How to submit a claim

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Short answer

Thrizer supports two main claim submission paths:

• Automatic claim submission through OON Pay or Thrizer Pay
• Client-submitted claims through superbill upload or manual claim entry

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. For superbill-based claims, the client submits the claim through their own Thrizer account by uploading a superbill or entering claim details manually. 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 submission path depends on how the session was paid for and whether Thrizer is handling claim submission. If the session is processed through OON Pay or Thrizer Pay, the claim submission workflow is automatic after successful payment. If the client has a superbill, the client may submit the claim manually through Thrizer, when that workflow is supported, or submit the superbill directly to insurance outside of Thrizer.

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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. The clinician will need to resolve the payment issue with the client and retry the charge. A claim is submitted only after payment succeeds.

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When does a client submit a claim manually?

A client may submit a claim manually when they have a superbill or claim details that need to be submitted through Thrizer. This may apply when:

• the clinician is not using an automatic claim submission flow
• the session happened outside an OON Pay or Thrizer Pay workflow
• the client has a superbill and wants Thrizer to submit the claim from that document

Manual claim submission is client-driven. The client must have their own Thrizer account to upload a superbill or enter claim details.

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Can a clinician upload a superbill for a client?

No. Superbill upload for claim submission is a client-driven workflow. A clinician may provide a superbill to the client, but the client is responsible for uploading the superbill or entering the claim details through their own Thrizer account.

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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
• diagnosis code
• 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. In a Self-Pay workflow, the client pays for the session without automatic Thrizer claim submission. A clinician may generate or provide a superbill for the client. The client may then choose to:

• submit the superbill directly to insurance outside of Thrizer, or
• submit the claim through a supported Thrizer superbill upload or manual claim entry workflow

Thrizer is not involved in claim submission or reimbursement processing unless the client separately submits the superbill or claim details through a supported Thrizer claim workflow.

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Can claims for past service dates be submitted?

Yes. Clients may submit claims for past service dates by uploading a valid superbill or entering claim details manually. However, 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. Claim processing time is controlled by the insurance carrier. Typical reimbursement timing may be around 4 to 6 weeks, but timing is not guaranteed.

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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 may review the issue. 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 workflow. For OON Pay and Thrizer Pay, Thrizer submits the claim automatically after a successful charge. For superbill upload or manual claim entry, Thrizer uses the information provided by the client to generate the claim.

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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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