---
title: "Insurance Guide Part 1: How do you set up the insurance essentials in Pabau?"
description: Connect Claim.MD, complete your billing profile, add and enroll payers, set practitioner NPIs, and add billing codes, units and place of service.
---

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# Insurance Guide Part 1: How do you set up the insurance essentials in Pabau?

## Credentialing, your Claim.MD connection, billing profile, payers and enrollments, provider NPIs, CPT-coded services and co-pays - the foundation that keeps claims clean.

Your insurance billing foundation is what makes every later step work: accurate claims, fewer denials, and payments that arrive without chasing. This guide walks through the essentials in the order Pabau's setup checklist presents them. Work top to bottom, because each step builds on the one before.

**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: Get Credentialed With Your Payers**

Credentialing is how insurers verify that a provider is licensed, qualified and allowed to bill them. It happens directly with each insurer, outside Pabau, and it is worth getting right first:

- Your claims are processed correctly the first time.
- You bill under the right provider and organization identity.
- You avoid delays, denials and rejections from payers.

Keep your NPIs, taxonomy codes and credentialing status current with every payer you bill.

**Step 2: Open Claim.MD Setup**

1. Go to **Setup → Claims** and open **Claim.MD** (the **Configure** button on the claims list also takes you to Setup → Claims). The **Overview** tab is a checklist that turns green as you finish each part below.

![The Claim.MD setup Overview checklist with the Credentials tab marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-01-overview.png)

*The Overview checklist shows what is done and what is left*

**Step 3: Connect Your Claim.MD Account**

Pabau sends claims through your own Claim.MD clearinghouse account.

1. Open the **Credentials** tab.
2. Paste your **AccountKey** and click **Connect**. You generate the key in the Claim.MD portal under **Settings → Account Settings**. Pabau verifies it with Claim.MD and stores it encrypted. Once connected, the tab shows when the key was last verified, with **Update AccountKey** and **Disconnect**.
3. Optionally tick **Automatically check for new remittances (ERAs)**. Pabau then looks for new ERAs in the background and shows a count on the **Remittance** tab.

![The Credentials tab of a connected Claim.MD account with Update AccountKey and the ERA check box marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-02-credentials.png)

*A connected account, with the automatic ERA check*

Under **Claim.MD account settings**, record how four settings are set in your Claim.MD portal (Pabau cannot read them): **Transmit Approval Required**, **Reject Denials**, **Automatic corrected claims** and **NCCI edits**. Then click **Confirm still current** whenever the account changes.

**IMPORTANT:** Turn off **Transmit Approval Required** in Claim.MD before you send claims from Pabau. While it is on, every claim waits in the portal's Pending Approval list until someone approves it there, and Pabau cannot release it.

**Step 4: Complete Your Billing Profile**

The billing profile identifies your practice as the billing provider. It prints in box 33 of every CMS-1500 and is used for payer enrollment.

1. On the **Billing profile** tab, enter the **Billing provider name**, **Billing provider NPI** (your group NPI), **Billing taxonomy**, **Tax ID (9 digits)** and **Tax ID type** (EIN or SSN), the address, ZIP and phone. Add a **Billing payer-assigned ID** only if a payer gave you one.
2. Choose the **Default place of service (box 24B)**. The Default place of service is pre-selected on every claim line, and a line can still override it. A mobile practice usually bills 12 (patient home), an office 11.
3. Click **Save**.

![The Billing profile tab with the default place of service and the Save button marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-03-billing-profile.png)

*The billing profile (details blurred)*

**TIP:** Payers expect the full 9-digit ZIP+4 for the billing address. Claims still send with five digits, but add the last four if you have them.

**NOTE:** A profile missing its NPI or Tax ID can't submit claims or start payer enrollments. The Overview checklist shows what is missing.

**Step 5: Add Your Payers**

The **Payers** tab lists every insurer you bill, with its logo, payer ID and enrollment state. The pills at the top count payers that are fully enrolled, partially enrolled or not enrolled, and insurers not linked yet.

1. To bring in a new payer, click **Add payer**.
2. For an insurer already set up in Pabau, click **Find payer** to link it to its Claim.MD payer ID so claims route electronically. **Unlink** removes the link.
3. In **Add payer from Claim.MD**, search the catalog by name or payer ID. Each entry shows what the payer supports: **Claims**, **ERA** and **Eligibility** (Yes, No or Enrollment).
4. Click **Add payer** on the right row. It becomes a Pabau insurer, already linked and ready to enroll.

