# August 13, 2026 — Retry notice for temporary payer errors
Source: https://docs.thrizer.com/help/changelog/2026-08-13
Benefit checks that hit a brief payer outage now show an amber 'Unable to check benefits' notice with Try Again, instead of a red denial-style screen.
Looking for older announcements? See [all past updates](/help/changelog/index).
## Updates
### Transient payer errors now show a retry-friendly message
When an insurance payer's automated eligibility system is briefly unable to respond, the benefit check result now shows an amber **Unable to check benefits** notice with a short "this may be a temporary issue, please try again" body and a **Try Again** action.
Previously, the same situation surfaced a red **Unable to Verify Benefits** screen with the raw payer error text ("Unable to Respond at Current Time") as the main copy, which read like a coverage denial.
**Who this affects:**
* Clinicians running an automated check from the **Instant Benefit Checker** in the Clinician Portal.
* Clients and prospective clients running a check through the **Thrizer Widget**.
**Why it matters:** a temporary payer outage is not a coverage denial. The new copy makes that clear and points you to the right next step. Retry instead of treating the client as ineligible.
**What to do:**
* If you see **Unable to check benefits**, use **Try Again**. Most transient payer errors clear on a retry.
* If retries keep failing, request a [manual benefit check](/help/widget/manual-benefit-checks) by emailing [help@thrizer.com](mailto:help@thrizer.com).
See [Checking client benefits](/help/clinician/check-benefits) and [How to use the Instant Benefit Checker](/help/widget/how-to-use-the-instant-benefit-checker).
# Register as an out-of-network Anthem provider
Source: https://docs.thrizer.com/help/claims/anthem-oon-registration
Register your practice as an out-of-network Anthem provider via Availity Essentials so client claims are not delayed or denied for missing provider.
Anthem is an Elevance Health plan. Thrizer Pay and OON Pay direct deposit are not available for Anthem clients, who now receive reimbursement by paper check. See [Elevance Health reimbursement changes](/help/claims/elevance-health-reimbursement) for details. Anthem OON registration (below) is still required regardless of that change.
## Before you start
Anthem now requires all non-participating (out-of-network) providers and practices to be **registered** before Anthem can process your clients' out-of-network claims. Registration means Anthem has your **Tax ID (TIN), each rendering provider's NPI, and practice address** on file as a verified provider.
Registration creates a non-participating profile tied to your Tax ID and NPI. It does **not** create an in-network contract. It only allows your clients' out-of-network claims to route without missing-provider rejections.
Thrizer continues to submit claims for your Anthem clients as usual. Registration status affects claim outcomes, so claims submitted from **July 6 onward** and future Anthem claims may be delayed or denied if your practice is not registered.
## How registration works
Complete registration through the **Provider Enrollment and Network Management** feature in **Availity Essentials**. Steps may vary slightly depending on your state or account setup. Contact Availity support if you need account-specific help.
## Steps to register your practice
1. If you do not already have an Availity Essentials account, register for one at [availity.com](https://availity.com). Then log in.
2. Select **Payer Spaces**.
3. Select **Anthem**.
4. Go to **Applications** > **Provider Enrollment and Network Management**.
5. Select **Out-of-Network / Single Case Agreements** to begin registration.
Select **Out-of-Network / Single Case Agreements** specifically. Do **not** select **Join Our Network**, which is a different, in-network process.
## Additional resources
* [Availity Essentials](https://availity.com) — log in and complete registration.
* [Anthem provider site](https://www.anthem.com/provider) — additional information about the process and requirements.
## What this means for your Thrizer claims
* Thrizer continues to handle claim submission for your Anthem clients as usual.
* Anthem may delay or deny out-of-network claims submitted on or after July 6, 2026, and future Anthem claims, if your practice is not registered.
* Registration does not create an in-network contract. Anthem still controls claim approval, processing, and final outcomes.
* For state-specific or Availity account-access questions, contact Anthem or Availity support directly.
If this process changes on Thrizer's side, Thrizer will share an update. If you have questions, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com).
## Related articles
Anthem, Carelon, NYSHIP, and Wellpoint clients now receive paper checks only. Thrizer Pay and OON Pay direct deposit are not available for these plans.
See which insurance companies Thrizer has prior claim experience with, including Anthem.
Learn how claims are submitted through Thrizer and when submission is automatic.
Understand typical claim processing timelines and why claim outcomes can vary.
# Claim and billing limitations
Source: https://docs.thrizer.com/help/claims/claim-and-billing-limitations
Learn which claim and billing processes Thrizer does not support, why these limits exist, and what alternatives are available for clinicians and clients.
## Overview
Thrizer supports common out-of-network payment and claim processes, but some billing setups cannot be handled automatically.
In general, Thrizer is structured around a few core rules:
* One charge connects to one claim
* One charge supports one CPT code
* A claim can only be submitted when the required information is complete
* A claim is submitted only after the client payment is successfully processed
If a request does not fit that structure, it may need to be handled differently.
## How this works
This article explains common claim and billing limitations so you know what to expect before creating a charge, submitting a claim, or choosing a payment option.
## Can one session be split across multiple cards?
No. A single session charge cannot be split across multiple payment methods.
The client needs to use one payment method for the full charge.
## Can multiple charges be combined into one claim?
No. Thrizer does not automatically combine multiple charges into one insurance claim.
Each charge corresponds to a single claim. If a session is split into multiple charges, those charges remain separate for claim purposes.
This matters because insurance carriers review claims based on the information submitted on each claim. A split payment or split charge may not behave the same way as one combined session claim.
## Can one charge include multiple CPT codes?
Each charge supports one primary CPT code. Add-on or extension units of the same underlying service (for example, time-based add-ons) may be included with the primary code.
If a session includes **unrelated** services that require separate CPT codes, those services need to be billed as separate charges. Each charge creates its own claim.
A CPT code is the billing code that identifies the type of service provided. Insurance carriers use CPT codes when reviewing claims.
## Can a claim be submitted without a diagnosis code?
No. A diagnosis code is required before submitting a charge that generates a claim.
Add Charge enforces this in the form. When the selected client has no qualifying diagnosis on file:
* OON Pay and Thrizer Pay are disabled in the billing type dropdown.
* If one of those options was already selected, the form silently switches the charge to Self-Pay and shows a warning toast.
* Thrizer rejects insurance charges submitted without a diagnosis, so no payment is collected and no claim is created.
Self-Pay does not require a diagnosis and remains available. To unblock insurance billing, add a diagnosis on the client detail page (**Edit Diagnoses**) and then return to Add Charge.
A diagnosis code is part of the insurance claim record. It helps identify why the service was provided.
## Can a failed payment still trigger a claim?
No. A claim is submitted only after the client's payment is successfully processed.
If the client's payment method fails, the charge does not go through and Thrizer does not submit the claim. Resolve the payment issue with the client and retry the charge.
Thrizer does not submit claims without successful payment, and failed charges are not automatically retried.
## Can a completed charge be moved to a different card?
No. Completed charges cannot be reassigned to a different payment method.
If a client adds a new card, that card can be used for future charges. It does not change the payment method used for past charges.
## Can past sessions be changed to Thrizer Pay?
No. Thrizer Pay can only be applied to future sessions.
You need to select the payment type before submitting the charge. Past sessions cannot be converted to Thrizer Pay after the fact.
## Is there a maximum charge amount in the Clinician Portal?
Yes. Charges submitted from the Clinician Portal are capped at a session rate of \$2,500. If the amount (or full rate, when set) exceeds \$2,500, an inline error appears on the amount field. Submit stays disabled until the amount is reduced.
If a practice needs to process a larger transaction, contact Thrizer support. A Thrizer administrator can review and process the charge on the practice's behalf.
## Can insurance be billed for sessions scheduled far in the future?
No. OON Pay and Thrizer Pay are only available when the Date of Service is today or tomorrow. This is a calendar-date restriction, not a rolling 24-hour window. Sessions two or more calendar days ahead cannot be billed to insurance through Thrizer.
In Add Charge, picking 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 insurance charge with a missing date, or a date more than one day ahead, is not accepted.
Self-Pay works for any future Date of Service. To bill insurance, create the charge on the day before or the day of the session.
## Can no-show or cancellation fees be submitted to insurance?
No. No-show and cancellation fees cannot be submitted to insurance through Thrizer.
Clinicians may charge clients directly for missed or canceled sessions, but those charges are handled separately from insurance reimbursement. They should be treated as Self-Pay charges.
Because no-show and cancellation fees are not submitted as insurance claims, clients should not expect reimbursement for those charges through Thrizer.
## Can clients submit claims for past sessions?
Not through the Client Portal. Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on August 9, 2026.
