Claim and billing limitations

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Short answer

Thrizer supports common out-of-network payment and claim workflows, but some billing setups cannot be handled automatically. In general, Thrizer is structured around a few core rules:

• One charge connects to one claim
• One charge supports one CPT code
• A claim can only be submitted when the required information is complete
• A claim is submitted only after the client payment is successfully processed

If a workflow does not fit that structure, it may need to be handled differently.

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How this works

This article explains common claim and billing limitations so clients and clinicians know what to expect before creating a charge, submitting a claim, or choosing a payment workflow.

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Can one session be split across multiple cards?

No. A single session charge cannot be split across multiple payment methods. The client needs to use one payment method for the full charge.

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Can multiple charges be combined into one claim?

No. Thrizer does not automatically combine multiple charges into one insurance claim. Each charge corresponds to a single claim. If a session is split into multiple charges, those charges remain separate for claim purposes. This matters because insurance carriers review claims based on the information submitted on each claim. A split payment or split charge may not behave the same way as one combined session claim.

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Can one charge include multiple CPT codes?

Each charge supports one primary CPT code. Add-on or extension units of the same underlying service (for example, time-based add-ons) may be included with the primary code. If a session includes unrelated services that require separate CPT codes, those services need to be billed as separate charges. Each charge creates its own claim. A CPT code is the billing code that identifies the type of service provided. Insurance carriers use CPT codes when reviewing claims.

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Can a claim be submitted without a diagnosis code?

No. A diagnosis code is required before submitting a charge that generates a claim. If the clinician does not yet have a diagnosis code, the charge may need to wait until the diagnosis is available. Claims require complete information before they can be submitted. A diagnosis code is part of the insurance claim record. It helps identify why the service was provided.

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Can a failed payment still trigger a claim?

No. A claim is submitted only after the client’s payment is successfully processed. If the client’s payment method fails, the charge does not go through and the claim is not submitted. The clinician needs to resolve the payment issue with the client and retry the charge. Thrizer does not submit claims without successful payment, and failed charges are not automatically retried.

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Can a completed charge be moved to a different card?

No. Completed charges cannot be reassigned to a different payment method. If a client adds a new card, that card can be used for future charges. It does not change the payment method used for past charges.

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Can past sessions be changed to Thrizer Pay?

No. Thrizer Pay can only be applied to future sessions. The payment type needs to be selected before the charge is submitted. Past sessions cannot be converted to Thrizer Pay after the fact.

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Can no-show or cancellation fees be submitted to insurance?

No. No-show and cancellation fees cannot be submitted to insurance through Thrizer. Clinicians may charge clients directly for missed or cancelled sessions, but those charges are handled separately from insurance reimbursement. They should be treated as self-pay charges. Because no-show and cancellation fees are not submitted as insurance claims, clients should not expect reimbursement for those charges through Thrizer.

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Can clients submit claims for past sessions?

Yes. Clients may submit claims for past service dates by uploading a valid superbill or entering claim details manually. However, claim acceptance is still determined by the insurer. Insurance plans may have timely filing limits, and Thrizer does not guarantee that an older claim will be accepted or reimbursed.

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Can clinicians upload superbills for clients?

No. Superbill claim submission through Thrizer is client-driven. Clients may upload a superbill or manually enter claim details through their own Thrizer account. Clinicians can generate a superbill only for Self-Pay sessions, where the client submits the claim to insurance independently. Superbill generation by clinicians is not available for OON Pay or Thrizer Pay. For OON Pay and Thrizer Pay, claim submission happens automatically after a successful charge when the workflow supports claim submission.

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Does Thrizer support secondary insurance?

No. Thrizer supports primary insurance only. Secondary insurance and coordination of benefits are not supported. If a client has more than one insurance plan, Thrizer cannot automatically coordinate claims across multiple insurers.

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Can practices split payouts between clinicians?

No. Thrizer does not support automated revenue splits between clinicians. Each team has one linked payout bank account. If a practice needs to divide payments among clinicians, that needs to be handled outside of Thrizer.

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What Thrizer does

Thrizer can help process supported payment workflows, submit claims when the workflow supports claim submission, and track claim status. For OON Pay and Thrizer Pay, claim submission happens automatically after a successful charge when the required claim information is present. For client-submitted claims, clients may upload a valid superbill or enter claim details manually.

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What insurance determines

Insurance carriers determine claim acceptance, claim approval, deductible application, reimbursement amount, and reimbursement timing. Thrizer does not guarantee claim approval, reimbursement amount, deductible application, or claim timing.

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