Skip to main content

​
Thrizer Payment Eligibility Rules

Last Updated: 2026-04-07 Status: Canonical
Purpose: Determines which payment types are available for a client based on deductible status and eligibility verification. Use this file when: Deciding whether a specific payment type (superbill, OON Pay, Thrizer Pay) is allowed Evaluating eligibility constraints before presenting or processing payment options Resolving conflicts about why a payment type is unavailable Do not use this file for: Pricing logic, fee calculations, or reimbursement amounts Claim outcomes or insurer-specific behavior All eligibility decisions must be resolved using this file before applying any pricing or payment logic.

​
Normalized Inputs

  • deductible_status ∈
  • Eligibility is defined as insurance confirmed via benefit check (see Canonical Terms)

​
Payment Type Availability

​
Pre-Deductible

  • payment_type = superbill → allowed
  • payment_type = oon_pay → allowed, no fee applied
  • payment_type = thrizer_pay → not allowed

​
Post-Deductible

  • payment_type = superbill → allowed
  • payment_type = oon_pay → allowed, fee applied
  • payment_type = thrizer_pay → allowed only if:
    • eligibility_verified is defined in Thrizer Pay Rules

​
System Constraint

  • pricing rules do not determine eligibility
  • eligibility must be resolved before pricing is applied

​
Benefit Check Requirement by Payment Type

  • OON Pay and Thrizer Pay require a completed benefit check
  • If no benefit check is available, these payment methods are not eligible and cannot be used for charging
  • Self-Pay does not require a benefit check and remains available regardless of benefit check status