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

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 — each section builds on the previous one.

📌 Note: Electronic insurance billing through Claim.MD covers United States payers only.

1. Credentialing and why it matters

Credentialing is how insurers verify that a provider is licensed, qualified, and authorized to deliver services and bill for them. It's worth getting right before anything else, because it means:

• 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.

Credentialing happens directly with each insurer, outside of Pabau — keep your NPIs, taxonomy codes, and credentialing status current with every payer you bill.

2. Connect your Claim.MD account

Pabau submits claims through your own Claim.MD clearinghouse account. To connect it:

1. Go to Setup → Claims and open the Claim.MD tile.
2. On the Credentials tab, paste your AccountKey (generate one in the Claim.MD portal under Settings → Account Settings).
3. Click Connect — Pabau verifies the key with Claim.MD and stores it encrypted.

Once verified, the Credentials tab shows your connected Claim.MD account and when the key was last verified. The Overview tab tracks your whole setup as a checklist that turns green as you complete each section below.

3. Complete your billing profile

The billing profile identifies your practice as the billing provider — it's what prints in box 33 of every CMS-1500 claim. On the Billing profile tab, enter:

• Billing organisation name
• Billing (group) NPI
• Tax ID (9 digits) and Tax ID type (EIN or SSN)
• Practice address and phone

📌 A profile missing its NPI or Tax ID can't submit claims or start payer enrollments — the Overview checklist will show you what's missing.

4. Add your insurance payers

Payers are added on the Payers tab, which lists every insurer you bill in Pabau. For each one you have two options:

• Find payer — link an existing Pabau insurer to its Claim.MD payer ID so claims route electronically.
• Add payer from Claim.MD — browse the full Claim.MD catalog (4,000+ payers, searchable by name or payer ID) and import one; it becomes a Pabau insurer, already linked and ready to enroll. Each catalog entry shows what the payer supports: claim filing, ERA, and eligibility.

The summary pills at the top of the tab show where you stand at a glance: Fully enrolled, Partially enrolled, Not enrolled, Not available (the payer doesn't support electronic transactions), and how many insurers aren't linked yet.

5. Enroll for claim filing, ERA and eligibility

Enrollment is what activates electronic transactions with each payer. Open any linked payer with View to see its enrollment drawer:

• A progress bar tracks the payer's three services — Eligibility, Claim filing, and ERA payment reports.
• Where a payer requires enrollment, click Enroll — Pabau opens the payer's Claim.MD enrollment form (a one-time secure link) and tracks the request as Processing until it's approved.
• Enrollments are made for the billing entity (your group NPI + Tax ID) from the billing profile.

📌 Good to know: requirements vary by payer — some accept claims with no enrollment at all, some auto-enroll ERA once you start submitting, and ERA approvals can take up to 30 days. Full detail: Electronic enrollments with insurance payers.

6. Add practitioner NPIs

Every practitioner who renders billable care needs their individual NPI — it's sent as the rendering provider (box 24J) on every claim line. On the Providers tab, enter each practitioner's NPI and, optionally, their taxonomy code.

7. Configure billable services with CPT codes

Claims bill services by CPT/HCPCS procedure code, so your services need the right codes and rates. Pabau ships the full US code sets under Setup → Diagnostic & Billing Codes — including ICD-10-CM for diagnoses and 20,000+ CPT/HCPCS codes for procedures, refreshed with the official releases.

Browse or search any code set — and set CPT/HCPCS as your billing default so claim forms and service pricing use it everywhere:

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 expand the Insurance Billing section.
3. Under Billing codes, click Add A Billing Code and choose CPT / HCPCS code.
4. Search by code or description, select the right result, and click Add CPT code.

When you invoice an insurance company for this service, the claim's charge line picks from these codes — and you can search the full code library right from the claim line too.

8. Enable client co-pay collection

Collecting the client's share at the time of service keeps balances low. Record each policy's co-pay (or co-insurance) and deductible on the client's policy details — you'll see them when raising the visit invoice, so you can take the co-pay at the point of sale and bill only the insurer's portion on the claim.

What's next?

With the foundation in place, move on to Insurance Guide Part 2: Client insurance setup — or jump back to Getting started with insurance billing for the full picture.