If a client has a superbill from a session that was not paid through Thrizer, they can still pursue reimbursement. They can email the PDF to [help@thrizer.com](mailto:help@thrizer.com), or submit it directly to their insurer.
Insurers still determine whether to accept a claim. Insurance plans may have timely filing limits, and Thrizer does not guarantee that an older claim will be accepted or reimbursed.
## Can I correct the wrong CPT code or other claim detail after submission?
Once a claim has been submitted to insurance, you cannot edit that claim directly from the Clinician Portal.
If a claim was submitted with an incorrect CPT code, diagnosis code, service date, or other detail, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com). The support team may be able to review the claim and help correct or resubmit it where possible.
Thrizer does not guarantee that the insurer will accept a corrected claim, approve it, or reimburse it. Insurer timely filing rules and re-processing rules still apply.
## Can a denied claim be corrected and resubmitted?
Contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com). The support team may review the denial and help correct or resubmit the claim where possible. Insurer acceptance, approval, and reimbursement are not guaranteed.
You cannot edit or resubmit a denied claim directly from the Clinician Portal.
## How do I cancel a charge or a claim?
A claim in Thrizer is generated from a charge, so canceling the charge and canceling the claim are linked.
* **If you successfully cancel the charge**, Thrizer also cancels the associated claim. No separate claim-cancel step is needed.
* **If the claim has already been submitted** and you cannot cancel or edit the charge directly, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com). The support team may be able to review and, where possible, cancel or correct the claim. Insurer acceptance of the cancellation is not guaranteed.
Refunds follow the same principle. See [I accidentally charged twice for one session](#i-accidentally-charged-twice-for-one-session) below.
## I accidentally charged twice for one session
If you charge the same session twice, refund the duplicate charge from the Clinician Portal. When you refund the duplicate charge, Thrizer also cancels the duplicate claim generated from that charge at the same time. You do not need to cancel the claim separately.
Only the duplicate transaction is affected. The remaining, correct charge and its claim continue to process normally.
If you cannot refund the duplicate charge from the Clinician Portal, or if you're unsure which transaction to refund, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com).
## Can I correct a wrong CPT code on a denied claim?
Once a charge has been submitted and a claim generated, you cannot edit the claim directly from the Clinician Portal.
If you submitted the wrong CPT code (or another claim field), contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com). The support team may be able to review the claim and, depending on the situation, help correct the information or resubmit the claim where the payment type allows.
A support review does not guarantee insurer acceptance, approval, or reimbursement. The insurance carrier still determines the final claim outcome. That includes whether a corrected or resubmitted claim is accepted under the insurer's rules and timely-filing limits.
## Can Thrizer fix or resubmit a superbill that was already sent to insurance?
No. Thrizer cannot take over, correct, appeal, or resubmit a superbill claim that has already been submitted to insurance through another path.
If a superbill was already submitted to insurance and the client believes it was reimbursed incorrectly, the client needs to work through the insurer or the original submission path. Re-uploading the same claim through Thrizer may create a duplicate-claim issue.
Thrizer's superbill process is for generating a new claim from a valid superbill that has not yet been submitted to insurance.
## Can clinicians upload superbills for clients?
No. A clinician cannot submit a superbill to insurance on a client's behalf through Thrizer.
Clinicians can generate a superbill PDF only for Self-Pay sessions, and the client then submits that superbill to their insurer directly (or emails it to Thrizer support). Superbill generation by clinicians is not available for OON Pay or Thrizer Pay.
For OON Pay and Thrizer Pay, claim submission happens automatically after a successful charge when the payment type supports claim submission.
## Does Thrizer support secondary insurance?
No. Thrizer supports primary insurance only.
Secondary insurance and coordination of benefits are not supported. If a client has more than one insurance plan, Thrizer cannot automatically coordinate claims across multiple insurers.
## Can practices split payouts between clinicians?
No. Thrizer does not support automated revenue splits between clinicians.
Each team has one linked payout bank account. If a practice needs to divide payments among clinicians, that needs to be handled outside of Thrizer.
## What Thrizer does
Thrizer can help process supported payment options, submit claims when the payment type supports claim submission, and track claim status.
For OON Pay and Thrizer Pay, claim submission happens automatically after a successful charge when the required claim information is present.
Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on August 9, 2026. Claims already submitted through those paths continue to process normally.
## What insurance determines
Insurance carriers determine claim acceptance, claim approval, deductible application, reimbursement amount, and reimbursement timing.
Thrizer does not guarantee claim approval, reimbursement amount, deductible application, or claim timing.
## Related articles
Learn the supported ways clients can submit claims through Thrizer.
Understand when Self-Pay applies and how superbills fit into claim submission.
See how CPT codes are used in Thrizer claim processes.
Learn why diagnosis codes are required for claims and how they are used.
Compare Self-Pay, OON Pay, and Thrizer Pay before choosing a payment type.
# Claims processing timeline
Source: https://docs.thrizer.com/help/claims/claims-processing-timeline
Understand how Thrizer claim submissions are processed by insurance, typical 4–6 week timelines, and why an approved claim may still pay $0.
## Overview
After a claim is submitted through Thrizer, the insurance carrier reviews it and determines the final outcome.
Claims typically take about 4 to 6 weeks to process, but the insurance carrier controls timing. A claim may be processing, investigating, approved, or denied.
An approved claim does not always mean money will be reimbursed. If the client's deductible has not been met, the carrier may apply the claim toward the deductible instead of issuing reimbursement.
## How this works
After submission, Thrizer sends the claim to the insurance carrier for review.
If the claim was created through OON Pay or Thrizer Pay, Thrizer submits the claim automatically after the charge is created and the client's payment is successfully processed.
If the claim was submitted through a superbill upload, Thrizer uses the information provided in that submission to generate the claim.
Once the claim is with the insurance carrier, the carrier determines what happens next.
## How long does claim processing usually take?
Insurance claims typically take about 4 to 6 weeks to process.
This is a general timeline, not a guarantee. Some claims may process faster, while others may take longer depending on the insurance carrier, the plan, the claim details, or whether additional review is needed.
## Why is my claim still processing?
A claim may stay in processing while the insurance carrier reviews the submitted information.
This does not always mean something is wrong. The carrier may still be reviewing the claim, checking plan rules, determining deductible status, or deciding whether reimbursement is owed.
If a claim appears delayed or stops progressing, Thrizer support may review the available claim information and help determine whether follow-up is needed.
## What does an approved claim mean?
An approved claim means the insurance carrier accepted the claim.
It does not always mean the client will receive money back. If the client's deductible has not been met, the insurance carrier will typically apply the claim amount toward the deductible instead of issuing reimbursement.
That means a claim can be approved and still result in \$0 reimbursement.
## What does it mean if a claim is applied to my deductible?
If a claim is applied to the deductible, the insurance carrier has counted the claim toward the amount the client must pay before insurance begins reimbursing eligible services.
In this case, the claim may still be considered processed successfully even if no reimbursement is paid.
## What happens if a claim is denied?
If a claim is denied, the insurance carrier has decided not to reimburse the claim and not to apply it toward the deductible.
A denial does not reduce the clinician's payout for charges processed through Thrizer. It may affect whether the client receives reimbursement or whether certain Thrizer fees are refunded, depending on the payment type and claim outcome.
This payout protection does not apply to refunds a clinician chooses to issue. If a clinician refunds a Thrizer Pay transaction, the clinician's payout for that transaction is reversed.
## What Thrizer does
Thrizer helps submit, track, and support the claim process.
For OON Pay and Thrizer Pay, Thrizer submits the claim automatically after the clinician creates a charge and the client's payment is successfully processed.
For superbill uploads, Thrizer uses the submitted information to generate the claim.
## What insurance determines
The insurance carrier decides the final claim outcome.
Thrizer does not control whether the carrier approves the claim, denies it, applies it to the deductible, issues reimbursement, or how long the carrier takes to process the claim.
## Related articles
Learn why an approved claim can still result in \$0 reimbursement.
Understand how reimbursement works and what insurance carriers decide.
Learn the insurance terms that affect whether a claim pays reimbursement.
See how claims are submitted through Thrizer and what information is needed.
Review the claim and billing processes Thrizer does not support automatically.
# Can I use a specific CPT code with Thrizer?
Source: https://docs.thrizer.com/help/claims/cpt-codes-and-thrizer
Learn how CPT codes work in Thrizer, why CPT code use does not guarantee coverage or reimbursement, and what to do if a session involves more than one CPT code.
## Overview
Thrizer can support claim submission when a session can be structured with a supported CPT code structure, a diagnosis code, provider information, service details, and a billed amount.
