: Submit and track insurance claims](https://support.pabau.com/en/pabau2/insurance-guide-part-4-submit-and-track-insurance-claims-in-pabau?hsLang=en) - [Tracking electronic claim submissions](https://support.pabau.com/en/pabau2/tracking-electronic-claim-submissions?hsLang=en) - [Exporting and submitting CMS1500 claims manually](https://support.pabau.com/en/pabau2/exporting-and-submitting-cms1500-claims-manually?hsLang=en) Questions? 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