Getting started with Thrizer

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Short answer

Thrizer helps clients and clinicians manage out-of-network payments, claims, and reimbursement in one place. Clients can use Thrizer to understand estimated costs, pay for sessions, submit claims when supported, and track reimbursement. Clinicians can use Thrizer to collect payments, check benefits, create charges, and manage claim-related workflows. Insurance still makes the final decision on coverage, claim approval, reimbursement, deductible application, and timing.

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How this works

Thrizer supports three main payment and claim workflows: The right workflow depends on the client’s insurance information, deductible status, available benefit details, and whether the workflow is supported for that client and session.

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What Thrizer helps with

Thrizer can help with:

• checking out-of-network benefits
• estimating reimbursement
• collecting client payments
• submitting supported claims
• tracking claim status
• routing reimbursement based on the payment type
• helping clients and clinicians understand what happens after a claim is submitted

Thrizer does not decide whether insurance approves a claim or how much insurance pays.

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If you are a client

Clients use Thrizer to manage the payment and claim side of out-of-network care. You may use Thrizer to:

• add or update insurance information
• add a payment method
• connect a reimbursement bank account
• view payments
• view claim status
• submit claims when supported
• receive reimbursement when insurance pays a claim through a client-reimbursement workflow

A good first step is to make sure your insurance, payment method, and reimbursement account are up to date.

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If you are a clinician

Clinicians use Thrizer to manage clients, payments, benefits, and claim workflows. You may use Thrizer to:

• add clients
• check out-of-network benefits
• create charges
• select available payment types
• view payments and payouts
• track claim activity

For OON Pay and Thrizer Pay, claim submission is tied to the charge workflow. When the workflow supports claim submission, Thrizer submits the claim after the client’s payment is successfully processed. A good first step is to add a client and confirm that their insurance and payment setup are ready before creating a charge.

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How the main workflows differ

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Self-Pay

With Self-Pay, the client pays for care without using Thrizer to submit an insurance claim. Self-Pay may be used when the client is not using insurance for the session, when no claim should be submitted, or when the workflow does not involve out-of-network reimbursement through Thrizer.

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OON Pay

With OON Pay, the client pays the full session fee upfront. After the payment is successfully processed, Thrizer submits the out-of-network claim when the workflow supports claim submission. If insurance reimburses the claim, the reimbursement is sent back to the client through Thrizer. OON Pay does not guarantee reimbursement. Insurance determines the final claim result.

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Thrizer Pay

With Thrizer Pay, the client pays an estimated amount upfront instead of paying the full session fee. Thrizer advances the remaining portion of the session fee to the clinician and submits the claim. Because Thrizer advanced part of the session fee, any insurance reimbursement for that claim is routed to Thrizer. Thrizer Pay is not available for every client or session. Availability depends on Thrizer’s eligibility rules, including insurance verification, deductible status, and claim history.

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What to check before using Thrizer

Before creating or submitting a claim-related workflow, make sure the basic information is complete. For clients, this usually means:

• insurance information is added
• payment method is available
• reimbursement account is connected when reimbursement may be returned to the client
• personal information is accurate

For clinicians, this usually means:

• the client is added
• the client’s insurance information is available when insurance will be used
• the client has a valid payment method
• the session details are accurate
• required claim information, such as diagnosis and service details, is available when a claim will be submitted

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What happens after a charge or claim

What happens next depends on the workflow. In OON Pay and Thrizer Pay, claim submission is generally tied to a successful charge. After the charge is processed, Thrizer submits the claim when the workflow supports automatic claim submission. Insurance then processes the claim. The final result may be reimbursement, deductible application, denial, or another carrier-determined outcome.

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What Thrizer does

Thrizer helps with supported payment, claim, benefit check, and reimbursement workflows. Depending on the workflow, Thrizer may:

• process the client’s payment
• submit an out-of-network claim
• track claim status
• route reimbursement based on the payment type
• update claim and reimbursement information after insurance processes the claim

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What insurance determines

Insurance determines the final claim outcome. That includes:

• whether the claim is approved or denied
• whether the claim applies to deductible
• whether reimbursement is paid
• how much reimbursement is paid
• when the claim is processed

Thrizer does not guarantee:

• insurance coverage
• claim approval
• reimbursement amount
• reimbursement timing
• final out-of-pocket cost
• availability of every payment type

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