How long does it take to process ERA and claims?

Once your claims are going out to Claim.MD, the next question is always "when do I get paid?" Insurance timelines are set by the payers, not by Pabau — but knowing the typical windows keeps your billing predictable and tells you when something has actually stalled versus when it's just working through the queue.

The insurance billing module is available for practices in the United States and works with your connected Claim.MD account.

What an ERA is

An ERA (Electronic Remittance Advice) is the digital version of an insurer's Explanation of Benefits — the notice that says how a claim was processed. It carries the billed amount, what the payer allowed, what they paid, any adjustments (with reason codes), and the patient's responsibility. Pabau reads the ERA automatically and settles the matching claim, so you reconcile far faster than keying paper EOBs by hand.

Your clearinghouse: Claim.MD

Pabau connects to payers through Claim.MD — it delivers your claims, checks them for formatting problems before they reach the payer, and returns the ERAs. You bring your own Claim.MD account (set up in Setup → Claims); Pabau charges nothing per claim or per remittance.

How long ERAs take after enrollment

ERAs only flow for payers you've enrolled for electronic remittance (Setup → Claims → Payers → the enrollment drawer). Each payer approves enrollment on its own schedule — anywhere from a few days to several weeks, up to about 30 days. Once a payer approves, ERAs usually start arriving within a few business days. Until then the payer may still pay the claim — you just won't get the electronic remittance, so the claim's status won't move on its own.

How long claims take to process

Processing time is the payer's, not Claim.MD's. Many payers finish in a few business days; some take a couple of weeks. The single best thing you can do is file at least one claim to a payer as early as possible — it gets your practice into their queue and surfaces any enrollment or credentialing gap while there's time to fix it.

How to read where a claim is

Every claim carries one of six statuses on the Money → Insurance claims dashboard:

• Draft — built from the invoice, not sent yet.
• Ready to submit — validated clean, waiting on you to send.
• Submitted — accepted by the clearinghouse and on its way to (or with) the payer.
• Paid — an ERA reported a payment; the amount is applied to the invoice.
• Rejected — bounced before adjudication (a front-end edit); fix the flagged field and resubmit.
• Denied — adjudicated and refused; review the payer's reason codes, then correct and resubmit or appeal.

Click Sync any time to pull the latest statuses for every claim at once, or use the per-row refresh on a single claim.

Frequently asked

My ERAs aren't arriving. The payer's ERA enrollment is almost certainly still pending — check the enrollment drawer for that payer. If you moved to Pabau from another system that was already receiving this payer's ERAs, that enrollment has to be stopped there first before the new one can approve.

A claim is taking longer than the others. Some payers simply take weeks. Delays also come from missing or wrong codes, out-of-date insurance on the client, or a rejection that's waiting to be corrected — check the claim for a rejection message.

How do I check whether a claim has a problem? Watch the dashboard for the Rejected and Denied statuses and read the reason shown beside the header pill; the claim's history drawer shows the full trail of payer and Claim.MD events.

Can I see the payer's/Claim.MD's internal processing status? No — Pabau shows what the payer and Claim.MD report back, and statuses update as those events arrive. If a claim looks genuinely stuck, contact Claim.MD support and reference the claim's Claim.MD ID (on the claim's history).

A claim shows Paid but no money arrived. The payer most likely paid outside Pabau (a paper cheque, or a portal payment). Contact the payer to confirm how and where it was sent.

My payer doesn't send ERAs — how do I settle the claim? When a payer pays on paper or by phone and never sends an electronic remittance, open the submitted claim and click Record payer payment. Enter what the EOB reported per line (paid amount, and any adjustment code such as CO-45), and Pabau settles the claim to Paid just as an ERA would — which also lets you bill a secondary claim, since that needs the primary's line-by-line detail. Recording the payment here settles the claim; posting the money to the invoice stays your normal payment step.

How do I speed processing up? Submit clean claims (validate before sending), keep each client's insurance current, use accurate CPT/HCPCS and ICD-10 codes, file promptly, keep an eye on your enrollments, and resolve rejections quickly.

Do I have to enrol every payer separately? Yes — ERA enrolment is per-payer. Enrolling one payer doesn't enrol the others.

What if I never enrol a payer for ERAs? Pabau won't receive that payer's remittances, so the claim's status won't advance on its own. You can still settle it: open the claim and use Record payer payment to enter the EOB by hand, which flips it to Paid and unlocks secondary billing. Enrolling for ERAs is what makes the loop automatic — recording by hand is the fallback for payers that don't send them.

What's next?

• Insurance Guide Part 4: Submit and track insurance claims
• Insurance Guide Part 1: Set up the essentials (enrolments live here)

Still stuck on a timeline? Message us on live chat or email support@pabau.com.