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Product System Map

Last Updated: 2026-04-07 Status: Canonical
Purpose: Defines the canonical product-system rules for Thrizer. Use this file when the question is about what exists in the product, how product concepts are modeled, which fields and statuses are canonical, what each role can access or do, which portal surfaces expose which information, how core objects relate to each other, how payment-type eligibility works, how pricing and fees are determined, how reimbursement is routed, how first-claim calibration works, and which global system constraints apply. This file is the routing authority for structural and policy questions about the Thrizer product model. It should be consulted for questions about roles, objects, state models, payment types, claim fields and outcomes, eligibility conditions, reimbursement destination, fee triggers, and portal field exposure. Do not use this file for UI click paths, step-by-step user instructions, support macros, Help Center phrasing, insurer-specific adjudication rules, or assistant behavior.
Chunking conventions
  • Each chunk begins with a heading that starts with ”## SYS-”.
  • Each SYS section is a deterministic chunk boundary.
  • Chunk IDs are stable. Never reuse an ID for a different meaning.
  • Do not add timestamps inside chunks. Only update the document header.

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SYS-TAXONOMY-PAYMENTTYPES-001

Type: system_rule Domain: taxonomy Audience: client, clinician Intents: policy Objects: payment Title: Payment type canonical labels Rule:
  • Canonical payment types are:
    • Thrizer Pay
    • OON Pay
    • Self-Pay

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SYS-TAXONOMY-CLAIMSTATUS-001

Type: system_rule Domain: taxonomy Audience: client, clinician Intents: policy Objects: claim Title: Claim Status canonical labels Rule:
  • Claim Status is the primary categorical field.
  • Canonical Claim Status values are:
    • Processing
    • Investigating
    • Denied
    • Approved

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SYS-TAXONOMY-CLAIMRESULT-001

Type: system_rule Domain: taxonomy Audience: client, clinician Intents: policy Objects: claim Title: Claim Result field model Rule:
  • Claim Result is a descriptive field.
  • Claim Result is not the primary claim state.
  • Claim Result may describe:
    • processing state
    • deductible application
    • reimbursement amount
    • reimbursement method
    • reimbursement date
Constraints:
  • Claim Result does not determine reimbursement destination.
  • Claim Result does not replace Claim Status.

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SYS-PORTALS-001

Type: system_rule Domain: surfaces Audience: internal Intents: policy Objects: portal Title: Portals and top-level surfaces Rule:
  • Thrizer has two primary portals:
    • Client Portal
    • Clinician Portal
Client Portal top-level surfaces:
  • Clinicians
  • Payments
  • Claims
  • Help
  • Me
Clinician Portal top-level surfaces:
  • Clients
  • Payments
  • Benefits
  • Help
  • Referral
  • Me

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SYS-NORMALIZED-INPUTS-001

Type: system_rule Domain: normalization Audience: internal Intents: policy Objects: insurance, payment, eligibility Title: Normalized condition inputs Rule:
  • The following condition inputs are canonical for eligibility and reimbursement rules:
    • PRIMARY_INSURANCE_ON_FILE = true | false
    Defined as “Primary Insurance On File” in Canonical Terms
    • DEDUCTIBLE_MET = true | false
    • ALLOWED_AMOUNT_VERIFIED = true | false
    • COVERAGE_VERIFIED = true | false
Constraint:
  • Do not substitute narrative phrases for these conditions in policy retrieval.

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SYS-ROLES-CLIENT-001

Type: system_rule Domain: roles Audience: client Intents: can_i, policy Objects: account, insurance, payment_method, bank_account, payment, claim, support Title: Role: Client Client can:
  • Manage account settings:
    • first name
    • last name
    • phone number
    • street address
  • View email address
  • Manage primary insurance
  • Manage payment methods
  • Manage reimbursement bank account where applicable
  • Select payment type subject to eligibility rules
  • View payments and payment details
  • Export payments
  • Add claims by superbill upload or manual entry
  • View claims and claim details
  • Request help
  • Request benefit check
Client cannot:
  • Edit email address after account creation
  • Use secondary insurance or coordination of benefits
  • Access clinician payout dashboard
  • Access practice-wide transactions
  • Access team management
  • Access widget configuration

