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Getting started with insurance billing

Connect Claim.MD, add client policies, link appointments to insurance, then submit and track claims through to payment - the full setup path, in order.

Welcome to insurance billing in Pabau! Insurance billing works best when it's set up in the right order. Work through the four steps below and you'll submit accurate claims, avoid unnecessary denials, and get paid on time.

The Insurance claims dashboard in Pabau, showing claims for US payers with their statuses

This article gives you the complete picture — and each step links to a detailed walkthrough you can come back to at any time:

  1. Insurance Guide Part 1: Set up the insurance essentials
  2. Insurance Guide Part 2: Client insurance setup
  3. Insurance Guide Part 3: Connect appointments to insurance
  4. Insurance Guide Part 4: Submit and track insurance claims

📌 Note: Electronic claim submission through our clearinghouse partner, Claim.MD, is available for United States payers only. If you bill UK private medical insurers, see our Healthcode articles instead.

Step 1: Set up your insurance billing foundation

Everything starts in Setup → Claims → Claim.MD. The Overview tab gives you a checklist that turns green as you complete each piece:

  • Connect your Claim.MD account — enter your AccountKey; Pabau verifies it with Claim.MD and stores it encrypted.
  • Complete your billing profile — the billing organization's name, NPI, Tax ID, and address. This is what prints in box 33 of every CMS-1500 claim.
  • Add provider NPIs — each practitioner who renders billable care needs a valid rendering-provider NPI (box 24J).
  • Link your payers — connect each insurer you bill to its Claim.MD payer ID so claims route electronically, or import payers straight from the Claim.MD catalog.
  • Enroll with payers — enrollment activates claim filing, ERA payment reports, and eligibility checks. Some payers approve instantly; others take up to 30 days.

The Claim.MD setup checklist in Pabau

The Payers tab, showing payer links and enrollment statuses

👉 Full walkthrough: Insurance Guide Part 1 and Electronic enrollments with insurance payers.

Step 2: Set up client insurance details

Accurate policy details are what keep claims from bouncing. On the client card, open the Insurance tab:

  • Add the policy — insurer, member ID, and group number, exactly as printed on the insurance card.
  • Record the details that drive billing — policy holder (the client or someone else), policy dates, co-pay or co-insurance, deductible, cover level, and plan type.
  • Attach card scans — front and back images of the insurance card are stored as client documents.
  • Use "Search coverage" — run a live eligibility check against the payer and let Pabau pre-fill the policy details from the response.
  • Check eligibility & benefits before you treat — a full report shows active coverage, co-pays, deductibles, and out-of-pocket amounts per service type.

The insurance policy details on the client card

An eligibility and benefits report in Pabau

👉 Full walkthrough: Insurance Guide Part 2 and Request eligibility and benefits report.

Step 3: Connect appointments to insurance
  • Bill the visit to insurance — raise the appointment's invoice against the client's insurer and it appears on the Insurance claims dashboard as a draft claim.
  • Code your services — charge lines carry CPT/HCPCS procedure codes; search the built-in code library right from the claim line.
  • Document diagnoses — diagnosis slots auto-fill from the client's active Problems (ICD-10), and you can search the full ICD-10 code set for anything else. Every charge line points at a diagnosis (boxes 21 and 24E).
  • Verify coverage first — re-check eligibility when a plan changes, every 30 days for ongoing care, at a new episode of care, or before the appointment.
  • Collect the co-pay — take the client's share at the point of sale so only the insurer's portion rides on the claim.

A claim in Pabau with CMS-1500 sections for patient, insurance, providers, diagnoses and charges

👉 Full walkthrough: Insurance Guide Part 3.

Step 4: Submit and track claims
  • Claims pre-fill for you — patient, policy, provider, diagnoses and charges come straight from the records you set up in steps 1–3.
  • Validate before you send — "Validate with Claim.MD" builds the claim and returns any errors without submitting, so you can fix issues early.
  • Submit electronically — claims travel to the payer through Claim.MD and move through six statuses: Draft → Ready to submit → Submitted → Paid / Rejected / Denied.
  • Fix and resubmit — rejections show the payer's reason on the claim; edit and send again. Pabau reuses the claim's identity, so a resubmission updates the original instead of creating a duplicate. Denied claims resubmit automatically as corrected claims, or you can start an appeal.
  • Post insurance payments — ERAs (electronic remittance advice) arrive in Money → Payment remittance; pull one in, review the matched invoices, and settle. Paid and denied statuses update from the ERA.
  • Go further — create secondary claims for a second policy, print CMS-1500 forms, or download superbills for out-of-network clients.

👉 Full walkthrough: Insurance Guide Part 4, Tracking electronic claim submissions and Submitting secondary claims.

FAQs

Is insurance billing available outside the United States?

Electronic claims through Claim.MD cover US payers only. UK practices billing private medical insurers should use Pabau's Healthcode integration instead.

What do I need before I can connect?

A Claim.MD account (your AccountKey is in the Claim.MD portal under Settings), your billing organization's NPI and Tax ID, and the NPI of each rendering provider.

Why can't I submit claims yet?

Check the Overview tab in Setup → Claims → Claim.MD. A billing profile missing its NPI or Tax ID, or an insurer that isn't linked to a Claim.MD payer, will keep claims from going out.

Can I submit claims while a payer enrollment is still processing?

Usually yes — many payers accept claims before enrollment completes. ERA payment reports and eligibility checks activate once the payer approves the enrollment, which can take from a few days up to about 30.

Why did my eligibility check fail?

New provider records must clear a one-time validation step with Claim.MD before transactions flow. Also confirm the member ID and date of birth match the insurance card, and note that a small number of payers don't support real-time eligibility.

What's the difference between Rejected and Denied?

A rejected claim was stopped before the payer adjudicated it — usually a data issue; fix the claim and resubmit. A denied claim was processed and refused payment — correct and resubmit (Pabau flags it as a corrected claim automatically) or start an appeal.

How often should I re-check eligibility?

There's no universal rule. Common practice: whenever the plan changes, every 30 days for recurring care, at each new episode of care, or right before the appointment.

Do insurance payments post automatically?

ERAs arrive in Money → Payment remittance. Pull a remittance in, review the invoice matches Pabau proposes, and settle it — the matched claims update to Paid or Denied. You stay in control of what posts.

Can I bill on paper or help out-of-network clients?

Yes. From the claim's Export menu you can print a CMS-1500 (full form replica, or text-only for pre-printed red-ink stock) and download a superbill your client can submit to their insurer for reimbursement.

Where do I go if I get stuck?

Start with the four-part Insurance Guide linked above, or reach out to our support team from the Help button in Pabau — we're happy to walk you through setup.