![The Payers tab with Add payer and Find payer marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-04-payers.png)

*Link existing insurers or add new payers*

![The Add payer from Claim.MD catalog searched for Aetna, with the search box and an Add payer button marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-05-payer-catalog.png)

*Search the Claim.MD payer catalog*

**NOTE:** When you link or add a payer, Pabau fills in the insurer's **Insurance program** (used for box 1 on printed CMS-1500s) from the Claim.MD catalog if it is blank. You can change it under **Setup → Company accounts** → the insurer → **Settings**, along with a **Billing provider ID for this insurer** if the payer gave you one.

**Step 6: Enroll for Claim Filing, ERA and Eligibility**

Enrollment is what switches on electronic transactions with each payer.

1. On the **Payers** tab, click **Complete enrollment** (or **View**) beside a payer. A progress bar tracks its three services: **Eligibility**, **Claim filing** and **ERA payment reports**.
2. Where a service says **Enrollment required**, click **Enroll**. Pabau opens the payer's Claim.MD enrollment and tracks it until the payer approves.
3. Already enrolled with this payer through a previous billing system? Click **Already enrolled** instead. A new request can reopen an approved enrollment.

![The payer enrollment panel showing Eligibility and Claim filing active and ERA payment reports with Enroll and Already enrolled marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-06-enrollment.png)

*The enrollment panel for one payer*

**IMPORTANT:** For a provider's first enrollment, Claim.MD phones the number listed for the provider in NPPES, and a provider representative must answer and approve (usually in under a minute). Check that number is current in NPPES before you start.

Enrollments are made for the billing entity shown under **Enrolling entity** (your group NPI and Tax ID from the billing profile). Requirements vary by payer: some accept claims with no enrollment, and ERA approvals can take up to 30 days.

Step-by-step help for each payer, including what to do while an enrollment is pending: [Electronic enrollments with insurance payers](https://support.pabau.com/en/pabau2/electronic-enrollments-with-insurance-payers?hsLang=en).

**Step 7: Set Up Your Practitioners**

Every practitioner who renders billable care needs their own NPI. It is sent as the rendering provider (box 24J) on every claim line.

1. On the **Providers** tab, find the practitioner. The list shows their **Default rendering ID** and how many insurer-specific settings they have. Click **Manage**.
2. Under **Default claim information**, click **Edit defaults** and enter the rendering provider NPI, taxonomy and any payer-assigned ID. Billing fields inherit from the clinic billing profile unless you change them here.
3. Under **ID numbers**, click **Add ID number** for any other identifiers you want on invoices, receipts and superbills.

![The Providers tab listing practitioners with a Manage button marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-07-providers.png)

*Every practitioner, with their default rendering ID*

![A practitioner page with Edit defaults and Add ID number marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-08-provider-defaults.png)

*A practitioner's claim information (billing details blurred)*

Lower on the same page, **Insurer-specific claim information** lets you change details for one insurer only with **Add insurer override**; every other insurer keeps the practitioner's defaults. More in [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).

**Step 8: Add Billing Codes to Your Services**

Claims bill services by CPT/HCPCS code. Pabau includes the full US code sets (ICD-10-CM for diagnoses and CPT/HCPCS for procedures) under **Setup → Diagnostic & Billing Codes**. Then attach the right code to each service you bill:

1. Go to **Setup → Services** and open the service you bill to insurance.
2. Open the **Pricing** tab and scroll to **Billing Codes**.
3. Click **Add A Billing Code**, choose **CPT / HCPCS code**, then search by code or description and add it.
4. Set the **Default units** for the code. **Total billed amount** updates to the price × units.
5. Choose a **Place of service** for the code, or leave **Use the practice default** to use the one from your billing profile.
6. Optionally pick a **Default diagnosis**. It is used when a claim or invoice line has no diagnosis of its own.

![A service billing code showing default units, place of service and default diagnosis, with Add A Billing Code marked](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-09-service-billing-codes.png)

*Billing codes on a service*

**NOTE:** Units and place of service are saved against the billing code, not the service. If you change a service's code, set its units and place of service again.

Billing a timed code, a home or mobile visit, or a local code that isn't in the standard list? See [How to bill timed codes in units](https://support.pabau.com/en/pabau2/how-to-bill-timed-codes-in-units?hsLang=en), [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) and [How to add your own billing codes](https://support.pabau.com/en/pabau2/how-to-add-your-own-billing-codes-such-as-medicaid-local-codes?hsLang=en).

