Overview
After a claim is submitted through Thrizer, the insurance carrier reviews it and determines the final outcome. Claims typically take about 4 to 6 weeks to process, but the insurance carrier controls timing. A claim may be processing, investigating, approved, or denied. An approved claim does not always mean money will be reimbursed. If the client’s deductible has not been met, the carrier may apply the claim toward the deductible instead of issuing reimbursement.How this works
After submission, Thrizer sends the claim to the insurance carrier for review. If the claim was created through OON Pay or Thrizer Pay, Thrizer submits the claim automatically after the charge is created and the client’s payment is successfully processed. For a client manual claim submitted before August 9, 2026, Thrizer used the superbill or manually entered information to generate the claim. Those existing claims continue to process normally. Once the claim is with the insurance carrier, the carrier determines what happens next.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.Why is my claim still processing?
A claim may stay in processing while the insurance carrier reviews the submitted information. This does not always mean something is wrong. The carrier may still be reviewing the claim, checking plan rules, determining deductible status, or deciding whether reimbursement is owed. If a claim appears delayed or stops progressing, Thrizer support may review the available claim information and help determine whether follow-up is needed.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. Your client can say: “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.What does an approved claim mean?
An approved claim means the insurance carrier accepted the claim. It does not always mean the client will receive money back. If the client’s deductible has not been met, the insurance carrier will typically apply the claim amount toward the deductible instead of issuing reimbursement. That means a claim can be approved and still result in $0 reimbursement.What does it mean if a claim is applied to my deductible?
If a claim is applied to the deductible, the insurance carrier has counted the claim toward the amount the client must pay before insurance begins reimbursing eligible services. In this case, the claim may still be considered processed successfully even if no reimbursement is paid.What happens if a claim is rejected?
A rejected claim is different from a denied claim. A rejection means the clearinghouse or the insurance carrier turned the claim away before reviewing it. No coverage decision was made. Clinicians see a specific rejection reason on the claim in the dashboard, translated from the rejection codes the clearinghouse or payer returned. For common rejections tied to practice details, such as an invalid NPI, Tax ID, or address, the claim drawer also explains what to check and what to do next. See Claims and superbills for clinicians for how these reasons read and how to act on them. The Client Portal shows a generic rejected message without the specific reason, so clients should ask their clinician first. If support review is needed, contact Thrizer support through your Thrizer account. Once the underlying detail is corrected, the claim can be resubmitted. Contact Thrizer support if you need help correcting or resubmitting a rejected claim.What happens if a claim is denied?
If a claim is denied, the insurance carrier has decided not to reimburse the claim and not to apply it toward the deductible. A denial does not reduce the clinician’s payout for charges processed through Thrizer. It may affect whether the client receives reimbursement or whether certain Thrizer fees are refunded, depending on the payment type and claim outcome. This payout protection does not apply to refunds a clinician chooses to issue. If a clinician refunds a Thrizer Pay transaction, the clinician’s payout for that transaction is reversed.Claims after provider registration
Once the required Blue plans confirm active practice records and clinician affiliations, notify Thrizer support and share the payer’s confirmation and any related documentation. You do not need to identify individual claims. After you share approval confirmation and documentation, Thrizer will handle resubmissions and follow-up as described below.- Thrizer will resubmit eligible claims rejected or denied because registration was missing, subject to the payer’s timely-filing window and processing rules.
- A pending or stalled claim continues through the standard process. Thrizer monitors it; do not request a duplicate solely because registration became active.
- An eligible claim not yet submitted follows the normal claim-submission process.
What Thrizer does
Thrizer helps submit, track, and support the claim process. For OON Pay and Thrizer Pay, Thrizer submits the claim automatically after the clinician creates a charge and the client’s payment is successfully processed. Thrizer continues to track and support client manual claims submitted before that workflow was retired on August 9, 2026.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.Related articles
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