---
title: How to set claim defaults on a client's insurance policy
description: Record signature on file, release of information, assignment, condition dates and referring provider once on the policy so new claims inherit them.
---

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# How to set claim defaults on a client's insurance policy

Some CMS-1500 boxes rarely change from one visit to the next for the same client and payer: the client’s signed authorizations (boxes 12, 13 and 27), whether the condition is related to work or an accident (box 10), key dates (boxes 14 to 18), additional claim information (box 19) and the referring provider (box 17). In Pabau you record these details once on the policy, and every new claim for that policy starts with them filled in.

**NOTE:** Insurance billing is currently available for practices in the United States. These policy fields appear for US practices only.

**Step 1: Open the Client’s Policy**

Open the client’s card. Then:

1. Select the **Insurance** tab.
2. Click the policy’s member number.
3. Click **Edit**.

![Open an existing policy from the Insurance tab](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/489459512561-00-open-policy.png)

*Open an existing policy from the Insurance tab*

For a new policy, click **New Policy**, choose the insurer and click **Assign to client** instead. The same form opens.

**Step 2: Show All the Policy Fields**

1. Enter the **Subscriber / member identification number** if it is not there yet, then click **More options**.

![More options shows the claim fields](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/489459512561-01-more-options.png)

*More options shows the claim fields*

**Step 3: Record the Client’s Authorizations**

Scroll to the end of **Policy information**. Each field has a **?** tip naming the CMS-1500 box it fills.

1. **Release of information** (box 12): **Yes** when the client has signed to authorize releasing the medical information needed to process their claims.
2. **Signature on file** (box 13): switch it on when you hold the insured’s signed authorization to pay medical benefits to your practice.
3. **Accept assignment** (box 27): **Yes** when you accept payment under the payer’s terms and want the payer to pay your practice.

![Release of information, Signature on file and Accept assignment](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/489459512561-02-signatures.png)

*Release of information, Signature on file and Accept assignment*

**NOTE:** A new US policy starts with all three set to yes. Change one only when you do not hold the client’s signed authorization, or your agreement with the payer says otherwise.

**TIP:** Keep the signed authorization on file, for example as a signed consent form on the client’s record. Payers can ask to see it.

**Step 4: Record the Condition and Its Dates**

These fields matter for injuries, accidents and work-related care. Leave them blank when they do not apply.

1. Under **Is the client's condition related to:**, tick **Employment? (Current or Previous)** (box 10a), **Auto accident** (box 10b) or **Other accident** (box 10c) if they apply. For an auto accident, also enter the **Auto accident state**. Unticked boxes go on the claim as No.
2. Use **Additional claim information** (box 19) only when the payer asks for a note.
3. Leave **Early and periodic screening, diagnostic and treatment (EPSDT) referral** (box 24h) as **Not Applicable** unless a Medicaid program asks for it.
4. Enter any dates the payer needs: **Date of current illness, injury, or pregnancy** (box 14) with **Which date is being reported**, another date related to the condition (box 15) with its type, **Last Worked** and **Return to Work** (box 16), and **Hospitalization From** and **Hospitalization Until** (box 18).

![Condition, claim information and dates on the policy](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/489459512561-03-condition.png)

*Condition, claim information and dates on the policy*

**Step 5: Add a Referring Provider (If Needed)**

Some payers, such as plans that need a prescription or referral for therapy, only pay when the claim names the provider who referred, ordered or supervised the care (box 17).

1. Under **Referring provider**, choose **Referring Provider**, **Ordering Provider** or **Supervising Provider**, then fill in **Provider name** and **NPI** (box 17b). Add a **Number type** and **ID number** only if the payer asks for another identifier.

![Choose the referring provider’s role](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/489459512561-05-referring.png)

*Choose the referring provider’s role*

Click **Save** (or **Create** for a new policy).

**Step 6: Check the Claim**

Open the client’s next claim from **More → Claims** and expand **Claim details**. The values come from the policy:

1. **Accept assignment** (box 27).
2. **Release of information** (box 12).
3. **Signature on file** (box 13).

![Claim details filled in from the policy](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/489459512561-04-claim-details.png)

*Claim details filled in from the policy*

The dates, box 19 and box 24h appear under **Condition dates**, and the referring provider under **Providers**. You can change any of them for one claim without changing the policy.

**IMPORTANT:** Pabau copies the policy’s claim defaults onto a claim when you open it. A claim you have already validated, printed or sent keeps its own values, so a later change to the policy does not rewrite it. If a claim depends on condition dates, a referring provider or box 19, open it and check it before you send it, rather than sending it from the claims list in a batch.

**What's next?**

- [How to add default billing codes to a client’s insurance policy](https://support.pabau.com/en/pabau2/how-to-add-default-billing-codes-to-a-clients-insurance-policy?hsLang=en)
- [Insurance Guide Part 2: Client Insurance Setup in Pabau](https://support.pabau.com/en/pabau2/insurance-guide-part-2-client-insurance-setup-in-pabau?hsLang=en)
- [Box 12 – Patient’s Signature](https://support.pabau.com/en/pabau2/box-12-patients-signature?hsLang=en) and [Box 13 – Insured’s Signature](https://support.pabau.com/en/pabau2/box-13-insureds-signature?hsLang=en)
- [Creating a US Professional (CMS 1500) Claim](https://support.pabau.com/en/pabau2/creating-a-us-professional-cms-1500-claim?hsLang=en)

---

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- [For Patients: How-to Guides](https://support.pabau.com/en/pabau2/for-patients-how-to-guides?hsLang=en#main-content)

    - [Client Portal Guide](https://support.pabau.com/en/pabau2/for-patients-how-to-guides?hsLang=en#client-portal-guide)
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- [Care Plus Upgrade](https://support.pabau.com/en/pabau2/care-plus-upgrade?hsLang=en#main-content)

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- [Marketing Plus upgrade](https://support.pabau.com/en/pabau2/marketing-plus-upgrade?hsLang=en#main-content)

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