**Step 9: Collect the Client Co-pay**

Collecting the client's share at the visit keeps balances low. Record each policy's co-pay or co-insurance and deductible on the client's policy (see [Part 2](https://support.pabau.com/en/pabau2/insurance-guide-part-2-client-insurance-setup-in-pabau?hsLang=en)), take the co-pay at the point of sale, and bill only the insurer's portion on the claim.

**Step 10: Set Your Authorization Warning Thresholds**

Authorizations run out two ways: the visits they cover are used up, or their end date passes. Pabau flags a case before either happens, using one setting for your whole practice.

1. Open any client's **Insurance** tab and click the gear beside **Case details**.
2. **Warn when remaining visits are at or below**: 2 visits by default.
3. **Warn when the authorisation expires within**: 7 days by default. Click **Save**.

![The Authorisation Warnings settings opened from the gear beside Case details](https://support.pabau.com/hubfs/Pabau%202%20Knowledge%20Base/kb/obc-2026/444677396712-10-auth-warnings.png)

*One setting for every client*

Leave a box blank to keep the default, or enter 0 to switch that warning off.

**TIP:** The same thresholds drive the **Ending authorisations** dashboard widget, which lists the cases closest to running out across all your clients. Add it from **Customise** on the dashboard.

**What's Next?**

With the foundation in place, move on to [Insurance Guide Part 2: Client insurance setup](https://support.pabau.com/en/pabau2/insurance-guide-part-2-client-insurance-setup-in-pabau?hsLang=en), or go back to [Getting started with insurance billing](https://support.pabau.com/en/pabau2/getting-started-with-insurance-billing?hsLang=en) for the full picture.

Questions? Reach us any time via the in-app chat. We're happy to help.

---

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    - [Policies](https://support.pabau.com/en/pabau2/financials?hsLang=en#policies)
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    - [Taxes](https://support.pabau.com/en/pabau2/financials?hsLang=en#taxes)
    - [Discounts](https://support.pabau.com/en/pabau2/financials?hsLang=en#discounts)
    - [Sales History](https://support.pabau.com/en/pabau2/financials?hsLang=en#sales-history)
    - [Payment Links](https://support.pabau.com/en/pabau2/financials?hsLang=en#payment-links)
    - [Payments](https://support.pabau.com/en/pabau2/financials?hsLang=en#payments)
    - [Payment Processing (Updated)](https://support.pabau.com/en/pabau2/financials?hsLang=en#payment-processing-updated)
- [Card Terminals](https://support.pabau.com/en/pabau2/card-terminals?hsLang=en#main-content)

    - [Setting up the Pabau Pay Card Terminal](https://support.pabau.com/en/pabau2/card-terminals?hsLang=en#setting-up-the-pabau-pay-card-terminal)
    - [Wallet](https://support.pabau.com/en/pabau2/card-terminals?hsLang=en#wallet)
    - [Card Terminal Troubleshooting](https://support.pabau.com/en/pabau2/card-terminals?hsLang=en#card-terminal-troubleshooting)
- [Products & Stock](https://support.pabau.com/en/pabau2/products-stock?hsLang=en#main-content)

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    - [Inventory](https://support.pabau.com/en/pabau2/products-stock?hsLang=en#inventory)
    - [Orders](https://support.pabau.com/en/pabau2/products-stock?hsLang=en#orders)
    - [Inventory Movement](https://support.pabau.com/en/pabau2/products-stock?hsLang=en#inventory-movement)
- [Leads](https://support.pabau.com/en/pabau2/leads?hsLang=en#main-content)

    - [General](https://support.pabau.com/en/pabau2/leads?hsLang=en#general)
    - [Leads](https://support.pabau.com/en/pabau2/leads?hsLang=en#leads)
    - [Pipelines](https://support.pabau.com/en/pabau2/leads?hsLang=en#pipelines)
- [Analytics](https://support.pabau.com/en/pabau2/analytics?hsLang=en#main-content)

    - [General](https://support.pabau.com/en/pabau2/analytics?hsLang=en#general)
    - [Custom Reports](https://support.pabau.com/en/pabau2/analytics?hsLang=en#custom-reports)
    - [Reports](https://support.pabau.com/en/pabau2/analytics?hsLang=en#reports)
- [Memberships](https://support.pabau.com/en/pabau2/memberships?hsLang=en#main-content)