Using a CPT code in Thrizer does **not** guarantee coverage, claim approval, deductible application, or reimbursement. The insurance carrier makes those decisions after the claim is processed.
Most standard psychotherapy CPT codes work with Thrizer. Some testing, crisis, health behavior, medication management, rehabilitation, speech, nutrition, acupuncture, and other service codes may also be compatible. They may require review depending on the service, provider type, and code combination.
## How CPT codes work in Thrizer
A CPT code tells the insurance carrier what type of service was provided.
For a charge to be submitted as a claim through Thrizer, the charge generally needs:
* a CPT code structure
* one or more diagnosis codes
* provider information, including a valid NPI
* service date and appointment details
* billed amount
* client insurance information
For OON Pay and Thrizer Pay, claim submission is tied to a successful charge. If the charge does not process successfully, the claim is not submitted.
CPT code support means the code may be compatible with Thrizer's claim submission process. It does not mean the code is covered, clinically appropriate, reimbursable, or accepted by every insurance plan.
## Common CPT codes for mental health clinicians
These are some of the most common codes clinicians ask about when using Thrizer.
| CPT code | Common use |
| -------- | --------------------------------------------------------------------- |
| 90791 | Psychiatric diagnostic evaluation |
| 90792 | Psychiatric diagnostic evaluation with medical services |
| 90832 | Individual psychotherapy, typically 30 minutes |
| 90834 | Individual psychotherapy, typically 45 minutes |
| 90837 | Individual psychotherapy, typically 60 minutes |
| 90839 | Psychotherapy for crisis |
| 90840 | Add-on code for additional crisis psychotherapy time |
| 90845 | Psychoanalysis |
| 90846 | Family psychotherapy without client present |
| 90847 | Family or couples psychotherapy with client present |
| 90853 | Group psychotherapy |
| 96130 | Psychological testing evaluation services |
| 96131 | Add-on code for additional psychological testing evaluation time |
| 96132 | Neuropsychological testing evaluation services |
| 96133 | Add-on code for additional neuropsychological testing evaluation time |
| 96136 | Psychological or neuropsychological test administration and scoring |
| 96137 | Add-on code for additional testing administration and scoring time |
| 96138 | Psychological or neuropsychological test administration by technician |
| 96139 | Add-on code for additional technician testing time |
| 99213 | Established patient evaluation and management visit |
| 99214 | Established patient evaluation and management visit |
| 99215 | Established patient evaluation and management visit |
## Add-on and extension codes
Some CPT codes are designed to be used with a primary CPT code. These are often called add-on or extension codes.
Thrizer may support a primary CPT code plus add-on or extension units when the additional code represents extra time or additional units for the same underlying service.
Examples include:
| Primary code | Add-on or extension code | Example use |
| ------------ | ------------------------ | ----------------------------------------------------- |
| 90839 | 90840 | Additional crisis psychotherapy time |
| 96112 | 96113 | Additional developmental testing time |
| 96130 | 96131 | Additional psychological testing evaluation time |
| 96132 | 96133 | Additional neuropsychological testing evaluation time |
| 96136 | 96137 | Additional testing administration and scoring time |
| 96138 | 96139 | Additional technician testing administration time |
| 96202 | 96203 | Additional behavior management training time |
| 97129 | 97130 | Additional therapeutic intervention time |
| 97550 | 97551 | Additional caregiver training time |
| 97810 | 97811 | Additional acupuncture time |
If you are unsure whether a code is an add-on code or a separate service, contact Thrizer support before charging the session through an insurance payment type.
## If a session involves more than one CPT code
Thrizer supports one primary CPT code per claim.
A claim may include a primary CPT code plus add-on or extension units when those additional units are part of the same underlying service.
If the session includes multiple unrelated services, each service should be billed separately. For example, if two codes represent different services rather than additional time for the same service, they may need to be entered as separate charges.
## Codes that may require review
Some services may require additional review before Thrizer can confirm compatibility.
Examples may include:
* EMDR intensives
* testing batteries with multiple units
* crisis services with add-on time
* services provided by supervised or associate clinicians
* services outside traditional psychotherapy
* occupational therapy, speech therapy, physical therapy, nutrition, or other pilot services
* medical specialist or medication-management services
* any CPT code combination where it is unclear whether the second code is an add-on or a separate service
When review is needed, include:
* the CPT code or codes
* the service description
* the session duration
* the clinician license type
* whether the code is intended as the main service or an add-on code
## What CPT support does not mean
CPT support in Thrizer means the service may be compatible with Thrizer's claim submission process.
It does not mean:
* the CPT code is clinically correct for the service
* the code is covered by the client's plan
* the claim will be approved
* the client will receive reimbursement
* the amount will apply to deductible
* the insurer will accept a specific CPT code combination
* the service meets medical necessity requirements
Those decisions are made by the insurance carrier and may vary by plan.
## What to avoid
Avoid combining unrelated CPT codes into one charge.
Avoid using a CPT code only because it appears more likely to reimburse.
Avoid treating a successful benefit check as a guarantee that a CPT code will be accepted.
Avoid submitting a claim before the service, diagnosis, provider, and charge details are complete.
## If you can't find a CPT code
Many CPT codes across psychotherapy, testing, health behavior, evaluation and management, rehabilitation, speech, nutrition, and acupuncture service families may be compatible with Thrizer.
If you want to confirm a specific code, contact support with the code, the service description, and the clinician license type. Compatibility with Thrizer does not guarantee insurer coverage, claim approval, or reimbursement.
For sessions that involve a primary CPT plus an add-on or extension representing additional time of the **same** underlying service, the units can typically be included on the same charge. Examples include 90839 with 90840, or 96132 with 96133. Unrelated services should be billed as separate charges. If you are unsure whether two codes represent the same service or separate services, contact support before charging.
## Non-CPT services
Some services, such as coaching or other non-medical services, may not be compatible with claim submission processes.
If a service cannot be structured with a supported CPT code, diagnosis code, and standard claim information, it should be processed as Self-Pay. No insurance claim is submitted for Self-Pay.
## Related articles
Learn how diagnosis-code support works in Thrizer and what diagnosis-code support does not guarantee.
Learn how insurer support works and why plan-level benefits still need to be checked.
Learn how to check estimated out-of-network benefits before charging a client.
# Can I use a specific diagnosis code with Thrizer?
Source: https://docs.thrizer.com/help/claims/diagnosis-codes-and-thrizer
How diagnosis codes work in Thrizer claims, why support for a code is not a coverage guarantee, and what to do if a code is missing or unrecognized.
## Overview
Thrizer supports many ICD-10 diagnosis codes commonly used in behavioral health and related out-of-network claim processes.
If a diagnosis code is supported in Thrizer, you can use it wherever a diagnosis code is required. That includes clinician client setup, claim submission, and claim documentation.
Support for a code does **not** mean the diagnosis is clinically correct. It also doesn't mean the client's insurance plan will cover the service, or that the claim will be approved or reimbursed.
You are responsible for selecting the diagnosis code that accurately reflects the client's clinical care. The insurance carrier determines whether a submitted claim is accepted, denied, applied to deductible, or reimbursed.
## How diagnosis codes work in Thrizer
A diagnosis code helps describe the clinical reason for the service on an insurance claim.
For a charge to be submitted as a claim through Thrizer, the claim generally needs:
* a diagnosis code
* a CPT code structure
* provider information, including a valid NPI
* service date and appointment details
* billed amount
* client insurance information
For OON Pay and Thrizer Pay, claim submission is tied to a successful charge. If the charge does not process successfully, the claim is not submitted.
Diagnosis code support means the code can be used in Thrizer. It is not clinical coding advice and does not guarantee insurance coverage, claim approval, deductible application, or reimbursement.