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SYS-ROLES-CLINICIAN-001

Type: system_rule Domain: roles Audience: clinician Intents: can_i, policy Objects: client, charge, payment, claim, payout, benefit_check, widget, support Title: Role: Clinician Clinician can:
  • Add client by email invite
  • Search clients
  • Filter active and archived clients
  • Pin client
  • Archive client
  • Remove client
  • Select payment type per client subject to eligibility rules
  • Configure client charging profile
  • Manage client diagnosis codes
  • Manage client payment methods
  • Add or edit client primary insurance
  • View client benefits
  • Add charges
  • View payment transactions
  • Export payment transactions
  • View transaction details
  • Issue refunds
  • View client claims and claim details
  • Use Instant Benefit Checker
  • Configure Thrizer Widget if enabled
  • Request help
  • Request fallback benefit check request for client
Cost rule:
  • Clinician payment transactions charged through Thrizer carry a 3% card processing fee.

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SYS-ROLES-PRACTICEADMIN-001

Type: system_rule Domain: roles Audience: clinician Intents: can_i, policy Objects: practice, team_member, business_settings, bank_account, payment, payout Title: Role: Practice Administrator Practice Administrator can:
  • Perform all clinician capabilities
  • Add and manage team members
  • Assign roles
  • Resend invites
  • Remove members
  • Manage business compliance settings
  • Manage payout bank account
  • View practice-wide payments
  • View payout dashboard

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SYS-OBJ-CLIENT-001

Type: system_rule Domain: objects Audience: client, clinician Intents: policy Objects: client, insurance, payment_method, bank_account Title: Object: Client Definition:
  • A Client is the end user receiving services and paying for services.
Core fields:
  • Identity:
    • first name
    • last name
    • email
    • DOB
  • Primary insurance:
    • insurance company
    • member ID
    • primary insurance holder
    • OON deductible
    • deductible remaining
  • Diagnosis:
    • diagnosis codes
  • Payment methods:
    • cards on file
  • Reimbursement account:
    • bank account
  • Payment type selection:
    • Thrizer Pay
    • OON Pay
    • Self-Pay
States:
  • Active
  • Archived
  • Removed
Relationships:
  • Client has many Charges.
  • Client has many Payment Transactions.
  • Client has many Claims.
Constraints:
  • Secondary insurance is not supported on this object.

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SYS-OBJ-CLINICIAN-001

Type: system_rule Domain: objects Audience: client, clinician Intents: policy Objects: clinician, practice Title: Object: Clinician Core fields:
  • first name
  • last name
  • email address
  • practice name
  • status
  • payment type displayed in client portal for the clinician relationship
  • compliance identifiers:
    • individual NPI
    • group NPI
    • tax ID
    • business address
Relationships:
  • Clinician has many Clients.
  • Clinician creates Charges for Clients.
  • Clinician views Claims for Clients.
  • Clinician receives payouts for Charges.

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SYS-OBJ-CHARGE-001

Type: system_rule Domain: objects Audience: clinician Intents: policy Objects: charge Title: Object: Charge Definition:
  • A Charge is a billed instance created by a clinician against a client.
Charge types:
  • Appointment
  • Client No-Show
  • Miscellaneous
Charge creation inputs:
  • client
  • clinician
  • client payment method
  • amount
  • date
  • location
  • service
  • duration

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Actor vs Provider Distinction

  • The logged-in user (clinician or practice admin) is the actor who creates the Charge.
  • The selected clinician on the Charge is treated as the provider of record for:
    • claim submission (provider NPI and claim data)
    • payout attribution
  • The rendering clinician does not need to be the logged-in user.
Implications:
  • A practice administrator or team member may create Charges on behalf of a clinician
  • Claims and payouts are always tied to the selected clinician, not the acting user
Charging profile fields:
  • service
  • amount
  • appointment duration
  • location
Charge-triggered workflow:
  • When a clinician creates a Charge, the system automatically:
    • charges the client’s selected payment method
    • submits a claim, when the selected payment flow includes claim submission
    • a claim is submitted only if the payment is successful
    • constraint: If payment fails, the claim must not be submitted
  • This trigger applies to both:
    • OON Pay
    • Thrizer Pay
Constraint:
  • Charge creation is the canonical trigger event for both client card charging and automatic claim submission in supported payment flows.
Constraint:
  • Payment status is not modeled here as a separate canonical taxonomy.

