Insurance billing glossary (UK)
UK insurance billing has its own vocabulary. Here's what each term means — and where it lives in Pabau.
This guide is for practices in the United Kingdom. Claims are submitted electronically through the Healthcode clearing service, with additional tools for BUPA membership checks and insurer remittances.
Healthcode
The company that operates the UK's medical bill clearing service. Owned by the major insurers, it receives electronic claims from practices and delivers them to the right insurer. Pabau submits your claims through Healthcode — you connect your account under Money → Claims → Configure.
Clearing service
Healthcode's claim pipeline: it validates each electronic bill, forwards it to the insurer, and reports its progress. Some insurers (Vitality, for example) only accept claims this way.
Site ID / Webservices ID
The credentials Healthcode issues when you register (the Site ID starts with "HC"). Pabau uses them to submit claims on your behalf.
Third party
Anyone you bill other than the client — insurers, employers, the NHS, embassies. Insurers are third parties of type Insurance in Setup → Third Parties.
Membership number (also registration number or policy number)
The number an insurer uses to identify the patient, printed on their insurance card. Recorded on the client's Insurance tab; claims are rejected when it doesn't match the insurer's records.
Pre-authorisation / authorisation code
The insurer's approval for a course of treatment, issued before the visit. In Pabau it's stored on an insurance case and travels onto every claim for that treatment.
Case
Pabau's container for one authorised course of treatment: the auth code, a session allowance, linked appointments and documents. Managed on the client's Insurance tab.
CCSD code
A procedure code from the Clinical Coding & Schedule Development group — the UK standard for describing private medical procedures (for example, 20300). Attached to services under Setup → Services → Pricing → Insurance Billing.
ISC (Industry Standard Code)
Healthcode's classification code for the type of service delivered (for example, E0000610 for an initial consultation). Attached to services alongside the CCSD code.
ICD-9 diagnosis code
The code describing the patient's diagnosis, required on most claims. Searchable on the claim's Clinical event section.
Service code
An insurer-specific code for a service, agreed between your practice and the insurer. Some insurers require it in addition to CCSD/ISC codes.
Payee code / payee provider
How an insurer identifies who should be paid — per clinic location and (unless GMC numbers are used) per clinician. Entered on the Healthcode setup's Locations and Clinicians tabs.
GMC number
A doctor's registration number with the General Medical Council. Healthcode can identify clinicians by GMC number instead of per-insurer payee codes.
Price list
A set of per-service contract rates. With a rule restricting it to one insurer, it prices insurer-charged bookings automatically (Setup → Price Lists).
Default payer
The insurer billed first on new invoices for a client. Set from the ⋮ menu on the client's policy row.
Claim
An invoice issued to an insurer, tracked on Money → Claims from Pending through Submitted to Paid (or Needs action if rejected).
Remittance (remittance advice)
The insurer's statement of what one payment covers. Recorded under Money → Remittance and matched against outstanding claims.
Shortfall
The gap when an insurer pays less than the invoice — an excess, co-payment or declined line. Pabau reissues the balance to the patient with a credit note against the original invoice.
Excess
The part of each claim the patient agreed to pay themselves under their policy. A common cause of shortfalls.
BUPA Providers Online
BUPA's portal for recognised providers. Connect it in Pabau to verify BUPA memberships from the client card or claim screen (guide).