Before you start
When a clinician on Thrizer charges a client through OON Billing, Thrizer automatically prepares the out-of-network claim after successful payment. Submission also requires complete, claim-compatible information and a Date of Service that is no longer in the future. The Reimbursement Method does not add a separate claim-submission step. The insurer decides the claim outcome, reimbursement, deductible application, and timing.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 Billing, Thrizer submits the claim automatically after successful payment. If your client has a superbill from a provider who is not on Thrizer, they submit it directly to their insurer outside of Thrizer. Thrizer does not accept or submit client superbills.When is a claim submitted automatically?
Automatic submission applies to eligible OON Billing charges using any available Reimbursement Method: Check, Bank, or Instant Reimbursement. In these payment flows, the clinician creates a charge for the session. After successful payment, Thrizer prepares the claim using the information attached to the charge. If tomorrow was selected as the Date of Service, the claim is held until that date is no longer in the future. There is no separate manual claim submission step for OON Billing.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 follow failed-payment steps for a new charge attempt. Thrizer submits a claim only after payment succeeds.If your client has a superbill from another provider
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 your client has a superbill from a provider who is not on Thrizer, they submit it directly to their insurer for out-of-network reimbursement. Thrizer does not accept or submit client superbills.Can a clinician upload a superbill for a client?
A clinician on Thrizer submits claims for their own clients automatically through OON Billing. A clinician cannot upload a superbill on a client’s behalf for a session that was not paid through Thrizer.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
What if the session was Self-Pay?
Self-Pay means no insurance claim is automatically submitted through Thrizer. Your practice or client can generate a superbill for an otherwise eligible Confirmed Self-Pay appointment using a Billable Service. See Self-Pay and superbills for eligibility and Payments and superbills for role-specific export steps. The client submits that superbill directly to their insurer outside of Thrizer. Thrizer does not submit client superbills on their behalf.Can claims for past service dates be submitted?
For OON Billing, 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.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
Why weren’t some sessions submitted as claims?
For OON Billing, Thrizer submits a claim only when all three conditions are met:- The client’s payment was successfully processed (the charge went through).
- All required claim information is present and claim-compatible.
- The Date of Service is no longer in the future.
- The payment failed. No payment is captured, and no claim is submitted. Update the payment method and follow failed-payment steps for a new charge attempt.
- The session was Self-Pay. Self-Pay does not automatically generate an insurance claim. If the client wants reimbursement, they can generate a superbill in Client Portal → Payments and submit it directly to their insurer.
- 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 and Non-billable Services cannot be submitted to insurance through Thrizer. Unrelated CPT codes cannot be bundled into one claim; see CPT codes and Thrizer for the exact supported add-on combinations.
- The session rate exceeds your practice’s effective cap. Add Charge blocks a rate above the practice’s current limit. Use Charge amount limit for the default, approved practice-specific limits, and prior-review steps. This is a charge control, not an insurer coverage limit.
- The Date of Service is tomorrow. The charge can process, but the claim is held until that date is no longer in the future.
- The Date of Service is more than one day ahead. OON Billing requires 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.
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
Why was a claim rejected?
A rejection happens before a coverage decision. Review the available claim details and follow Rejected claim reason and next steps. That guide covers common information and registration problems, correcting records for future charges, and Support review of an existing claim. Updating a record does not itself resubmit the affected claim. Clients retain direct Support access.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 or investigate with the insurer. If you entered a charge incorrectly, follow the Support review for charge or claim edits. A delay or denial alone does not establish how the issue will be resolved. The final decision still belongs to the insurance carrier.What Thrizer does
Thrizer prepares, submits, and tracks eligible OON Billing claims using the charge details and the payment and service-date requirements above.What insurance determines
The insurer decides coverage, claim approval, reimbursement, deductible application, and timing. Thrizer can’t guarantee those outcomes.Related articles
Claim and billing limitations
Learn which claim and billing processes Thrizer does not support automatically.
Claims processing timeline
Understand what happens after a claim is submitted and why timing can vary.
Self-Pay and superbills
Learn how Self-Pay works and when clients may use superbills for claim submission.
CPT codes and Thrizer
See how CPT codes are used when preparing claims through Thrizer.
Diagnosis codes and Thrizer
Learn why diagnosis codes are required before a claim can be submitted.
Which billing options are available?
Compare Self-Pay or OON Billing with an available Reimbursement Method before choosing a Billing Type.