Skip to content
Get Support
  • There are no suggestions because the search field is empty.

Insurance Guide Part 2: Client Insurance Setup in Pabau

Add policies on the client card, verify coverage with a live eligibility search, and keep card scans on file - so claims start from accurate data.

With your billing foundation in place (Part 1), the next step is the client record. Capturing accurate policy details before the first appointment lets you check coverage early, bill the right payer, and avoid denials later. In this article, you will learn how to turn on insurance billing, add a client's policy with the details claims need, check coverage, and store the insurance card.

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: Turn On Insurance Billing

Insurance billing is switched on once for your whole practice. Every client card then gets an Insurance tab.

  1. Go to Setup → Business Details and open Features.
  2. Switch on Insurance Billing, then click Save changes at the top of the page.

The Insurance Billing switch on the Business Details Features page

Insurance Billing on the Features page

Step 2: Add the Client's Insurance Provider

  1. Open the client's card and select the Insurance tab in the left panel. Policies and cases live here.
  2. Click New Policy.
  3. Pick the client's payer from your practice's list (set up in Part 1). If it isn't there, click + Add insurance provider.
  4. Click Assign to client. The policy form opens straight away.

The Insurance tab on the client card with the New Policy button marked

The Insurance tab lists the client’s policies

The Add Insurance Provider picker with a payer and Assign to client marked

Choose the payer, then Assign to client

TIP: A payer marked Already linked can still be picked. It adds a second policy with the same insurer, for example a separate workers' compensation claim.

Step 3: Enter the Policy Details

  1. Enter the Subscriber / member identification number (Required) exactly as printed on the card. It fills box 1a of the CMS-1500.
  2. Click Search coverage to check the policy with the payer in real time (see Step 4).
  3. Click More options to fill in the rest of the CMS-1500 details for this policy.

The top of the policy form with the member number, Search coverage and More options marked

The member number is the only required field

More options groups the details your claims draw on:

  • Insurer: Policy, group, or plan number, Insurance plan name and the policy Status.
  • Insured's information: the Relationship to insured. If the client is covered under someone else's policy (a spouse or parent, for example), choose the relationship and fill in the insured's details.
  • Policy information: the number of services used so far, the policy end date, adjuster contact details, and three claim defaults: Release of information, Signature on file and Accept assignment.
  • Condition: whether the client's condition relates to employment or an accident, with the related dates. Use this for workers' compensation and auto claims.
  • Referring provider, Default billing codes (codes, units, diagnoses and modifiers that pre-fill new claims for this policy) and Coverage amounts (co-pay or co-insurance, deductibles and coinsurance %).

The Policy information section showing Release of information, Signature on file and Accept assignment

Claim defaults on the policy

IMPORTANT: New US policies start with Signature on file switched on, which tells the payer you hold the client's signed authorization (boxes 12 and 13). Policies added before this default may still have it off; open the policy and switch it on if you hold the signature.

Step 4: Check Coverage With Search Coverage

Instead of typing everything by hand, let the payer confirm the policy:

  1. With the member number entered, click Search coverage. If the client has no date of birth on file, enter it when asked; it is saved to the client's record.
  2. Pabau runs a real-time eligibility check with the payer through Claim.MD. When coverage is found, the plan and policy subscriber are shown and the details are filled in below. Review them, then save.

For the full benefits picture (co-pays, deductibles and out-of-pocket amounts per service type), run an eligibility check from the claim. See Request eligibility and benefits report.

NOTE: Some payers don't offer real-time eligibility through Claim.MD, and some need eligibility enrollment first (under Setup → Claims → Claim.MD → Payers). Pabau tells you which applies. A failed search does not mean the client is uninsured.

Step 5: Store the Insurance Card and Save

  1. Under Coverage amounts, record the co-pay or co-insurance and deductible so the front desk knows what to collect.
  2. Scroll to the bottom and upload the Insurance card (front) and Insurance card (back). JPG, JPEG and PNG up to 5 MB are accepted, and the images are saved to the client's documents.
  3. Click Save. The policy appears on the Insurance tab with its member number.

The Coverage amounts section, the insurance card upload tiles and the Save button

Co-pay, card images and Save

TIP: When a client has more than one policy, open the ⋮ menu on the policy you bill first and choose Set as default payer. It wears a Default Payer chip.

What's Next?

With policies on file, connect visits to insurance: Insurance Guide Part 3: Connect appointments to insurance. Or go back to Getting started with insurance billing for the full picture.

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

Was this guide helpful? Let us know by voting below - your feedback helps us write clearer articles.

For more guides, browse the related articles below or use the search bar at the top of the page. You can also watch our video learning series, the Pabau Academy, or visit the Support page for additional help.