Who can use Thrizer

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Short answer

Thrizer is most commonly used by licensed mental health clinicians. Some other licensed healthcare providers may also be able to use Thrizer when their services can be submitted for out-of-network insurance reimbursement. Whether a provider can use Thrizer depends on the provider’s license, whether they are legally allowed to provide the service, whether the service can be billed with appropriate claim information, and whether insurance reimbursement may be available. Thrizer cannot guarantee that every provider type, service, or insurance plan will be reimbursed. Insurance reimbursement depends on the provider, the service, the client’s plan, the submitted claim details, and the insurance carrier’s rules.

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Which mental health clinicians commonly use Thrizer?

Thrizer is most commonly associated with mental health clinicians, including:

• Licensed Clinical Social Workers, such as LCSW, LICSW, and LMSW
• Marriage and Family Therapists, such as LMFT and AMFT
• Professional Counselors, such as LPC, LPCC, LCPC, and LMHC
• Psychologists, including PhD and PsyD clinicians
• Psychiatrists, including MD and DO clinicians
• Psychiatric Mental Health Nurse Practitioners, such as PMHNPs

These clinicians commonly provide psychotherapy, behavioral health treatment, psychological testing, or medication management.

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Can other behavioral health practitioners use Thrizer?

Some related behavioral health practitioners may also be able to use Thrizer, including:

• Board Certified Behavior Analysts, or BCBAs
• Addiction counselors, such as CADCs or licensed substance use counselors

Whether reimbursement is available depends on the client’s insurance plan, the provider’s credentials, the service provided, the claim details, and how the insurance carrier processes the claim.

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Can non-mental-health providers use Thrizer?

Some licensed healthcare providers outside traditional mental health care may be able to use Thrizer, but support and reimbursement may be more variable. Provider types that may require additional review include:

• Occupational Therapists
• Physical Therapists
• Registered Dietitians and Registered Dietitian Nutritionists
• Medical specialists
• Physicians
• Nurse Practitioners
• Physician Assistants

For these provider types, Thrizer may need to review the provider type, services, commonly used CPT codes, and claim submission requirements before determining whether the workflow can be supported. Support for a provider type or workflow does not guarantee insurance reimbursement.

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Can supervised or associate-level clinicians use Thrizer?

Supervised or associate-level clinicians may be able to use Thrizer in some situations, but reimbursement rules vary. Examples of supervised or pre-licensed clinicians include:

• AMFTs
• APCCs
• Associate therapists, such as Licensed Associate Professional Counselors, or LAPCs
• Interns
• Residents
• Limited license clinicians

Some insurance plans may not reimburse services from supervised practitioners, or may require claims to be submitted using the supervising clinician’s information. Because of that, Thrizer should not be treated as a guarantee that claims for supervised clinicians will be reimbursed.

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What makes a provider eligible?

At a high level, provider eligibility depends on three things:

1. The provider has an appropriate license.
2. The provider is legally allowed to provide the service.
3. The service may be eligible for insurance reimbursement.

Licensing rules vary by state and territory. A provider’s ability to practice, including through telehealth, may also depend on where the client is located during the session.

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Can clinicians who are in-network with an insurer use Thrizer?

In many cases, yes. Claims submitted through Thrizer use Thrizer’s billing structure for out-of-network claim submission. They are not submitted as direct in-network claims under the clinician’s personal billing relationship with the insurer. Because of that structure, a clinician’s personal in-network status with an insurer does not by itself determine whether Thrizer claim workflows can be used. This includes situations such as transitioning off an in-network platform, depaneling from an insurer, or participating in a mix of in-network and out-of-network arrangements. Clinicians are still responsible for following the terms of any agreements they have with insurers or platforms. Final claim processing, reimbursement, and insurer acceptance are determined by the insurance carrier.

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Can clinicians practice across state lines?

Thrizer does not determine whether a clinician is legally permitted to practice across state lines. Clinicians are responsible for understanding and following the licensing rules that apply to their services, including telehealth rules and any state-specific requirements. Insurance reimbursement may also depend on the client’s location during the session.

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Which provider types are not currently supported?

Thrizer does not currently support chiropractors or massage therapists.

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Does provider eligibility guarantee reimbursement?

No. Provider eligibility does not guarantee reimbursement, coverage, claim approval, or final payment amount. Insurance carriers determine final claim outcomes. Even when a provider type is commonly supported, reimbursement still depends on the client’s plan, the service provided, claim details, and the insurance carrier’s rules.

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What Thrizer does

Thrizer helps determine whether a provider workflow may be supportable based on provider type, claim requirements, available service information, and insurance-related workflow constraints. Thrizer may ask for additional information, such as commonly used CPT codes, to better understand whether the provider’s services fit supported claim workflows.

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What insurance determines

The insurance carrier determines whether a claim is accepted, denied, applied to the deductible, or reimbursed. Thrizer does not guarantee coverage, claim approval, reimbursement amount, deductible application, or claim timing.

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Are music therapy or music-based therapy services supported?

Music therapy or music-based therapy services may be supported when the service can be billed using appropriate claim information, including a CPT code that fits the service provided. Support depends on the provider’s credentials, the service, the client’s insurance plan, and how the insurance carrier processes the claim. Because reimbursement depends on insurance rules and claim processing, support for a music-based therapy workflow does not guarantee that a claim will be approved or reimbursed.

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