## Common diagnosis codes clinicians ask about
These are diagnosis codes clinicians commonly ask about. Inclusion here is for orientation only. It is not clinical advice, and it does not indicate that any insurer will accept the code or cover it for a specific service.
| Code | Description |
| ------ | ---------------------------------------------------------------------------- |
| F32.0 | Major depressive disorder, single episode, mild |
| F32.1 | Major depressive disorder, single episode, moderate |
| F32.2 | Major depressive disorder, single episode, severe without psychotic features |
| F32.A | Depression, unspecified |
| F32.9 | Major depressive disorder, single episode, unspecified |
| F33.0 | Major depressive disorder, recurrent, mild |
| F33.1 | Major depressive disorder, recurrent, moderate |
| F33.2 | Major depressive disorder, recurrent, severe without psychotic features |
| F33.41 | Major depressive disorder, recurrent, in partial remission |
| F34.1 | Dysthymic disorder |
| F39 | Unspecified mood \[affective] disorder |
| F41.0 | Panic disorder \[episodic paroxysmal anxiety] |
| F41.1 | Generalized anxiety disorder |
| F41.9 | Anxiety disorder, unspecified |
| F42.2 | Mixed obsessional thoughts and acts |
| F43.10 | Post-traumatic stress disorder, unspecified |
| F43.12 | Post-traumatic stress disorder, chronic |
| F43.20 | Adjustment disorder, unspecified |
| F43.21 | Adjustment disorder with depressed mood |
| F43.22 | Adjustment disorder with anxiety |
| F43.23 | Adjustment disorder with mixed anxiety and depressed mood |
| F43.9 | Reaction to severe stress, unspecified |
| F50.01 | Anorexia nervosa, restricting type |
| F50.2 | Bulimia nervosa |
| F60.3 | Borderline personality disorder |
| F84.0 | Autistic disorder |
| F90.0 | Attention-deficit hyperactivity disorder, predominantly inattentive type |
| F90.2 | Attention-deficit hyperactivity disorder, combined type |
| F31.81 | Bipolar II disorder |
| F31.9 | Bipolar disorder, unspecified |
## Supported diagnosis-code families
Thrizer supports many diagnosis codes across behavioral health ICD-10 F-code ranges, along with selected Z-codes that may appear in clinical or administrative use.
| Code family | Examples of included categories |
| ----------- | ---------------------------------------------------------------------------------- |
| F01–F09 | Dementia, delirium, and mental disorders due to known physiological conditions |
| F10–F19 | Substance-related disorders |
| F20–F29 | Schizophrenia spectrum and other psychotic disorders |
| F30–F39 | Mood disorders, including bipolar and depressive disorders |
| F40–F48 | Anxiety, OCD, trauma, stress-related, dissociative, somatic, and related disorders |
| F50–F59 | Eating, sleep, sexual, gender, and behavioral syndromes |
| F60–F69 | Personality and adult behavior disorders |
| F70–F89 | Intellectual disability and developmental disorders |
| F90–F99 | ADHD, conduct, tic, childhood, adolescent, and unspecified mental disorders |
| Z-codes | Selected relationship, counseling, history, and contextual factors |
Do not assume that every possible ICD-10 code in a family is supported. To confirm a specific code, check it in Thrizer or contact support.
## Using more than one diagnosis code
A claim submitted through Thrizer requires at least one ICD-10 diagnosis code. A claim may include more than one diagnosis code when additional codes are clinically appropriate and supported by the claim process.
You select which diagnosis codes to include based on the clinical care delivered. Including more than one diagnosis code does not change how the insurance carrier processes the claim. It also doesn't increase the likelihood of approval or reimbursement.
If a specific code or combination is not accepted in the Add Charge form, contact support with the codes and where the issue is occurring.
## If the diagnosis code is not listed here
A diagnosis code may still be usable even if it is not shown in the common-code table above.
If you cannot find the diagnosis code you need, contact Thrizer support with:
* the diagnosis code
* the diagnosis description
* the client or account context, if relevant
* whether the issue is occurring during client setup, charging, or claim submission
Thrizer can review whether the code is supported for use in the claim process.
## What diagnosis-code support does not mean
Diagnosis-code support in Thrizer does not mean:
* the diagnosis is clinically correct for the client
* the diagnosis should be used for a specific service
* the client's plan covers services for that diagnosis
* the diagnosis establishes medical necessity
* the claim will be approved
* the claim will be reimbursed
* the amount will apply to deductible
* the insurer will accept the diagnosis for a specific CPT code
Those decisions depend on the clinician's clinical judgment and documentation. They also depend on the client's insurance plan and the insurance carrier's claim-processing rules.
## When to wait before charging
If no diagnosis has been assigned yet, wait until the diagnosis is available before submitting an insurance claim.
Claims require diagnosis information. Submitting incomplete claim information can cause claim issues or prevent claim submission.
Add Charge reflects this by disabling OON Pay and Thrizer Pay for clients without a diagnosis on file. If an insurance option was already selected, the form falls back to Self-Pay and shows a warning toast. Self-Pay does not require a diagnosis, so a Self-Pay charge can still be created while the diagnosis is being finalized.
## What to avoid
Avoid choosing a diagnosis code only because it appears more likely to reimburse.
Avoid using a diagnosis code that does not accurately reflect the client's clinical care.
Avoid treating diagnosis-code support as confirmation that the insurance carrier will accept the claim.
Avoid submitting an insurance claim before the diagnosis, CPT code, provider, and charge details are complete.
## If you can't find a diagnosis code
Thrizer's supported diagnosis codes cover the behavioral health ICD-10 F-code ranges (F01–F99) along with selected Z-codes that commonly appear in out-of-network mental health claims.
If a specific code does not work in your portal or you are unsure whether it is supported, contact Thrizer support. Include the code, description, and where you encountered the issue. The support team can confirm whether Thrizer supports it.
Support for a code in Thrizer is not a statement that the insurance carrier will accept or reimburse a claim using that code.
## Related articles
Learn how CPT code support works and how to handle add-on codes or multiple services.
Learn how insurer support works and why plan-level benefits still need to be checked.
Learn how to check estimated out-of-network benefits before charging a client.
# Elevance Health reimbursement changes for Anthem plans
Source: https://docs.thrizer.com/help/claims/elevance-health-reimbursement
Anthem, Carelon, NYSHIP, and Wellpoint now reimburse by paper check only. Thrizer Pay and OON Pay direct deposit are unavailable and Thrizer fees are waived.
## Overview
Elevance Health has updated its guidelines so that third-party entities like Thrizer are no longer permitted to receive reimbursement on a client's behalf. As a result, **Thrizer Pay** and **OON Pay direct deposit** are not available for Elevance Health plans, and clients now receive reimbursement by **paper check directly from their insurance company**.
**Plans affected:**
* Anthem BCBS
* Carelon
* NYSHIP (administered by Carelon)
* Wellpoint
Thrizer is working with Elevance Health to restore electronic reimbursement and Thrizer Pay support for these plans. If the carrier policy changes, Thrizer will share an update.
## What changes for clinicians
* Charge affected clients as you normally would. Thrizer continues to submit claims, and clients receive paper checks once claims are approved.
* Thrizer Pay and OON Pay are turned off for future sessions on these plans.
* Thrizer is **not** charging claim support fees on these claims at this time. The 5% Thrizer Pay fee and 1% OON Pay fee do not apply to future claims on affected plans.
* If this pricing policy changes, Thrizer will notify you in advance.
Anthem clients also require an additional step: your practice must be registered as a non-participating provider with Anthem before OON claims can process. See [Register as an out-of-network Anthem provider](/help/claims/anthem-oon-registration).
## What changes for clients on affected plans
* Claims are still submitted with every charge as usual.
* Former **Thrizer Pay** clients now pay the clinician's full cash rate upfront and wait for reimbursement by paper check once the claim is approved. Timing is typically about 6 weeks and varies by plan.
* Former **OON Pay direct deposit** clients also receive reimbursement by paper check instead of direct deposit.
* No 5% Thrizer Pay fee or 1% OON Pay fee is applied while this policy is in effect.
## Related articles
Anthem-specific step: register your practice through Availity Essentials so OON claims are not delayed or denied.
See Thrizer's insurance company reference, including Elevance Health plans.
Learn how Thrizer Pay normally works when it is available for a client's plan.
Learn how OON Pay routes reimbursement to a client's linked bank account when supported.
# How to submit a claim
Source: https://docs.thrizer.com/help/claims/how-to-submit-a-claim
Learn how claims are submitted through Thrizer, when submission is automatic, and what to do with a superbill from a provider who is not on Thrizer.
## Before you start
When a clinician on Thrizer charges a client through **OON Pay** or **Thrizer Pay**, Thrizer submits the out-of-network claim automatically after the payment is successfully processed. The client does not need to do anything.
**Client Portal changes:** As of **August 9, 2026**, client-side **Upload Superbill** and **Add Claim** (manual claim entry) have been retired from the Client Portal. Claims submitted before that date continue to process normally. See the [August 8, 2026 update](/help/changelog/2026-08-08-upload-superbill-retired).
In all cases, the insurance carrier determines the final claim outcome, reimbursement amount, deductible application, and processing timing.
## How this works
The right claim path depends on how the session was paid and whether the clinician is on Thrizer.
If the session is processed through OON Pay or Thrizer Pay, Thrizer submits the claim automatically after successful payment.
