Claims processing timeline

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Overview

Use this guide to explain your client’s claim status and decide when to request help. After Thrizer submits a claim, the insurer reviews it and determines the outcome. Processing typically takes 4 to 6 weeks, though the insurer controls the timing. An approved claim can pay no reimbursement, and approval doesn’t mean a payment has arrived.

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How this works

A successful eligible OON Billing charge starts automatic claim submission, subject to the Date of Service. You do not submit a separate routine claim. See How Thrizer submits insurance claims for the complete submission and historical-claim rules, and Date of Service and Billing Type when charging before a session. Client manual claims submitted before August 9, 2026 continue to process normally.

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How long does claim processing usually take?

Insurance claims typically take about 4 to 6 weeks to process. This is a general timeline, not a guarantee. Some claims may process faster, while others may take longer depending on the insurance carrier, the plan, the claim details, or whether additional review is needed.

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Why is my claim still processing?

Open Clinician Portal → Clients → select the client → Claims, then select the claim to review its status and details. The insurer may still be checking the submitted information, plan rules or deductible application. A processing status alone does not mean something is wrong. If the claim appears delayed or stops progressing, contact Support through your Thrizer account with the claim number, service date, status and any notice or request received. Thrizer can review whether follow-up is needed; it cannot guarantee a completion date. Your client can also contact Support directly, including through an available support-request option when unable to sign in.

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Why did MultiPlan, Claritev, or Zelis contact my practice?

Your client’s insurer may use another company to price or negotiate an out-of-network claim, even when Thrizer submitted it. Clinicians can decline a negotiation offer in writing and keep a copy. You can also ask your client to open a ticket with their insurer’s Member Services requesting that claims no longer be sent to MultiPlan/Claritev, Zelis, or the named company. Member Services is the insurer’s member-support team. Shareable client wording for the insurer: “Please stop sending my claims to MultiPlan/Claritev for pricing or negotiation. Can you confirm whether you can honor this request and whether it covers my pending claims, future claims, or both?” Replace the company name if another vendor contacted your practice. The insurer determines whether it can honor the request. Neither action guarantees a particular reimbursement amount or processing time. Verify unfamiliar messages through independently obtained payer or vendor contact information before opening links or signing in. A negotiation offer is different from a request for information needed to process a claim.

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What does an approved claim mean?

Approval means the insurer accepted the claim, but does not always mean your client receives money. Check the amount reimbursed or applied to the deductible, as well as whether a payment has been sent. Why an approved claim may not pay reimbursement explains deductible-only and other no-payment results.

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What does it mean if a claim is applied to my deductible?

The insurer counted the eligible amount toward the client’s deductible rather than paying it as reimbursement. The claim can still be processed successfully. Use Deductibles, coinsurance, and allowed amounts for the full calculation and examples.

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What happens if a claim is rejected?

A rejected claim is different from a denied claim. Rejection means the clearinghouse or insurer turned it away before making a coverage decision. Review rejection reasons and next steps. Support reviews whether an existing claim can be corrected or resubmitted; correcting a record does not itself resubmit it. Clients retain direct Support access through their own account.

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What happens if a claim is denied?

A denial means the insurer decided not to reimburse the claim or apply it toward the deductible. If information needs correction, use Support review for charge or claim edits. Insurer denials do not reduce your gross payment for Thrizer-processed charges. A refund your practice chooses to issue is a separate exception. See Clinician payout protection for the complete distinction and Pricing overview for applicable fee outcomes.

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Claims after provider registration

Once the required Blue plans confirm active practice records and clinician affiliations, notify Thrizer Support with the payer confirmation and documentation. You do not need to identify individual claims. After receiving the confirmation, Thrizer reviews the affected claims:

• Thrizer resubmits eligible claims rejected or denied because registration was missing, subject to the payer’s timely-filing window and processing requirements.
• A pending or stalled claim remains under monitoring. Do not request a duplicate solely because registration became active.
• An eligible claim not yet submitted follows the normal claim-submission process.

Registration does not guarantee approval or reimbursement. Thrizer continues to submit eligible BCBS claims while registration is incomplete; the payer may delay, reject or deny them.

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What Thrizer does

Thrizer submits eligible claims, tracks the information it receives and helps investigate problems. How Thrizer submits insurance claims explains automatic submission and the historical client-claim boundary; Claims and superbills for clinicians gives the dashboard steps.

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What insurance determines

The insurance carrier decides the final claim outcome. Thrizer does not control whether the carrier approves the claim, denies it, applies it to the deductible, issues reimbursement, or how long the carrier takes to process the claim.

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