    - [Getting started](https://support.pabau.com/en/pabau2/memberships?hsLang=en#getting-started)
    - [General](https://support.pabau.com/en/pabau2/memberships?hsLang=en#general)
    - [Selling memberships online & at POS](https://support.pabau.com/en/pabau2/memberships?hsLang=en#selling-memberships-online-at-pos)
- [Activities](https://support.pabau.com/en/pabau2/activities?hsLang=en)
- [App Marketplace (Integrations)](https://support.pabau.com/en/pabau2/app-marketplace-integrations?hsLang=en#main-content)

    - [General](https://support.pabau.com/en/pabau2/app-marketplace-integrations?hsLang=en#general)
    - [Payments & Accounting](https://support.pabau.com/en/pabau2/app-marketplace-integrations?hsLang=en#payments-accounting)
    - [UAE (Emirates ID and NABIDH)](https://support.pabau.com/en/pabau2/app-marketplace-integrations?hsLang=en#uae-emirates-id-and-nabidh)
- [FAQs & Troubleshooting](https://support.pabau.com/en/pabau2/faqs-troubleshooting?hsLang=en#main-content)

    - [FAQs](https://support.pabau.com/en/pabau2/faqs-troubleshooting?hsLang=en#faqs)
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    - [Getting started](https://support.pabau.com/en/pabau2/for-patients-how-to-guides?hsLang=en#getting-started)
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- [Pabau Product Portal](https://support.pabau.com/en/pabau2/pabau-product-portal?hsLang=en)
- [Compliance](https://support.pabau.com/en/pabau2/compliance?hsLang=en)
- [Care Plus Upgrade](https://support.pabau.com/en/pabau2/care-plus-upgrade?hsLang=en#main-content)

    - [Getting started](https://support.pabau.com/en/pabau2/care-plus-upgrade?hsLang=en#getting-started)
    - [Cases](https://support.pabau.com/en/pabau2/care-plus-upgrade?hsLang=en#cases)
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    - [Prescriptions](https://support.pabau.com/en/pabau2/care-plus-upgrade?hsLang=en#prescriptions)
- [Marketing Plus upgrade](https://support.pabau.com/en/pabau2/marketing-plus-upgrade?hsLang=en#main-content)

    - [Getting started](https://support.pabau.com/en/pabau2/marketing-plus-upgrade?hsLang=en#getting-started)
- [Labels](https://support.pabau.com/en/pabau2/labels?hsLang=en#main-content)

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- [Engage](https://support.pabau.com/en/pabau2/engage?hsLang=en#main-content)

    - [Getting Started](https://support.pabau.com/en/pabau2/engage?hsLang=en#getting-started)
    - [Inbox & Conversations](https://support.pabau.com/en/pabau2/engage?hsLang=en#inbox-conversations)
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- [Insurance Billing](https://support.pabau.com/en/pabau2/insurance-billing?hsLang=en#main-content)

    - [Insurance Billing (UK)](https://support.pabau.com/en/pabau2/insurance-billing?hsLang=en#insurance-billing-uk)
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    - [US Insurance Billing Additional Resources](https://support.pabau.com/en/pabau2/insurance-billing?hsLang=en#us-insurance-billing-additional-resources)
- [New Client Card](https://support.pabau.com/en/pabau2/new-client-card?hsLang=en)
- [Data Hub](https://support.pabau.com/en/pabau2/data-hub?hsLang=en)
- [Ultrasound Configuration (DICOM Setup)](https://support.pabau.com/en/pabau2/ultrasound-configuration-dicom-setup?hsLang=en#main-content)

    - [GE Ultrasound Machines](https://support.pabau.com/en/pabau2/ultrasound-configuration-dicom-setup?hsLang=en#ge-ultrasound-machines)
    - [Mindray Ultrasound Machines](https://support.pabau.com/en/pabau2/ultrasound-configuration-dicom-setup?hsLang=en#mindray-ultrasound-machines)
    - [Samsung Ultrasound Machines](https://support.pabau.com/en/pabau2/ultrasound-configuration-dicom-setup?hsLang=en#samsung-ultrasound-machines)
    - [Philips Ultrasound Machines](https://support.pabau.com/en/pabau2/ultrasound-configuration-dicom-setup?hsLang=en#philips-ultrasound-machines)
    - [Canon Ultrasounds](https://support.pabau.com/en/pabau2/ultrasound-configuration-dicom-setup?hsLang=en#canon-ultrasounds)

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