If you have a superbill from a provider who is **not** on Thrizer, email the PDF to [help@thrizer.com](mailto:help@thrizer.com). You can also submit it directly to your insurer outside of Thrizer.
## When is a claim submitted automatically?
Claims are submitted automatically for:
* OON Pay
* Thrizer Pay
In these payment flows, the clinician creates a charge for the session. Once the client's payment is successfully processed, Thrizer submits the claim to insurance using the information attached to that charge.
There is no separate manual claim submission step for OON Pay or Thrizer Pay.
## What happens if the payment fails?
If the client's payment does not go through, the charge fails and the claim is not submitted.
Resolve the payment issue with the client, then retry the charge. Thrizer submits a claim only after payment succeeds.
## What if my clinician is not on Thrizer?
Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on August 9, 2026. Clients can no longer submit new claims themselves through the portal.
If you have a superbill from a provider who is not on Thrizer and you would like it submitted for out-of-network reimbursement, email the PDF to [help@thrizer.com](mailto:help@thrizer.com). You can also submit the superbill directly to your insurer outside of Thrizer.
## Can a clinician upload a superbill for a client?
A clinician on Thrizer submits claims for their own clients automatically through OON Pay or Thrizer Pay. A clinician cannot upload a superbill on a client's behalf for a session that was not paid through Thrizer.
## What information does a claim need?
Claims generally need enough information for the insurance carrier to process the service.
A superbill or claim entry should include:
* provider name
* provider NPI
* tax ID or TIN
* service date
* billed amount
* one or more diagnosis codes
* CPT code
If required information is missing or incorrect, the claim may be delayed, fail, or be denied by the insurer.
## What if the session was Self-Pay?
Self-Pay means no insurance claim is automatically submitted through Thrizer.
A client can generate a superbill PDF from **Client Portal → Payments** for a Confirmed Self-Pay session. See [Viewing payments and exporting receipts](/help/client/payments-and-receipts).
The client can then submit that superbill directly to their insurer outside of Thrizer, or email it to [help@thrizer.com](mailto:help@thrizer.com).
## Can claims for past service dates be submitted?
For OON Pay and Thrizer Pay, claims are tied to the charge and are submitted with the session's Date of Service.
Insurance carriers have their own timely filing rules. If a claim is submitted too late under the insurer's rules, the insurer may deny it. Thrizer does not guarantee that a claim for a past service date will be accepted or reimbursed.
## What happens after a claim is submitted?
After a claim is submitted, the insurance carrier processes it.
The claim may result in:
* reimbursement
* application toward the deductible
* denial
An approved claim does not always mean money will be reimbursed. If the deductible has not been met, the claim may be approved and applied to the deductible instead.
The insurance carrier controls claim processing time. Typical reimbursement timing may be around 4 to 6 weeks, but timing is not guaranteed.
## Why weren't some sessions submitted as claims?
For OON Pay and Thrizer Pay, Thrizer submits a claim only when **both** conditions are met:
1. The client's payment was successfully processed (the charge went through).
2. All required claim information is present and claim-compatible.
If either condition fails, no claim is submitted for that session. Common reasons include:
* **The payment failed.** No payment is captured, and no claim is submitted. Update the payment method and retry the charge.
* **The session was Self-Pay.** Self-Pay does not automatically generate an insurance claim. If reimbursement is expected, a superbill needs to be uploaded separately.
* **Insurance is not verified.** A usable benefit check is required. If insurance is not linked, or the automated check failed and no manual verification is complete, Thrizer cannot submit a claim.
* **Required claim information is missing.** A missing diagnosis, missing Individual NPI on the rendering clinician, missing supported CPT, missing service date, or another required field can block submission. You see an inline message in Add Charge when this happens.
* **The service or CPT structure is not claim-compatible.** No-show and cancellation fees cannot be submitted to insurance through Thrizer. Sessions above the \$2,500 cap, or sessions with unrelated CPT codes bundled together, cannot be submitted as a single insurance claim.
* **The Date of Service is more than one day ahead.** OON Pay and Thrizer Pay require a Date of Service of today or tomorrow. This is a calendar-day restriction, not a rolling 24-hour window. Sessions two or more calendar days ahead must use Self-Pay.
* **The claim is under Thrizer support review.** Some claims are held for support review before submission.
If none of these apply and a claim is still missing, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com).
## Why was a claim denied?
Thrizer can accept a claim, and the insurance carrier can still deny it. Denial is an insurance-side decision. Common reasons include:
* the CPT code, diagnosis code, or provider information does not match insurer records
* the service is not covered under the client's plan
* the client's plan does not include out-of-network benefits
* the insurer's timely filing window has passed
* documentation or additional information the insurer requested is missing
* plan-specific rules that Thrizer cannot see before submission
If a claim was denied because of a claim-detail error (for example, a wrong CPT code), contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com). Support can review the claim and, where possible, correct or resubmit it. Insurer acceptance is not guaranteed. See [Claim and billing limitations](/help/claims/claim-and-billing-limitations#can-a-denied-claim-be-corrected-and-resubmitted).
## What if a claim is delayed or has an issue?
If a claim fails, stalls, or needs more information, Thrizer support may review the issue.
Depending on the situation, Thrizer may request missing information, investigate with the insurer, or help correct and resubmit the claim when possible.
The final decision still belongs to the insurance carrier.
## What Thrizer does
Thrizer helps submit and track claims when the claim is submitted through a supported Thrizer process.
For OON Pay and Thrizer Pay, Thrizer submits the claim automatically after a successful charge, using the claim information attached to that charge.
## What insurance determines
The insurance carrier determines final coverage, claim approval, reimbursement, deductible application, and processing timing.
Thrizer does not guarantee claim approval, reimbursement amount, deductible application, or claim timing.
## Related articles
Learn which claim and billing processes Thrizer does not support automatically.
Understand what happens after a claim is submitted and why timing can vary.
Learn how Self-Pay works and when clients may use superbills for claim submission.
See how CPT codes are used when preparing claims through Thrizer.
Learn why diagnosis codes are required before a claim can be submitted.
Compare Self-Pay, OON Pay, and Thrizer Pay before choosing a payment type.
# Self-Pay and superbills
Source: https://docs.thrizer.com/help/claims/self-pay-and-superbills
Learn how Self-Pay works in Thrizer, when a superbill may be used, and what to expect if you submit a claim separately for reimbursement.
## Overview
Self-Pay means the client pays the full session fee without using insurance through that payment flow. Thrizer doesn't submit an insurance claim automatically, doesn't route reimbursement through Thrizer, and doesn't apply a client insurance-related fee to the Self-Pay payment itself. Standard card processing fees on the clinician side still apply.
A superbill is different. A superbill is a document a client can use to submit claim information separately for possible out-of-network reimbursement or deductible credit. Reimbursement is not guaranteed, and the insurance carrier decides the final claim outcome.
## When would I use Self-Pay?
Use Self-Pay when a session is paid without insurance involvement through Thrizer.
With Self-Pay:
* the client pays the full session fee
* no claim is automatically submitted
* no reimbursement is expected through that payment flow
* no insurance information is required for the Self-Pay payment
* no diagnosis code is required for the Self-Pay payment
For example, a client may use Self-Pay when they are not using insurance for the session or when no claim will be submitted through Thrizer.
## Does Self-Pay create an insurance claim?
No. Self-Pay does not create an insurance claim.
That means the client should not expect claim tracking, deductible credit, or reimbursement from the Self-Pay payment itself.
If the client wants to pursue reimbursement separately, they may need to submit claim information separately, such as by using a superbill.
## What is a superbill?
A superbill is a document with information an insurance carrier may need to process a claim.
A valid superbill generally includes information such as:
* provider name
* provider NPI
* tax ID or TIN
* service date
* billed amount
* one or more diagnosis codes
* CPT code
The insurer uses the submitted claim information to decide whether the service is eligible for reimbursement or deductible credit.
## Can a client submit a superbill through Thrizer?
Not through the Client Portal anymore. Client-side **Upload Superbill** and **Add Claim** were retired on August 9, 2026.
If your clinician is on Thrizer and uses OON Pay or Thrizer Pay, they submit claims on your behalf automatically after the charge processes. If you have a superbill from a provider who is not on Thrizer, email the PDF to [help@thrizer.com](mailto:help@thrizer.com). The Thrizer team can help you submit it for reimbursement.
Superbills and claims that were submitted through Thrizer before August 9, 2026 continue to process normally. You can still view them in **Client Portal → Claims**. See [Claims and superbills](/help/client/claims-and-superbills).
If a superbill was already submitted to insurance through another path, Thrizer cannot take over, correct, appeal, or reprocess that claim. The client needs to work through the insurer or the original submission path.
