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Overview

Thrizer supports three payment types: Self-Pay, OON Pay, and Thrizer Pay.

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Self-Pay

Use Self-Pay when no insurance claim is submitted through Thrizer. Self-Pay means:
  • Client pays the session fee.
  • No automatic claim is submitted.
  • No insurance reimbursement is sent through Thrizer.
  • No benefit check is required.
  • Individual NPI is not required on the rendering clinician.

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OON Pay

Use OON Pay when the client pays the full session fee upfront and Thrizer submits an out-of-network claim. OON Pay means:
  • Client pays the full session fee when the charge is created.
  • Thrizer submits the claim automatically after successful payment.
  • Insurance reimbursement goes to the client.
  • The 1% OON Pay fee applies only when reimbursement greater than $0 is sent to the client through Thrizer. If insurance reimburses $0, no OON Pay fee is charged.
  • The 1% OON Pay fee is also not charged when the insurer sends reimbursement directly to the client instead of through Thrizer. For example, some insurers mail a paper check to the client.
  • A valid Individual NPI on the rendering clinician is required to charge. Without one, OON Pay is disabled and the form falls back to Self-Pay.

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Thrizer Pay

Use Thrizer Pay when the client pays estimated responsibility upfront and Thrizer advances the remaining session fee to the clinician. Thrizer Pay means:
  • Client pays estimated responsibility plus a 5% Thrizer Pay fee when you successfully process the Charge.
  • Thrizer advances the remaining portion of the full session fee to the clinician.
  • Thrizer submits the claim automatically after successful payment.
  • Insurance reimbursement goes to Thrizer.

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Thrizer Pay eligibility

Thrizer Pay requires all of the following:
  • Primary insurance on file
  • A usable benefit check
  • Deductible met
  • At least one successful processed claim on the client’s record (this helps set the allowed amount and coinsurance used in the estimate)
  • A Date of Service that is today or tomorrow (calendar day, not a rolling 24 hours)
  • A valid Individual NPI on the rendering clinician
If those conditions are not met, other payment or claim options such as Self-Pay, OON Pay, or superbill-based claim submission may still be available. Thrizer Pay cannot be applied retroactively to past sessions. Thrizer may also pause or remove Thrizer Pay for a client if repeated claim denials or inconsistent reimbursement patterns make the estimate unreliable.
Thrizer Pay and OON Pay direct deposit are not available for clients on plans within the Blue Cross Blue Shield (BCBS) umbrella. These plans reimburse by paper check directly to the client. Charge as usual, and Thrizer will continue to submit eligible OON Pay claims. See BCBS reimbursement.
For a client-friendly explanation of why Thrizer Pay does not appear as an option, share Why isn’t Thrizer Pay available?.

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Date of Service restrictions

OON Pay and Thrizer Pay are limited to a Date of Service that is today or tomorrow. This is a calendar-date restriction, not a rolling 24-hour window. Sessions two or more calendar days in the future cannot be billed to insurance through Thrizer and must use Self-Pay. In Add Charge:
  • Selecting a date more than one day ahead disables OON Pay and Thrizer Pay in the payment type dropdown and switches the form to Self-Pay.
  • An OON Pay or Thrizer Pay charge with a missing date, or a date more than one day ahead, is not accepted.
Self-Pay accepts any future Date of Service and is the supported option for advance billing.

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Account readiness to charge

Regardless of payment type, your account must be ready to bill before any charge can be submitted:
  • Business and banking setup must be complete and approved by Thrizer (merchant verification).
  • Your clinician account must not be pending verification or suspended.
  • The rendering clinician must have a first and last name on file.
These checks apply to all charge types, including Self-Pay. Individual NPI is only checked for OON Pay and Thrizer Pay. See Charging clients for the inline messages shown when a charge is blocked.

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Charge amount limit

Charges submitted from the Clinician Portal have a default session-rate cap of $2,500. If your practice regularly needs to charge more, contact Thrizer support for prior review. Thrizer may approve a higher practice-specific cap, up to the absolute maximum of $25,000, for every clinician on the team. A Thrizer administrator can still process an individual one-off oversized charge on your behalf.

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Clinician processing fee

Payment transactions processed through Thrizer carry the clinician card-processing fee defined by Thrizer’s pricing rules.

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How eligibility and pricing interact

Eligibility rules determine which payment types are available. Pricing rules determine fees after eligibility is established.