How to submit a claim

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Before you start

When a clinician on Thrizer charges a client through OON Pay or Thrizer Pay, Thrizer submits the out-of-network claim automatically after the payment is successfully processed. The client does not need to do anything. In all cases, the insurance carrier determines the final claim outcome, reimbursement amount, deductible application, and processing timing.

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How this works

The right claim path depends on how the session was paid and whether the clinician is on Thrizer. If the session is processed through OON Pay or Thrizer Pay, Thrizer submits the claim automatically after successful payment. If you have a superbill from a provider who is not on Thrizer, submit it directly to your insurer outside of Thrizer. Thrizer does not accept or submit client superbills.

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When is a claim submitted automatically?

Claims are submitted automatically for:

• OON Pay
• Thrizer Pay

In these payment flows, the clinician creates a charge for the session. Once the client’s payment is successfully processed, Thrizer submits the claim to insurance using the information attached to that charge. There is no separate manual claim submission step for OON Pay or Thrizer Pay.

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What happens if the payment fails?

If the client’s payment does not go through, the charge fails and the claim is not submitted. Resolve the payment issue with the client, then retry the charge. Thrizer submits a claim only after payment succeeds.

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What if my clinician is not on Thrizer?

Client-side Upload Superbill and Add Claim were retired from the Client Portal on August 9, 2026. Clients can no longer submit new claims themselves through the portal. If you have a superbill from a provider who is not on Thrizer, submit it directly to your insurer for out-of-network reimbursement. Thrizer does not accept or submit client superbills.

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Can a clinician upload a superbill for a client?

A clinician on Thrizer submits claims for their own clients automatically through OON Pay or Thrizer Pay. A clinician cannot upload a superbill on a client’s behalf for a session that was not paid through Thrizer.

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What information does a claim need?

Claims generally need enough information for the insurance carrier to process the service. A superbill or claim entry should include:

• provider name
• provider NPI
• tax ID or TIN
• service date
• billed amount
• one or more diagnosis codes
• CPT code

If required information is missing or incorrect, the claim may be delayed, fail, or be denied by the insurer.

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What if the session was Self-Pay?

Self-Pay means no insurance claim is automatically submitted through Thrizer. A client can generate a superbill PDF from Client Portal → Payments for a Confirmed Self-Pay session. See Viewing payments and exporting receipts. The client submits that superbill directly to their insurer outside of Thrizer. Thrizer does not submit client superbills on their behalf.

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Can claims for past service dates be submitted?

For OON Pay and Thrizer Pay, claims are tied to the charge and are submitted with the session’s Date of Service. Insurance carriers have their own timely filing rules. If a claim is submitted too late under the insurer’s rules, the insurer may deny it. Thrizer does not guarantee that a claim for a past service date will be accepted or reimbursed.

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What happens after a claim is submitted?

After a claim is submitted, the insurance carrier processes it. The claim may result in:

• reimbursement
• application toward the deductible
• denial

An approved claim does not always mean money will be reimbursed. If the deductible has not been met, the claim may be approved and applied to the deductible instead. The insurance carrier controls claim processing time. Typical reimbursement timing may be around 4 to 6 weeks, but timing is not guaranteed.

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Why weren’t some sessions submitted as claims?

For OON Pay and Thrizer Pay, Thrizer submits a claim only when both conditions are met:

1. The client’s payment was successfully processed (the charge went through).
2. All required claim information is present and claim-compatible.

If either condition fails, no claim is submitted for that session. Common reasons include:

• The payment failed. No payment is captured, and no claim is submitted. Update the payment method and retry the charge.
• The session was Self-Pay. Self-Pay does not automatically generate an insurance claim. If reimbursement is expected, a superbill needs to be uploaded separately.
• Required claim information is missing. A missing diagnosis, missing Individual NPI on the rendering clinician, missing supported CPT, missing service date, or another required field can block submission. You see an inline message in Add Charge when this happens.
• The service or CPT structure is not claim-compatible. No-show and cancellation fees cannot be submitted to insurance through Thrizer. Sessions above your practice’s effective session-rate cap ($2,500 by default, or an approved higher cap up to $25,000), or sessions with unrelated CPT codes bundled together, cannot be submitted as a single insurance claim.
• The Date of Service is more than one day ahead. OON Pay and Thrizer Pay require a Date of Service of today or tomorrow. This is a calendar-day restriction, not a rolling 24-hour window. Sessions two or more calendar days ahead must use Self-Pay.
• The claim is under Thrizer support review. Some claims are held for support review before submission.

If none of these apply and a claim is still missing, Thrizer support can investigate.

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Why was a claim denied?

Thrizer can accept a claim, and the insurance carrier can still deny it. Denial is an insurance-side decision. Common reasons include:

• the CPT code, diagnosis code, or provider information does not match insurer records
• the service is not covered under the client’s plan
• the client’s plan does not include out-of-network benefits
• the insurer’s timely filing window has passed
• documentation or additional information the insurer requested is missing
• plan-specific rules that Thrizer cannot see before submission

If a claim was denied because of a claim-detail error (for example, a wrong CPT code), Thrizer support can review the claim and, where possible, correct or resubmit it. Insurer acceptance is not guaranteed. See Claim and billing limitations.

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Why was a claim rejected?

A rejected claim is different from a denied claim. Rejections happen before the payer processes the claim, either because Thrizer’s clearinghouse could not accept the submission or because the payer returned the claim as unprocessable. For rejected claims, the claim detail drawer in the Clinician Portal now shows a reason from the clearinghouse or payer where one is available. The Results row reads as Claim Rejected: {reason}. When the payer returned an additional status message, that message is included as a second sentence. Common reasons include:

• A bad Tax ID or missing billing NPI on the submission. The claim is rejected immediately and never reaches the payer.
• An NPI or eligibility check that could not be verified for the client.
• The payer returning the claim as unprocessable for an entity such as the rendering provider or subscriber.
• A subscriber ID that does not match the payer’s records.

Use the reason to decide next steps. Fields you own on the client or clinician record can be corrected and the claim resubmitted with support’s help. If the reject wording is payer-specific and unclear, note the exact text the payer returned so Thrizer support can review it. The Client Portal shows only a generic rejected message. Only the Clinician Portal claim drawer and the Thrizer admin console include the clearinghouse or payer reason.

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What if a claim is delayed or has an issue?

If a claim fails, stalls, or needs more information, Thrizer support can review the claim. Depending on the situation, Thrizer may request missing information, investigate with the insurer, or help correct and resubmit the claim when possible. The final decision still belongs to the insurance carrier.

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What Thrizer does

Thrizer helps submit and track claims when the claim is submitted through a supported Thrizer process. For OON Pay and Thrizer Pay, Thrizer submits the claim automatically after a successful charge, using the claim information attached to that charge.

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What insurance determines

The insurance carrier determines final coverage, claim approval, reimbursement, deductible application, and processing timing. Thrizer does not guarantee claim approval, reimbursement amount, deductible application, or claim timing.

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