Claims and superbills for clinicians

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Overview

Thrizer submits claims automatically for eligible OON Billing charges. You and your clients can also generate superbills for eligible appointment payments. A superbill is a document, not a claim submission. For Self-Pay, the client sends it to their insurer. Generating one doesn’t submit or resubmit a claim.

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Automatic claims from charges

For an eligible OON Billing session, a successful charge starts Thrizer’s automatic claim process. Submission waits until the Date of Service is no longer in the future. You do not need to submit a separate manual claim. See How Thrizer submits insurance claims for the complete submission conditions.

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Client claim lists

Practice members with access to the connected client and permission to view claims can open Clinician Portal → Clients → select the client → Claims. If your account cannot access the client or claim, ask an authorized practice team member to check it. The claims list shows:

• Claim number
• Submission date
• Appointment date
• Status
• Result

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Claim details

Select a claim to open the claim details drawer. Alongside the claim’s status, dates, and amounts, the drawer shows a Claim created by row so you can see who initiated the claim:

• Claims that Thrizer submitted automatically from an OON Billing charge show as Thrizer Admin.
• Claims created by someone on your team show that person’s display name.

Use this to check who submitted a claim or help Support trace it.

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Rejected claim reason

A rejection means the claim was turned away before the insurer made a coverage decision. Check the available claim details. If the reason isn’t clear, contact Support through your Thrizer account and include any payer message or rejection codes you can see. The next step depends on the reason for rejection.

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Next steps on common rejections

Start by checking for common problems: missing or incorrect member details, date of birth, NPI, or Tax ID; missing practice or clinician registration; or the wrong payer. Confirm the details with the client, your practice, or the payer. See provider registration if the plan requires it. Correct the client or practice fields you can edit so future charges use the right information. For a charge or claim that already exists, request Support review. Support will check whether it can be corrected or resubmitted. Updating a record or confirming registration doesn’t resubmit a claim; don’t create a duplicate. Clients can ask you for help or contact Support directly through their account.

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Claim filters

Use claim filters for:

• Date range
• Charge type
• Billing Type
• Clinician for group practices

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Client superbill uploads

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Clinician-generated superbills

You can generate a superbill PDF for an eligible Billable Service appointment payment with Confirmed status, whether it was Self-Pay or OON Billing. Non-billable Services don’t qualify. For a Self-Pay session, the client can submit the document independently to their insurer. An eligible OON Billing session already starts Thrizer’s automatic claim process; do not submit the same insurer claim again. See Self-Pay and superbills for the complete document eligibility and submission distinction.

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How to generate a superbill for a client

• Batch export for one client: Clinicians, staff, practice administrators, and team owners with access to the connected client and permission to view transactions can open Clinician Portal → Clients → select the client → Payments → Generate Superbill. This exports eligible appointment payments for that client matching the applied filters. Review the eligible transaction and superbill counts before confirming.
• Per-transaction export: Clinicians, staff, practice administrators, and team owners can open Clinician Portal → Transactions → Payments and use an eligible row’s Export Superbill action. It targets that single payment, independent of list filters. The practice-wide Transactions page does not offer the batch Generate Superbill control.

Staff with the required access can use the client’s Payments tab for batch exports too. Filtering the practice-wide Transactions page to one client won’t add that control. Clients can also generate their own document under Client Portal → Payments → Generate Superbill. Both actions offer the same delivery options:

• Download: save the superbill PDF to your device. For a batch export, if the filtered transactions span more than one clinician, Thrizer returns one PDF per clinician in a ZIP archive.
• Email to client: send the superbill directly to the client on file. For a batch export across multiple clinicians, the client receives one email with all PDFs attached.

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Batch export (Generate Superbill)

A batch includes only that client’s eligible payments matching your filters: transaction date, appointment date, clinician, Billing Type, and status. Set the filters before generating the superbill. Before confirming, check the number of eligible transactions and superbills shown in the dialog. There is one superbill per clinician. Generate Superbill is disabled if no eligible appointment payments match your selection.

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Per-transaction export (Export Superbill)

Open the row actions menu on a Payments row and select Export Superbill to generate a superbill for that single transaction. The action only appears when the row is eligible. The payment must be an eligible appointment charge with a Confirmed display status. Refunded, partially refunded, pending, or failed rows do not show the action. This exports only the selected transaction, regardless of the Payments filters. Use it when a client needs a superbill for one session. Confirm the transaction date and appointment date shown in the modal, then select Download or Email to client.

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What you cannot do

• You cannot upload a superbill to insurance on a client’s behalf through Thrizer.
• You cannot submit a manual superbill claim to insurance on behalf of a client.
• Export is limited to otherwise eligible, Confirmed Billable Service appointment payments. Non-billable Services are excluded. An OON Billing export does not authorize a duplicate insurer submission.

If a client has a superbill from a provider who is not on Thrizer, they submit it directly to their insurer. Thrizer does not accept or submit client superbills. See Claims and superbills.

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Required claim information

Claims and superbills need these details:

• Provider name
• Provider NPI
• Service date
• Billed amount
• CPT code
• One or more diagnosis codes

Missing required claim information can prevent claim submission or lead to insurer denial.

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How your provider details appear on Thrizer-submitted claims

For claims that Thrizer submits automatically from OON Billing charges:

• Rendering provider: the selected clinician on the charge. The clinician’s Individual NPI appears as the rendering provider on the claim.
• Billing provider: determined by the insurance plan’s claim-submission configuration. Depending on the payer, the claim may use a Thrizer-managed billing provider or your practice as the billing provider.

If the wrong clinician was selected, contact Support. See What if I selected the wrong rendering clinician?. Your personal in-network or out-of-network status with the insurer does not by itself determine whether you can use Thrizer’s claim submission process. The insurance carrier determines final claim acceptance, network treatment, and reimbursement.

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When claims bill under your practice instead of Thrizer

Some payers require the group practice, not the individual clinician, as the billing provider. For those payers, Thrizer can submit claims with your practice as the billing provider. Thrizer uses your practice name, group NPI, and Tax ID as the billing entity instead of Thrizer’s. The rendering provider on the claim is still the clinician who saw the client. To enable this on a payer, Thrizer support handles the change. Before you make the request, confirm your practice name, Tax ID, and group NPI are on file under Clinician Portal → Settings → Practice Settings. See Manage your Clinician Portal profile and settings. If the payer bills under your practice and no group NPI is saved, Thrizer uses the rendering clinician’s Individual NPI and full name (“First Last”) as the billing identity. This pairs the individual NPI with the clinician’s name, as many payers expect. Tax ID, address, and taxonomy still come from your practice. If you have a group NPI, add it in Practice Settings so future claims use your practice name as the billing name. Existing claims keep their original billing identity. The updated name applies to new or recreated claims. Contact Support about resubmitting an older claim with the corrected name. For practice-billed claims, Thrizer uses a complete Mailing address from Practice Settings when one is saved. Otherwise, it uses the Business address. The optional apt / suite / floor value is sent as a separate address line. Address changes apply to new claims and claims that are recreated; they do not rewrite existing claims automatically. See Manage your Clinician Portal profile and settings for both fields. Clinician-generated superbills for self-pay clients are different: the superbill PDF reflects your own practice information, and the client submits the claim to their insurer directly.

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