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SYS-OBJ-PAYMENTTXN-001

Type: system_rule Domain: objects Audience: client, clinician Intents: policy Objects: payment, transaction, refund, payout Title: Object: Payment Transaction Definition:
  • A Payment Transaction is a recorded financial transaction related to a charge.
  • A Refund Transaction is a Payment Transaction representing reversal or offset of a prior charge.
Client payment fields:
  • transaction date
  • appointment date
  • clinician
  • charge type
  • amount
  • payment type
  • claim number
Clinician payment fields:
  • transaction ID
  • transaction date
  • payout date
  • clinician
  • client
  • appointment date
  • charge type
  • gross amount
  • processing fee
  • net amount
  • payment type
  • client paid
  • refund indicator where applicable
Constraint:
  • Existence of a refund transaction does not define fee-refund policy.
  • Fee-refund policy must be defined only in pricing rules.

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SYS-OBJ-CLAIM-001

Type: system_rule Domain: objects Audience: client, clinician Intents: policy Objects: claim, superbill Title: Object: Claim Definition:
  • A Claim is a submission to an insurance company for reimbursement or deductible credit.
Claim creation sources:
  • Automatic submission triggered when a clinician creates a Charge in a payment flow that supports automatic claim submission
  • Manual submission by client superbill upload or manual entry
Automatic claim trigger:
  • For OON Pay and Thrizer Pay, claim submission occurs automatically when the clinician creates a Charge.
  • At the same time, the client’s payment method is charged using the information attached to that Charge.
  • No separate manual claim-submission action is required for these automatic claim flows.
Client claim input fields:
  • appointment information
  • diagnosis code
  • provider name
  • practice name
  • provider NPI
  • group NPI
  • tax ID
  • address
Claim detail fields:
  • claim number
  • date submitted
  • appointment date
  • billed amount
  • CPT code
  • status
  • result
  • client name
  • client DOB
  • insurance company
  • member ID
  • diagnosis code
  • primary insurance holder
  • clinician name
  • individual NPI
  • group NPI
  • tax ID
Constraint:
  • This file defines claim object structure.
  • It does not define insurer adjudication logic.

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SYS-CLAIM-OUTCOMES-001

Type: system_rule Domain: state_model Audience: client, clinician Intents: policy Objects: claim Title: Claim outcome interpretation Rule:
  • Claim Status = Approved may correspond to either:
    • reimbursement
    • deductible application with reimbursement amount = $0
  • Claim Status = Denied corresponds to:
    • no reimbursement
    • no deductible credit
  • Reimbursement and deductible application are both successful claim-processing outcomes.
  • Denied is an unsuccessful claim-processing outcome.
Constraint:
  • Approved does not by itself identify reimbursement destination.
  • Approved does not by itself guarantee cash reimbursement to the client.

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SYS-ELIG-DEDGATING-001

Type: system_rule Domain: eligibility Audience: client Intents: policy Objects: deductible, payment Title: Deductible gating Rule:
  • Payment type availability is determined exclusively by the Thrizer Payment Eligibility Rules.
Constraint:
  • This file must not define or duplicate payment type eligibility logic.
  • All eligibility decisions must be routed to:
    • Thrizer Payment Eligibility Rules
Clarification:
  • Deductible status impacts payment type availability only through the Payment Eligibility Rules.
  • This file may reference deductible status but must not independently determine payment type eligibility.

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SYS-ELIG-THRIZERPAY-001

Type: system_rule Domain: eligibility Audience: client Intents: can_i, policy Objects: payment, insurance, claim Title: Thrizer Pay eligibility Rule: Thrizer Pay eligibility is determined by Thrizer Pay Rules

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SYS-PRICE-CLIENT-PREDED-001

Type: system_rule Domain: pricing Audience: client Intents: policy Objects: payment, claim Title: Client pricing before deductible is met Rule:
  • Client platform fee = $0 when DEDUCTIBLE_MET = false.
Includes:
  • automatic claim submission where supported
  • claim status tracking
  • resubmissions
  • claim denial support
Constraint:
  • This rule defines client pricing only.
  • It does not remove clinician card-processing fees.

