How to submit a claim

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Before you start

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 process is automatic after successful payment. If the client has a superbill, the client may submit the claim manually through Thrizer when that path is supported. The client may also 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. You will need to resolve the payment issue with the client and retry the charge. Thrizer submits a claim 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 charge
• 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 process. 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
• 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. In a Self-Pay charge, 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

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 process.

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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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Why weren’t some of my sessions submitted as claims?

Claim submission through OON Pay or Thrizer Pay requires both:

1. a successful client payment (the charge went through), and
2. complete claim-submittable information on file.

Common reasons a session may not have been submitted as a claim:

• The payment failed. No payment is captured, and no claim is submitted. The charge must be retried after resolving the payment issue.
• 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.
• Insurance is not verified. A claim cannot be submitted if the client’s insurance is not linked or the benefit check has not returned usable information.
• Required claim information is missing. A missing diagnosis code, missing provider NPI, or another missing required field can block claim 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, sessions above the $2,500 cap, or sessions with unrelated CPT codes bundled together cannot be submitted as a single insurance claim through Thrizer.
• The Date of Service is more than one day ahead. OON Pay and Thrizer Pay require a Date of Service of today or tomorrow (UTC). Sessions further out must use Self-Pay.

If none of these apply and a claim is still missing, contact Thrizer support at help@thrizer.com.

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Why was my claim denied?

Denial is an insurance-side decision. Common reasons include:

• the service is not covered under the client’s plan
• the CPT code, diagnosis code, or provider information does not match insurer records
• the client’s plan does not include out-of-network benefits
• the insurer’s timely filing window has passed
• documentation or additional information is required

If a claim was denied because of a claim-detail error (for example, wrong CPT code), contact Thrizer support so the claim can be reviewed and, where possible, corrected or resubmitted. Insurer acceptance is not guaranteed. See Claim and billing limitations.

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Why were some sessions not submitted as claims?

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

1. The charge has been successfully processed (client payment succeeded).
2. All required claim information is present and claim-compatible.

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

• Payment failed. If the client’s payment method fails, no payment is captured and no claim is generated. Update the payment method and retry the charge.
• The session was Self-Pay. Self-Pay does not generate an insurance claim. If the client wants reimbursement, they can submit a superbill through their Client Portal.
• Insurance is not verified. A usable benefit check is required. If the automated check failed and no manual verification is complete, Thrizer cannot submit a claim.
• Required claim fields are missing. Missing diagnosis, missing individual NPI on the rendering clinician, missing supported CPT, or missing service date can block submission.
• The service or CPT structure is not claim-compatible. For example, no-show / cancellation fees are not submitted to insurance, and unrelated services requiring separate CPT codes must be billed as separate charges.
• The claim is under Thrizer support review. Some claims are held for support review before submission.

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Why was a claim denied?

Thrizer can accept a claim, and the insurance carrier can still deny it. Denial reasons come from the insurer. Common reasons include:

• Incorrect CPT or diagnosis codes for the plan.
• Out-of-network benefits not applying to the specific plan.
• Timely-filing issues.
• Missing information the insurer requested.
• Plan-specific rules that Thrizer cannot see before submission.

If a claim was denied and the clinician believes the wrong information was submitted, contact help@thrizer.com. Support may be able to review and, where possible, help correct or resubmit the claim. Insurer acceptance 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 process. 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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