Claim and billing limitations

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Overview

Thrizer supports common out-of-network payment and claim processes, 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 request 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 option.

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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. Add Charge enforces this in the form. When the selected client has no qualifying diagnosis on file:

• OON Pay and Thrizer Pay are disabled in the billing type dropdown.
• If one of those options was already selected, the form silently switches the charge to Self-Pay and shows a warning toast.
• Thrizer rejects insurance charges submitted without a diagnosis, so no payment is collected and no claim is created.

Self-Pay does not require a diagnosis and remains available. To unblock insurance billing, add a diagnosis on the client detail page (Edit Diagnoses) and then return to Add Charge. 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 Thrizer does not submit the claim. 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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Is there a maximum charge amount in the Clinician Portal?

Yes. Charges submitted from the Clinician Portal are capped at a session rate of $2,500. If the amount (or full rate, when set) exceeds $2,500, an inline error appears on the amount field. Submit stays disabled until the amount is reduced. If a practice needs to process a larger transaction, contact Thrizer support. A Thrizer administrator can review and process the charge on the practice’s behalf.

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Can insurance be billed for sessions scheduled far in the future?

No. OON Pay and Thrizer Pay are only available when the Date of Service is today or tomorrow (UTC). Sessions two or more calendar days ahead cannot be billed to insurance through Thrizer. In Add Charge, picking a date more than one day ahead disables OON Pay and Thrizer Pay in the payment type dropdown and switches the form to Self-Pay. An insurance charge with a missing date, or a date more than one day ahead, is not accepted. Self-Pay works for any future Date of Service. To bill insurance, create the charge on the day before or the day of the session.

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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 canceled 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, as long as the claim has not already been submitted to insurance. Clients may submit claims for past service dates by uploading a valid superbill or entering claim details manually through their own Thrizer account. However, the insurer still determines whether to accept the claim. 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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I selected the wrong CPT code (or other claim detail). Can it be corrected after submission?

Once a claim has been submitted to insurance, you cannot edit that claim directly from the Clinician Portal. If a claim was submitted with an incorrect CPT code, diagnosis code, service date, or other detail, contact Thrizer support at help@thrizer.com. Support may be able to review the claim and help correct or resubmit it where possible. Thrizer does not guarantee that the insurer will accept a corrected claim, approve it, or reimburse it. Insurer timely filing rules and re-processing rules still apply.

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Can a denied claim be corrected and resubmitted?

Contact Thrizer support at help@thrizer.com. Support may review the denial and help correct or resubmit the claim where possible. Insurer acceptance, approval, and reimbursement are not guaranteed. Clinicians cannot edit or resubmit a denied claim directly from the Clinician Portal.

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How do I cancel a charge? Does that cancel the claim?

If you successfully cancel a charge, Thrizer also cancels the associated OON Pay or Thrizer Pay claim. You do not need to cancel the claim separately. If the claim has already been submitted and you cannot cancel the charge directly, contact Thrizer support at help@thrizer.com to review options.

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I accidentally charged twice for one session. How do I fix it?

Refund the duplicate charge from the Clinician Portal. When the duplicate charge is refunded, Thrizer also cancels the duplicate claim at the same time. You do not need to cancel the duplicate claim separately. See Payments, payouts, and refunds for how to issue a refund.

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How do I cancel a charge or a claim?

A claim in Thrizer is generated from a charge, so cancelling the charge and cancelling the claim are linked.

• If you successfully cancel the charge, Thrizer also cancels the associated claim. No separate claim-cancel step is needed.
• If the claim has already been submitted and you cannot cancel or edit the charge directly, contact Thrizer support at help@thrizer.com. Support may be able to review and, where possible, cancel or correct the claim. Insurer acceptance of the cancellation is not guaranteed.

Refunds follow the same principle. See I accidentally charged twice for one session below.

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I accidentally charged twice for one session

If you charge the same session twice, refund the duplicate charge from the Clinician Portal. When you refund the duplicate charge, Thrizer also cancels the duplicate claim generated from that charge at the same time. You do not need to cancel the claim separately. Only the duplicate transaction is affected. The remaining, correct charge and its claim continue to process normally. If you cannot refund the duplicate charge from the Clinician Portal, or if you’re unsure which transaction to refund, contact Thrizer support at help@thrizer.com.

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I selected the wrong CPT code and the claim was denied. Can it be corrected?

Once a charge has been submitted and a claim generated, you cannot edit the claim directly from the Clinician Portal. If you submitted the wrong CPT code (or another claim field), contact Thrizer support at help@thrizer.com. Support may be able to review the claim and, depending on the situation, help correct the information or resubmit the claim where the payment type allows. Support review does not guarantee insurer acceptance, approval, or reimbursement. The insurance carrier still determines the final claim outcome. That includes whether a corrected or resubmitted claim is accepted under the insurer’s rules and timely-filing limits.

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Can Thrizer fix or resubmit a superbill that was already sent to insurance?

No. Thrizer cannot take over, correct, appeal, or resubmit a superbill claim that has already been submitted to insurance through another path. If a superbill was already submitted to insurance and the client believes it was reimbursed incorrectly, the client needs to work through the insurer or the original submission path. Re-uploading the same claim through Thrizer may create a duplicate-claim issue. Thrizer’s superbill process is for generating a new claim from a valid superbill or manual claim entry that has not yet been submitted to insurance.

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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 payment type 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 options, submit claims when the payment type 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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