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SYS-PRICE-CLIENT-OONPAY-001

Type: system_rule Domain: pricing Audience: client Intents: policy Objects: payment, claim, reimbursement Title: Client pricing: OON Pay Eligibility: If DEDUCTIBLE_REMAINING > 0 → OON Pay allowed, no fee If DEDUCTIBLE_REMAINING = 0 → OON Pay allowed, fee applies Fee rule:
  • Client fee = 1% of provider full session fee.
Fee trigger:
  • Fee is charged only when reimbursement is distributed to the client.
  • Fee is deducted from reimbursed funds.
  • If reimbursed funds amount = $0, the 1% fee is not charged.
Payment model:
  • Client pays provider full fee.
  • Client waits for reimbursement.
Includes:
  • automatic claim submission where supported
  • claim status tracking
  • resubmissions
  • denial support

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SYS-PRICE-CLIENT-THRIZERPAY-001

Type: system_rule Domain: pricing Audience: client Intents: policy Objects: payment, claim, reimbursement Title: Client pricing: Thrizer Pay Eligibility: Thrizer Pay eligibility is defined in Thrizer Pay Rules. Fee rule:
  • Client fee = 5% of provider full session fee.
Fee trigger:
  • 5% fee is charged upfront when the client pays their co-insurance amount.
Payment model:
  • Client pays co-insurance amount plus 5% fee.
  • Thrizer advances the remaining portion of provider full session fee.
  • Insurance reimbursement for the advanced portion is routed to Thrizer.
Fee refund rule:
  • If Claim Status = Denied, the 5% fee is refunded.
  • If Claim Status = Approved, the 5% fee is retained.
Risk boundary:
  • If reimbursement is lower than expected or not received, Thrizer absorbs the loss.
  • Therapist payout is not reduced by reimbursement shortfall.
Constraint:
  • This rule does not waive clinician card-processing fees unless another canonical pricing rule states otherwise.

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SYS-PRICE-CLIENT-SUPERBILL-001

Type: system_rule Domain: pricing Audience: client Intents: policy Objects: claim, superbill, reimbursement Title: Client pricing: Superbill Upload Rule:
  • Client fee = $2 per session.
Pre-deductible rule:
  • If claim is not successfully applied toward the deductible, the $2 fee is refunded.
  • If Claim Status = Approved, including deductible application, the $2 fee is retained.
Post-deductible rule:
  • If Claim Status = Approved, the $2 fee is retained.
  • If Claim Status = Denied, the $2 fee is refunded.
Constraint:
  • No percentage fee applies to superbill upload claims.

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SYS-PRICE-CLINICIAN-PLATFORM-001

Type: system_rule Domain: pricing Audience: clinician Intents: policy Objects: payment, claim, payout Title: Clinician pricing for payment transactions Rule:
  • Card processing fee = 3% on clinician payment transactions charged through Thrizer.
Includes:
  • automatic claim submission where supported
  • benefits tooling where available
  • claim management support
Constraint:
  • This rule defines clinician transaction fees.
  • It does not define referral incentives or promotional waivers.

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SYS-PRICE-CLINICIAN-SUPERBILL-001

Type: system_rule Domain: pricing Audience: clinician Intents: policy Objects: superbill, claim Title: Clinician pricing: Superbill Upload Rule:
  • Clinician fee = $0 when clients submit their own superbills through Thrizer.
Clinician responsibility:
  • Provide a superbill.

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SYS-CALIB-FIRSTCLAIM-001

Type: system_rule Domain: calibration Audience: client Intents: policy Objects: claim, reimbursement, payment Title: First-claim calibration Rule:
  • The first claim uses a best-guess allowed amount assumption.
  • The first processed claim is used to calibrate future expectations.
If insurance pays less than expected on the first claim:
  • Thrizer adjusts expected coverage to match actual coverage.
  • The client may owe an adjustment.
Approved claims update system understanding of:
  • allowed amount
  • deductible status

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SYS-CALIB-AFTERFIRST-001

Type: system_rule Domain: calibration Audience: client Intents: policy Objects: claim, reimbursement, payment Title: Post-calibration rule Rule:
  • Once true coverage is known, no back charges to clinician occur because of later reimbursement shortfall.
If insurance pays less than expected after the first claim:
  • Client is responsible for the difference.
  • Thrizer updates the client profile to match actual coverage.
Constraint:
  • Percentage-based fees remain based on provider full charge.