If reimbursement is issued for a claim that Thrizer submits on your behalf, it is sent to the client following the same rules as before.
## Can a clinician submit a superbill for a client?
A clinician on Thrizer submits claims for their own clients automatically through OON Pay or Thrizer Pay. A clinician cannot submit a superbill on a client's behalf for a session that was not paid through Thrizer.
If a client has a superbill from a provider who is not on Thrizer, they can email the PDF to [help@thrizer.com](mailto:help@thrizer.com).
## Does a superbill guarantee reimbursement?
No. A superbill does not guarantee reimbursement.
The insurance carrier decides whether the claim is accepted, denied, applied to the deductible, or reimbursed. Claims may also be subject to the insurer's timely filing rules.
A claim can be accepted by the insurer and still result in no cash reimbursement if the allowed amount is applied to the client's deductible.
## How is this different from OON Pay?
With OON Pay, the client pays the full session fee upfront and Thrizer automatically submits the claim after the charge is successfully processed. If reimbursement is issued, it is routed back to the client.
With Self-Pay, no insurance claim is automatically submitted. If the client wants to pursue reimbursement, they need to use a separate claim process, such as emailing a superbill PDF to [help@thrizer.com](mailto:help@thrizer.com) or submitting claim information directly to insurance.
## How is this different from Thrizer Pay?
With Thrizer Pay, the client pays an estimated out-of-pocket amount upfront, Thrizer advances the remaining session fee to the clinician, and insurance reimbursement is routed to Thrizer.
With Self-Pay, the client pays the full session fee, Thrizer does not advance payment based on insurance, and no claim is automatically submitted.
## What should I expect after submitting a superbill?
After a superbill is submitted, the claim outcome depends on the insurance carrier.
The claim may be:
* reimbursed
* applied to the deductible
* denied
The final result depends on the client's plan, the insurer's rules, the submitted claim details, and any timely filing limits that apply.
Thrizer does not guarantee claim approval, reimbursement amount, deductible application, or claim timing.
## What Thrizer does
Thrizer supports Self-Pay payments where no insurance claim is automatically submitted.
For sessions paid through OON Pay or Thrizer Pay, Thrizer submits the out-of-network claim automatically on the client's behalf. Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on August 9, 2026.
## What insurance determines
The insurance carrier determines whether a submitted claim is accepted, denied, applied to the deductible, or reimbursed.
The carrier also determines the reimbursement amount and claim processing timing.
## Related articles
Learn the supported ways clients can submit claims through Thrizer.
Review what Thrizer does not support, including split payments, multiple CPT codes, and incomplete claim information.
Compare Self-Pay, OON Pay, and Thrizer Pay before choosing a payment option.
Understand how out-of-network reimbursement, deductible credit, and allowed amounts work.
Learn what happens after a claim is submitted and why timing depends on the insurance carrier.
# Which insurance companies does Thrizer work with?
Source: https://docs.thrizer.com/help/claims/supported-insurance
How insurance company support works in Thrizer, why each client's plan still needs a benefit check, and what to do if an insurer is not listed.
## Overview
Thrizer works with many commercial insurance companies and benefit administrators that have appeared in Thrizer claims before.
However, an insurance company name by itself does **not** guarantee out-of-network benefits, claim approval, or reimbursement for a client's specific plan.
The best next step is to run a benefit check for the client's specific plan. If the automatic benefit check does not work, Thrizer may be able to review the client's insurance manually. Manual review uses the front and back of the insurance card and the client's date of birth.
## Why the insurance company name is not enough
Insurance coverage is determined at the plan level, not just the insurance-company level.
For example, two clients may both have the same insurance company, but their plans may have different:
* out-of-network benefits
* deductible rules
* coinsurance
* reimbursement rules
* behavioral health benefit administrators
* claim-processing requirements
A listed insurance company means Thrizer has seen claims involving that insurer before. It is not a statement that Thrizer is in-network with the insurer. It is also not a guarantee that any specific plan from that company will work, be reimbursed, or support Thrizer Pay.
A listed insurance company does not guarantee coverage, claim approval, deductible application, reimbursement, or Thrizer Pay availability for a specific client plan.
## Common insurance companies clinicians ask about
Thrizer has prior claim experience with many commonly requested insurers and benefit administrators, including:
| Insurance company or administrator | Common names or notes |
| ---------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Aetna | Aetna |
| Anthem Blue Cross Blue Shield | Anthem, Anthem BCBS. Elevance Health plan. Non-par providers must be [registered with Anthem](/help/claims/anthem-oon-registration) before OON claims can process, and [reimbursement is currently paid by paper check only](/help/claims/elevance-health-reimbursement). |
| Blue Cross Blue Shield | BCBS |
| Carelon | Elevance Health plan, including NYSHIP (administered by Carelon). [Reimbursement is currently paid by paper check only](/help/claims/elevance-health-reimbursement); Thrizer Pay and OON Pay direct deposit are not available for this plan. |
| Cigna | Cigna |
| Emblem Health | EmblemHealth, GHI |
| Harvard Pilgrim Health Care | Harvard Pilgrim |
| Kaiser Permanente | Region-specific Kaiser plans may need review |
| Optum Behavioral Health | Optum |
| Oscar Health | Oscar |
| Oxford Health | Oxford, Oxford Health Plans |
| United Healthcare | UnitedHealthcare, United Health Care, UHC |
| UMR | UMR, UnitedHealthcare UMR |
| Wellpoint | Elevance Health plan. [Reimbursement is currently paid by paper check only](/help/claims/elevance-health-reimbursement); Thrizer Pay and OON Pay direct deposit are not available for this plan. |
This is not a complete list. See the appendix below for a broader reference list.
## How to check a specific client's plan
To check whether a client's plan can be used with Thrizer, run a benefit check using the client's insurance information.
A benefit check usually requires:
* insurance company
* member ID
* client date of birth
* client name
* other subscriber details, when applicable
A successful benefit check may return estimated out-of-network benefit information, such as deductible, coinsurance, estimated reimbursement, and estimated out-of-pocket cost.
Benefit-check results are estimates. Final coverage, allowed amount, deductible application, claim approval, and reimbursement are determined by the insurance carrier after the claim is processed.
## If the automatic benefit check does not work
An unsuccessful automatic benefit check does not necessarily mean the client lacks coverage.
Automatic checks can fail or return incomplete results for several reasons, including:
* the client's information does not match insurer records
* the insurance company returns incomplete benefit details
* the plan does not support real-time benefit checks
* the plan requires phone verification
* behavioral health benefits are managed separately
* out-of-network benefit details are not exposed digitally
If this happens, Thrizer may need to verify benefits manually.
For manual review, send:
* front of the client's insurance card
* back of the client's insurance card
* client date of birth
## If the insurance company is not listed
If an insurance company is not listed, that does not automatically mean Thrizer cannot work with it.
It may mean:
* the company is outside Thrizer's prior claim experience
* the company uses a different administrator or network name
* the plan needs manual review
* the insurer name needs to be entered differently
* the client's card needs to be reviewed to identify the correct payer
In that case, send the client's insurance card and date of birth to Thrizer support so the plan can be reviewed.
## Special cases
### Blue Cross Blue Shield plans
Blue Cross Blue Shield plans can be especially plan-specific.
The most helpful starting point is the client's BCBS home plan listed on the insurance card. If the card shows a specific BCBS plan, such as Regence, Premera, Horizon, or BCBS of Massachusetts, use that plan name when checking benefits.
Do not assume the client's plan based only on the client's location, the clinician's location, or the general phrase "BCBS."
### Kaiser Permanente plans
Kaiser Permanente is region-specific. If a client says they have Kaiser, the region matters.
Examples include:
* Kaiser Permanente Northern California
* Kaiser Permanente Southern California
* Kaiser Permanente Colorado
* Kaiser Permanente Washington
* Kaiser Permanente Northwest
* Kaiser Permanente Mid-Atlantic
* Kaiser Permanente Georgia
* Kaiser Permanente Hawaii
Kaiser plans often require extra review because plan structure and out-of-network benefit availability can vary.
### Medicare, Medicare Advantage, and Medicaid
Medicare, Medicare Advantage, and Medicaid generally do not include out-of-network benefits in a way that Thrizer can support automatically.
Medicare Advantage and other commercially administered Medicare-related plans typically require **manual benefit verification**. The plan name alone (for example, "UnitedHealthcare Medicare Advantage" or "Aetna Medicare") is not enough to confirm support.
If a manual benefit check returns usable out-of-network benefit information and payment eligibility rules are met, Thrizer payment options may be available.
