Claims and superbills for clinicians

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Overview

Thrizer supports both automatic claim submission and superbill-based claim filing.

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Automatic claims from charges

For OON Pay and Thrizer Pay, creating a successful charge triggers automatic claim submission. You do not need to submit a separate manual claim for that charge.

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Client claim lists

From a client profile, open Claims to view that client’s claims. 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 Pay or Thrizer Pay charge show as Thrizer Admin.
• Claims created by someone on your team show that person’s display name.

This is useful when reconciling submissions across a team or when following up with Thrizer support.

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Rejected claim reason

When a claim is Rejected, the claim drawer includes a specific reason instead of a generic rejected message. Use this to decide whether you can fix the issue yourself, or whether to share the reason with Thrizer support. Thrizer builds the reason from the rejection codes the clearinghouse or payer returned for the claim. Thrizer translates those codes into plain-language labels from its own maps, so the copy is consistent and never echoes raw payer text. A rejected result reads as Claim Rejected: {reason}. The reason combines up to three parts:

• Category: why the claim was turned away, for example Returned as unprocessable, Rejected for missing information, Rejected for invalid information, or Rejected for related field error.
• Status: which field or check failed, for example Entity NPI, Entity tax ID, Entity address, Entity not approved, or Subscriber and subscriber ID not found.
• Entity: who the failed field belongs to, for example Billing provider, Rendering provider, Subscriber, or Payer.

For example, Claim Rejected: Rejected for invalid information; Entity NPI; Billing provider means the payer could not validate the billing provider’s NPI. When the payer returned an additional status message with the rejection, a sanitized version of that message appears as a second sentence after the reason. Both kinds of rejection show a reason this way: clearinghouse rejections, where the claim was turned away before it reached the payer, and payer-level rejections, where the payer rejected the claim before making a coverage decision.

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Next steps on common rejections

For the most common rejection patterns, the claim drawer replaces the code labels with a short explanation of what went wrong and what to do next. These cover rejections tied to your practice details:

• NPI rejections: Invalid or unrecognized NPI. Confirm the practice NPI in Account Settings. If it is already correct, check registration status with the plan.
• Tax ID rejections: Invalid or unrecognized TIN. Confirm the practice TIN in Account Settings. If it is already correct, check registration status with the plan.
• Address rejections: Invalid or unrecognized address. Confirm the practice address in Account Settings. If it is already correct, check registration status with the plan.
• Enrollment rejections: The practice is not approved to submit to this plan. Confirm the practice NPI in Account Settings. If it is already correct, check registration status with the plan.

The client claims list’s Result column shows the shorter code labels. Open the claim drawer for the fuller next-step guidance. If the guidance points to plan registration for a Blue Cross Blue Shield plan, see provider registration. That page covers how to register and what happens to claims rejected before registration was in place. Rejected claims that Thrizer’s clearinghouse turned away for structural reasons (for example, a missing billing NPI or an invalid Tax ID) move to Rejected immediately, rather than sitting in Submitted or Pending. If the reason points to a claim-detail field you own, such as a wrong TIN or a missing NPI, update the detail on the client or practice record. If support needs to correct or resubmit the claim, contact Thrizer support through your Thrizer account and include the exact rejection text. The Client Portal shows only a generic rejected message and does not include the rejection reason or next-step guidance. Clients who ask about a rejection need to be referred back to you or to Thrizer support for the specific reason.

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Claim filters

Use claim filters for:

• Date range
• Charge type
• Payment 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 Self-Pay sessions so the client can submit a claim to insurance independently. In this case, Thrizer does not submit the claim or manage reimbursement. The client owns the claim submission.

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How to generate a superbill for a client

You can generate a superbill in two ways from the Payments view (or the Transactions hub Payments tab):

• Batch export from the Payments header: use Generate Superbill to export every eligible Self-Pay charge that matches the filters currently applied to the view.
• Per-transaction export from a row: use the Export Superbill action on a single Payments row to target one specific Self-Pay charge, independent of the filters.

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)

The superbill’s scope always matches the filters currently applied to the Payments view: date range, appointment date, clinician, client, payment type, and status. Adjust the filters first, then generate. Before you confirm, the modal shows how many eligible transactions will be included and how many separate superbills (one per clinician) will be produced. Use this to double-check the scope before exporting. Generate Superbill is disabled when no eligible Self-Pay appointment charges are in scope.

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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 appointment charge type must be Self-Pay and the transaction’s display status must be Confirmed. Refunded, pending, or failed rows do not show the action. The per-row action ignores the filters applied to the Payments view. It is scoped to that one transaction only. This is useful when a client asks for a receipt-style superbill for a specific session without changing the batch filters. 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.
• You can only generate superbills for Self-Pay sessions. OON Pay and Thrizer Pay sessions already have claims submitted automatically, so a separate superbill is not needed.

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 structured claim information, including:

• 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 Pay or Thrizer Pay 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.

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 in Practice Settings. See Settings and profile. If a payer is set to bill under your practice but you haven’t added a group NPI, Thrizer falls back to two things. Thrizer uses the rendering clinician’s Individual NPI as the billing NPI. Thrizer also submits the rendering clinician’s full name (“First Last”) as the billing name, instead of your practice name. This matches what many payers expect when a Type-1 (individual) NPI is used, and keeps submissions from being held up. Other practice-level details that are not person-specific, such as Tax ID, address, and taxonomy, still come from your practice. Add a group NPI in Practice Settings if you have one, so your practice name is used as the billing name going forward. Claims created before this behavior took effect keep the billing identity they were originally stamped with. Only new claims, and claims that are recreated, use the updated billing name. Thrizer support can resubmit an older claim under 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 Settings and profile 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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