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SYS-REIMB-ROUTING-001

Type: system_rule Domain: reimbursement Audience: client, clinician Intents: policy Objects: reimbursement, payment Title: Reimbursement routing by payment type Rule:
  • OON Pay:
    • reimbursement is sent to the client
  • Superbill Upload:
    • reimbursement is sent to the client
  • Thrizer Pay:
    • reimbursement is sent to Thrizer
Constraint:
  • Claim Result wording such as bank deposit or check does not by itself identify the final destination of funds.

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SYS-REIMB-TIMING-001

Type: system_rule Domain: reimbursement Audience: client, clinician Intents: policy Objects: reimbursement Title: Reimbursement timing guidance Rule:
  • Typical reimbursement timing is 4 to 6 weeks.
  • Insurance carrier timing governs actual timing.
Constraint:
  • Do not promise reimbursement timing beyond this guidance.

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SYS-SCOPE-PRIMARYONLY-001

Type: system_rule Domain: scope Audience: client, clinician Intents: policy Objects: insurance Title: Insurance scope Rule:
  • Primary insurance only is supported.
  • Secondary insurance is not supported.
  • Coordination of benefits is not supported.

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SYS-DISCLAIMER-BENEFITS-001

Type: system_rule Domain: constraints Audience: client, clinician Intents: policy Objects: insurance, benefits Title: Benefits and coverage disclaimer Rule:
  • Information shown in benefits or coverage displays is not a guarantee of coverage.
  • The health plan determines coverage and claim outcomes according to plan terms and processes.
  • Do not promise reimbursement amount based on displayed benefits information.

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SYS-SURFACE-CLIENT-CLINICIANS-001

Type: system_rule Domain: surfaces Audience: client Intents: policy Objects: clinician Title: Client Portal surface: Clinicians Authoritative exposure:
  • clinician name
  • payment type for clinician relationship
  • email address
  • practice name
  • status
  • remove clinician action

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SYS-SURFACE-CLIENT-PAYMENTS-001

Type: system_rule Domain: surfaces Audience: client Intents: policy Objects: payment Title: Client Portal surface: Payments Authoritative exposure:
  • transaction date
  • clinician
  • appointment date
  • charge type
  • amount
  • payment type
  • claim number

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Widget Purpose

  • The Thrizer Widget allows prospective clients to check out-of-network benefits using the clinician’s configured services and rates. Clinicians can share a link to their customized widget or embed it within their practice website.
System role:
  • The widget collects:
    • service selection
    • session rate
    • client insurance details
  • These inputs are used to generate:
    • estimated reimbursement
    • estimated out-of-pocket cost
Dependencies:
  • At least one team member must have:
    • an active service
    • a defined rate
Constraint:
  • The widget provides estimates only and does not guarantee coverage or reimbursement.
  • Final outcomes are determined by the insurance carrier after claim adjudication.
  • Client information is not saved by Thrizer

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SYS-SURFACE-CLIENT-CLAIMS-001

Type: system_rule Domain: surfaces Audience: client Intents: policy Objects: claim Title: Client Portal surface: Claims Authoritative exposure:
  • date
  • claim number
  • clinician
  • appointment date
  • status
  • result
  • claim details
Claim creation support:
  • superbill PDF upload
  • manual entry

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SYS-SURFACE-CLIENT-ME-001

Type: system_rule Domain: surfaces Audience: client Intents: policy Objects: account, insurance, payment_method, bank_account, payment Title: Client Portal surface: Me Authoritative exposure:
  • account settings
  • primary insurance
  • payment methods
  • reimbursement bank account
  • payment type selection
Account constraints:
  • email address cannot be edited after account creation

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SYS-SURFACE-CLIN-CLIENTS-001

Type: system_rule Domain: surfaces Audience: clinician Intents: policy Objects: client, charge Title: Clinician Portal surface: Clients Authoritative exposure:
  • client list
  • client status
  • payment type selection per client
  • add charge
  • manage client
  • pin client
  • archive client
  • remove client
Constraint:
  • Payment type selection remains subject to canonical eligibility rules.