Thrizer does **not** credential clinicians and does not "make" a clinician in-network or out-of-network with any insurer, including Medicare or Medicare Advantage. Thrizer supports out-of-network billing where the clinician's status and the client's plan already allow out-of-network claims.
### HMO plans
HMO plans generally do not include out-of-network benefits, but rare plan-level exceptions may exist.
If a benefit check returns usable out-of-network benefit information, or if the result appears inconsistent with the plan type, the plan should be reviewed before drawing a conclusion.
## What insurance-company support does not mean
Insurance-company support in Thrizer does not mean:
* the client has out-of-network benefits
* the client's deductible has been met
* the client is eligible for Thrizer Pay
* the claim will be approved
* the claim will be reimbursed
* the reimbursement amount is guaranteed
* the insurer will process the claim in a specific way
* the insurer will route reimbursement through Thrizer
* the plan will support every CPT or diagnosis code
Those decisions depend on the client's specific plan and the insurance carrier's claim-processing rules.
## What to avoid
Avoid telling clients that Thrizer "takes" or "accepts" their insurance in the same way an in-network provider does.
Avoid telling clients that their insurance company is supported without checking their specific plan.
Avoid using a listed insurer as a guarantee of reimbursement.
Avoid assuming that PPO, HMO, Medicare, Medicaid, BCBS, or Kaiser plan behavior is the same across all clients.
## Related articles
Learn how to check estimated out-of-network benefits before charging a client.
Learn how CPT code support works and how to handle add-on codes or multiple services.
Learn how diagnosis-code support works in Thrizer and what diagnosis-code support does not guarantee.
# Claims and superbills for clients
Source: https://docs.thrizer.com/help/client/claims-and-superbills
View out-of-network claims in the Thrizer Client Portal, generate a superbill for reimbursement, and see what to do now that superbill upload has been retired.
## Overview
Use **Client Portal → Claims** to view claims that have been submitted through Thrizer. You can also generate a superbill PDF from **Client Portal → Payments** for your own records.
As of **August 9, 2026**, client-side **Upload Superbill** and **Add Claim** have been retired from the Client Portal. Claims already submitted are not affected. If your clinician uses Thrizer, they continue to submit claims automatically. If you have a superbill from a provider who is not on Thrizer, email it to [help@thrizer.com](mailto:help@thrizer.com).
## If my clinician said payments are automatically claimed, do I need to submit anything?
Usually no. When your clinician uses **OON Pay** or **Thrizer Pay**, Thrizer submits the out-of-network claim automatically after the charge processes successfully. You do not need to do anything for those sessions.
If you just need a superbill PDF for a Self-Pay session you already paid in Thrizer, you can generate one from **Client Portal → Payments** using **Generate Superbill**. The export matches the filters currently applied to the Payments list. See [Viewing payments and generating superbills](/help/client/payments-and-receipts).
## Where do I see my claims?
Go to:
**Client Portal → Claims**
Each claim shows Submission Date, Claim #, Appointment Date, Clinician, Amount, and Status.
If you expected an automatic claim to appear here but do not see it, possible reasons include:
* **The payment failed.** No payment means no claim is submitted. Ask your clinician to retry the charge after updating your payment method.
* **The session was Self-Pay.** Self-Pay does not generate an insurance claim.
* **Required claim information is missing.** For example, missing diagnosis, CPT, NPI, or billing details on the clinician's side.
* **Your insurance is not verified.** A usable benefit check is required before automatic claim submission.
* **The claim is pending Thrizer support review.** Some claims are held for manual review before they appear.
If none of these apply and the claim is still not visible after a few business days, contact [help@thrizer.com](mailto:help@thrizer.com).
## Claims list
The claims list shows:
* Submission Date
* Claim #
* Appointment Date
* Clinician
* Amount
* Status
To find a specific claim, use the search box on the Claims page to search by **clinician name** or **claim number**. You can search a full name like `Jane Smith`. Thrizer matches each word against the clinician's first and last name, so multi-word searches work as expected.
## Claim details
Select a claim number to open claim details.
## I have a superbill from a provider who is not on Thrizer. What do I do?
Email the superbill PDF to [help@thrizer.com](mailto:help@thrizer.com) and the Thrizer team can help.
Client-side **Upload Superbill** was retired on August 9, 2026, and manual claim entry (**Add Claim**) has been removed from the Client Portal. If your clinician is on Thrizer, they continue to submit claims automatically through OON Pay or Thrizer Pay, so no action is needed on your side.
Reimbursement is not guaranteed. Insurance carriers determine claim approval, reimbursement amount, deductible application, and processing time. Insurer timely filing rules still apply.
## Claims submitted before August 9, 2026
Superbills and manual claims you submitted before the retirement continue to process normally. You can still view them under **Client Portal → Claims**.
Benefit checks and reimbursement estimates help set expectations. Insurance carriers determine final coverage, reimbursement amounts, deductible application, claim approval, and processing time.
## Related articles
Learn typical 4–6 week processing times and why an approved claim may still pay \$0.
Review how claims are submitted through Thrizer and who is responsible for each step.
Understand how Self-Pay sessions produce a superbill PDF you can share with your insurer.
See what Thrizer's claim process does not support, including re-submitting already-billed sessions.
# Clinician connections
Source: https://docs.thrizer.com/help/client/clinician-connections
See your connected clinicians, open clinician details, and accept or decline a pending clinician invitation from your Client Portal.
## Overview
Use Clinicians to manage clinician relationships connected to your Thrizer account.
## Where to go
Go to:
**Client Portal → Clinicians**
## Clinicians list
The clinicians list shows:
* Clinician
* Email
* Practice
* Payment Type
* Status
Pending invitations show **Accept** and **Decline** actions on the row.
## Clinician details
Select a clinician to view details. The detail view is organized into:
* Connection
* Practice Information
## Accept or decline an invitation
If a clinician invites you to connect, the invitation appears as a pending row in your **Clinicians** list with **Status** showing the pending state and **Actions** available on the row.
From the pending row, use:
* **Accept** to accept the connection
* **Decline** to decline the connection
After you accept or decline, the row leaves the pending state.
## What a connection does
A clinician connection lets your clinician manage supported Thrizer features for your care, such as payments and claims that apply to your account and payment type.
# Understanding estimates and reimbursement
Source: https://docs.thrizer.com/help/client/estimates-and-reimbursement
Understand allowed amounts, deductibles, coinsurance, claim outcomes, where reimbursement is sent, and why out-of-network insurance estimates can change.
## Overview
Thrizer uses available benefit information to estimate out-of-network costs. Those estimates help you plan, but the insurer determines the final claim result.
## Key terms
### Provider fee
The provider fee is your clinician's full session rate.
### Allowed amount
The allowed amount is the amount the insurer recognizes for a covered service. Reimbursement is based on the allowed amount, not necessarily the provider fee.
### Deductible
Your deductible is the amount you pay before insurance starts reimbursing eligible services. If your deductible is not met, an approved claim can apply to your deductible and still pay \$0 in reimbursement.
### Coinsurance
Coinsurance is your share of the allowed amount after the deductible is met.
## Why estimates change
Before a claim is processed, Thrizer estimates the allowed amount and reimbursement using available benefit information. After the insurer processes a claim, Thrizer updates expectations based on the insurer's actual allowed amount and claim result.
## Approved does not always mean reimbursed
A claim can be approved and still result in \$0 reimbursement when the allowed amount is applied to your deductible.
Claim outcomes generally fall into these categories:
* **Reimbursed:** insurance pays part of the allowed amount.
* **Applied to deductible:** insurance approves the claim but applies the allowed amount to your deductible instead of paying reimbursement.
* **Denied:** insurance does not issue reimbursement or deductible credit.
## Who receives reimbursement
Where reimbursement is sent depends on the payment option used for the session:
* **OON Pay:** reimbursement goes to you. Some insurers may mail a check directly to you instead of sending funds through Thrizer.
* **Thrizer Pay:** reimbursement goes to Thrizer, because Thrizer already advanced part of the session fee to your clinician.
If Thrizer sends the reimbursement to you, add a [reimbursement bank account](/help/client/reimbursement-bank) so Thrizer knows where to deposit funds.
## Does Thrizer track my deductible progress?
Thrizer does not automatically track a running deductible balance across claims. Benefit checks estimate deductible status at the time the check is run. The insurance carrier determines deductible application on each claim when it processes the claim.
To refresh your deductible progress after new claims have been approved, contact Thrizer support and ask for a manual recheck.
For the most accurate, up-to-date deductible balance, contact your insurance carrier directly.