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SYS-SURFACE-CLIN-CLIENTDETAIL-001

Type: system_rule Domain: surfaces Audience: clinician Intents: policy Objects: client, insurance, payment_method, payment, claim, charge Title: Clinician Portal surface: Individual Client Authoritative exposure:
  • diagnosis codes
  • payment methods
  • primary insurance
  • benefits view
  • client payment transactions
  • client claims
  • charging profile
Constraint:
  • Benefits displayed on this surface are subject to the global benefits disclaimer.

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SYS-SURFACE-CLIN-PAYMENTS-001

Type: system_rule Domain: surfaces Audience: clinician Intents: policy Objects: payment, payout Title: Clinician Portal surface: Payments Authoritative exposure:
  • payment transactions across clients in practice scope
  • payout dashboard:
    • Confirmed Charges
    • Pending Charges
    • Payout History

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SYS-SURFACE-CLIN-BENEFITS-001

Type: system_rule Domain: surfaces Audience: clinician Intents: policy Objects: benefit_check, widget Title: Clinician Portal surface: Benefits Authoritative exposure:
  • Instant Benefit Checker
  • Thrizer Widget
Widget constraint:
  • At least one team member must be active with a service to enable widget functionality.

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SYS-SURFACE-CLIN-ME-MYTEAM-001

Type: system_rule Domain: surfaces Audience: clinician Intents: policy Objects: team_member Title: Clinician Portal surface: Me → My Team Authoritative exposure:
  • team member name
  • email
  • role
  • status
Supported roles:
  • Practice Administrator
  • Clinician

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SYS-SURFACE-CLIN-ME-SETTINGS-001

Type: system_rule Domain: surfaces Audience: clinician Intents: policy Objects: account, business_settings, bank_account Title: Clinician Portal surface: Me → Account Settings Authoritative exposure:
  • personal profile
  • business compliance information
  • payout bank account
Account constraint:
  • email address cannot be changed on the existing account

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SYS-CONSTRAINTS-001

Type: system_rule Domain: constraints Audience: client, clinician Intents: policy Objects: insurance, benefits, reimbursement Title: Global constraints Rule:
  • Secondary insurance is not supported.
  • Coordination of benefits is not supported.
  • Benefits shown are not a guarantee of coverage.
  • Do not promise reimbursement amount.
  • Do not promise reimbursement timing beyond canonical guidance.

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SYS-CLAIM-001

Type: system_rule Domain: claims Audience: client, clinician, internal Intents: definition, eligibility, policy Objects: claim, coverage, eligibility, verification Title: Successful claim definition and verification collapse Rule:
  • A claim is considered successful when it has been processed and accepted by the insurer.
  • A successful claim is the canonical source of truth for coverage verification.
  • If at least one successful claim exists, the following are considered verified:
    • Coverage is verified.
    • Allowed amount is verified.
    • Coinsurance is verified.
    • coverage_verified = true
  • No additional verification fields are required once a successful claim exists.

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SYS-SUPERBILL-WORKFLOW-001

Type: system_rule
Domain: claims
Audience: client, clinician
Intents: policy
Objects: superbill, claim, payment Title: Superbill workflows and constraints Rule: Thrizer supports two distinct superbill-related workflows:

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1) Client Superbill Upload (Claim Submission)

  • Clients may upload a superbill to submit a claim manually.
  • In this workflow:
    • Payment may occur inside or outside Thrizer
    • The client submits a claim via:
      • superbill upload, or
      • manual claim entry
  • Thrizer uses the submitted superbill data to generate a claim.
Ownership constraint:
  • Superbill submission is client-driven.
  • A client must have their own Thrizer account to upload or manually enter a superbill claim.
  • Clinicians cannot upload or submit superbill claims on behalf of clients.
Constraint:
  • Claim accuracy depends entirely on the uploaded superbill
  • Thrizer does not validate or guarantee reimbursement

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2) Clinician Superbill Generation (Self-Pay Only)

  • Superbill generation by clinicians is only supported when the client is set to Self-Pay.
  • In this workflow:
    • The clinician charges the client using Self-Pay (or collects payment externally)
    • The clinician generates a superbill from the session
    • The client submits the claim independently to their insurance
  • Thrizer is not involved in claim submission or reimbursement processing in this flow.
Constraint:
  • Superbill export is not available for OON Pay or Thrizer Pay
  • Claim submission responsibility lies entirely with the client

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System Distinction

  • Self-Pay:
    • payment only
    • optional superbill generation
    • client submits claim
  • OON Pay / Thrizer Pay:
    • payment + automatic claim submission
    • no superbill generation

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Data Requirements

All superbills must include:
  • provider name
  • NPI
  • TIN
  • service dates
  • billed amount
  • diagnosis codes (ICD-10)
Constraint:
  • Missing required fields may result in claim denial by the insurer

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SYS-DATA-VISIBILITY-001

Type: system_rule Domain: constraints Audience: client, clinician Intents: policy Objects: clinician, business_settings, address Title: Business address visibility constraints Rule:
  • Business address is collected for:
    • payment processor compliance
    • tax reporting (e.g., 1099-K)
    • business verification requirements
  • Business address is not displayed in client-facing portal surfaces.
Constraint:
  • Thrizer does not explicitly transmit business address data to insurers

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SYS-CLAIM-ASSOCIATE-001

Type: system_rule Domain: claims Audience: clinician, internal Intents: policy Objects: claim, clinician Title: Associate clinician claim submission behavior Rule:
  • Thrizer standard claim submission uses the NPI of the clinician associated with the Thrizer account.
  • If an associate clinician creates the Thrizer account, the associate clinician’s own NPI is used on submitted claims.
  • Standard claim submission does not include a supervising provider NPI.
  • Standard claim submission does not include dual provider representation for rendering provider and supervising provider.
Fallback handling:
  • If an insurer denies a claim because supervising provider information is required, support may collect supervising provider information after the denial for manual follow-up or correction where possible.
Constraints:
  • Thrizer does not currently provide a standard UI flow to enter a supervising provider NPI for claim submission.
  • Thrizer does not guarantee insurer acceptance of claims submitted under an associate clinician’s own NPI.
  • Requirements for supervising provider information are determined externally by the insurer.

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SYS-IDENTITY-TAXID-001

Type: system_rule
Domain: identity
Audience: client, clinician, admin
Intents: policy
Objects: claim, payout, tax_reporting Title: Thrizer Tax Identification Number (TIN) Rule:
  • Thrizer’s Tax Identification Number (TIN) is: 863015188

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Tax Reporting Usage (1099-K)

  • Thrizer issues 1099-K forms to clinicians for payments processed through the platform.
  • When completing tax filings using a 1099-K issued by Thrizer:
    • The payer TIN to use is Thrizer’s TIN (863015188)
  • This applies to:
    • tax software entry
    • manual tax filing
    • any workflow referencing the 1099-K payer

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Claim Submission Usage

  • Claims submitted through Thrizer may require a Tax ID field.
  • The Tax ID used on a claim depends on the billing configuration:
    • If the clinician is the billing entity:
      • The clinician’s TIN should be used
    • If Thrizer is acting as the billing entity in the claim submission workflow:
      • Thrizer’s TIN may be used

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Constraints

  • Thrizer’s TIN must not be assumed as the default for all claims
  • Tax usage (1099-K) and claim usage are separate contexts and must not be conflated

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External Determination

  • Insurers determine claim acceptance based on submitted billing information

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DATA-VISIBILITY-CONSTRAINTS

  • Business address is collected for:
    • payment processor compliance
    • tax reporting (e.g., 1099-K)
    • business verification requirements
  • Business address is not displayed in client-facing portal surfaces
  • Business address is not shared with clients through Thrizer
  • Business address is not explicitly transmitted to insurers by Thrizer systems
  • Exposure of business address to external systems (e.g., insurers) is:
    • not defined by Thrizer system rules
    • determined externally where applicable