## Will a recheck ever undo a met deductible?
Not in the same calendar year. Automated benefit checks often report the plan-level deductible remaining and do not reflect the out-of-network payments you have already made toward it. To avoid incorrectly flipping a met deductible back to not met, Thrizer preserves the previously recorded met value for the rest of the calendar year. The discrepancy is flagged for internal review.
A recheck can change your deductible status in these cases:
* **A new calendar year.** Most out-of-network plans reset on January 1, so a recheck in the new year is allowed to show the new plan-year deductible as not met.
* **You update your insurance to a different plan or payer.** The previous plan's deductible no longer applies. The new plan's deductible is used going forward, even if the previous plan's deductible was met.
If your deductible should be marked as met and it is not, contact Thrizer support so the recorded value can be reviewed.
## Why an OON claim may not appear to count toward your deductible
When a claim is processed, the insurer decides how the allowed amount is applied. Common reasons an OON claim may not appear to reduce your deductible balance:
* **The claim is still processing.** Deductible application is not final until the insurer finishes processing the claim.
* **The claim was denied.** A denied claim gives no reimbursement and no deductible credit.
* **The allowed amount is different from the session fee.** Deductible credit is based on the insurer's allowed amount, not the full amount your clinician charged.
* **Your plan applies out-of-network costs to a separate out-of-network deductible.** Some plans track in-network and out-of-network deductibles separately.
* **The insurer's records are not yet updated.** Deductible balances shown by your insurer can lag behind recently processed claims.
If a claim has been processed and you still have questions about how it was applied, contact your insurance carrier. They determine final deductible application.
## Timing
Insurance claims commonly take several weeks to process. The insurance carrier controls actual timing.
## Related articles
Learn how out-of-network reimbursement generally works and why estimates can change.
Understand the insurance terms that most directly affect what you get reimbursed.
See why an approved claim can still result in \$0 paid back to you.
Learn why the final insurer decision may not match the estimate you saw before the claim was processed.
Add or update the bank account Thrizer uses to send reimbursement to you.
See what happens after a claim is submitted and why timing depends on the insurance carrier.
# Getting started as a client
Source: https://docs.thrizer.com/help/client/getting-started
Set up your Thrizer client account, complete onboarding steps like linking insurance and payment methods, and learn how to navigate the Client Portal.
## Before you start
Thrizer helps you manage out-of-network payments and claims. How this works depends on your clinician, your insurance, and the payment type used for care.
## Main setup steps
Start with these items:
1. **Create or sign in to your client account.**
2. **Add your insurance plan** if you want Thrizer to check out-of-network benefits or support claims.
3. **Add a payment method** so your clinician can charge you through Thrizer when needed.
4. **Add a reimbursement bank account** if Thrizer should send reimbursements to you.
5. **Review clinician connections** if a clinician invited you to connect.
## Home
The Home page shows your account summary at a glance. It can show:
* Welcome message
* Pending actions, including pending clinician invitations
* Quick actions to jump into common tasks
* Account Summary with connected clinicians and year-to-date payment and claim totals
* Announcement banner
Home shows quick actions such as **Add Payment Method**, **Link your plan**, and **View Invitations**. Which actions appear depends on what your account is missing or waiting on. Pending clinician invitations and prompts to add a payment method appear in the Pending Actions section. When an active announcement appears, you can dismiss it from Home.
To manage insurance, go to [Settings → Insurance plan](/help/client/link-insurance).
## Settings
Settings includes:
* My profile
* Insurance plan
* Payment methods
* Reimbursement bank
Use Settings to edit profile details, manage insurance, add cards, and manage reimbursement bank information.
## Claims
The Claims page lets you:
* View your claims list
* Search claims by clinician name or claim number
* Open claim details
Client-side **Upload Superbill** and **Add Claim** (manual claim entry) were retired from the Client Portal on August 9, 2026. If your clinician uses OON Pay or Thrizer Pay, they submit claims automatically. If you have a superbill from a provider who is not on Thrizer, email it to [help@thrizer.com](mailto:help@thrizer.com).
## Payments
The Payments page lets you:
* View payment history
* Search by clinician name and filter by clinician, date range, or charge type
* Open payment details
* Generate a superbill when that option is available
## Clinicians
The Clinicians page shows clinicians connected to your account. You can view clinician details and respond to pending invitations with **Accept** or **Decline**.
# Client help
Source: https://docs.thrizer.com/help/client/index
Help for clients using Thrizer to manage insurance, payments, claims, superbills, reimbursement bank details, and clinician connections.
## Start here
Use these guides to set up and manage your Thrizer client account.
Learn the main client setup steps and how to use Home, Claims, Payments, Clinicians, and Settings.
Walk through the Client Portal in a short interactive demo before you set up your account.
Understand what Thrizer does, what it does not do, and how it works when you pay your clinician.
Learn when insurance can be used with Thrizer and what benefit checks can and cannot confirm.
Edit profile details, request a password reset, and review account settings.
Add or edit insurance details and understand what benefit checks do.
Add cards, view saved cards, set a default card, and delete cards.
Add, edit, or view the bank account used for reimbursements.
View payment history, open payment details, and generate superbills.
View your claims, open claim details, and see what to do now that client-side superbill upload is retired.
View connected clinicians and accept or decline clinician invitations.
Understand estimated costs, allowed amounts, deductibles, coinsurance, and claim outcomes.
Get help with failed benefit checks, claim delays, account changes, and support requests.
# Linking or editing insurance
Source: https://docs.thrizer.com/help/client/link-insurance
Add, view, and edit your insurance information in the Thrizer Client Portal so benefit checks, claims, and reimbursement estimates use the right plan.
## Where to link or edit insurance
View or update your insurance from:
**Client Portal → Settings → Insurance plan**
You can also reach insurance settings from the Claims page. When Thrizer asks you to link insurance, select **Link your health plan** to open insurance settings.
## Insurance fields
When editing an insurance plan, the Insurance Information form has two sections.
Subscriber Details:
* First Name
* Last Name
* Date of Birth
* Relationship to Subscriber
Policy Details:
* Insurance Provider
* Member ID
If you are the primary policyholder, select yourself as the relationship and enter your own name and date of birth. If the plan is under someone else, such as a spouse or parent, select the correct relationship. Then enter that person's name and date of birth so Thrizer knows whose plan you use.
After you save, Thrizer stores the updated insurance information and shows a success confirmation.
### Finding a Blue Cross Blue Shield plan by brand name
If you have a Blue Cross Blue Shield plan, type the brand name printed on your card into the Insurance Provider search. Examples include **Anthem**, **Regence**, and **Excellus**.
The correct BCBS parent payer appears at the top of the results. Matches on a brand name show an `Includes: ` subtitle so you can confirm the payer covers your plan before selecting it.
## What the insurance page shows
The Insurance plan page shows your current insurance plan information, or an error message if the plan details cannot load.
From this page you can:
* Review your saved insurance information.
* Select **Edit Insurance Plan** to open the Insurance Information form and update any field.
* Select **Save** to store your changes. Thrizer shows a confirmation once the update is saved.
Like any benefit check, results are estimates. Insurance carriers determine final coverage.
## Why insurance matters for claims
Linked insurance is required for automatic claim submission. When your clinician charges you through **OON Pay** or **Thrizer Pay**, Thrizer submits the out-of-network claim only if your insurance is linked. If insurance is not linked, select **Link your health plan** from the Claims page to open insurance settings.
## If your insurance does not link
A failed automated benefit check does not mean coverage was denied. It usually means the insurer did not return enough information through the automated check. Manual verification may still confirm benefits. Thrizer support may ask for the front and back of the insurance card and your date of birth.
For the full list of common reasons and what manual verification can confirm, see [Manual benefit checks](/help/widget/manual-benefit-checks).
## Trying to "add a provider"?
"Provider" can mean the insurance company (payer), your therapist, or a therapist who does not use Thrizer. To change the insurance company or member ID, use the fields above.
For the other cases (connecting to a therapist, or submitting a superbill from a therapist who is not on Thrizer), see [How do I add a new provider?](/help/faq/how-do-i-add-a-provider).
## Related articles
Learn what a benefit check estimates and why it is not a guarantee.
See what happens when an automated benefit check does not return enough information.
Understand how benefit estimates relate to the final reimbursement from your insurance carrier.
Pick the right path when "provider" could mean the payer, a therapist, or a team member.
# Adding and managing payment methods
Source: https://docs.thrizer.com/help/client/payment-methods
Add a card, view saved payment methods, set a default, and remove cards in the Thrizer Client Portal so charges can be processed reliably.
## Before you start
Use Payment Methods to manage the card your clinician can charge through Thrizer.
## Where to go
Go to:
**Client Portal → Settings → Payment Methods**
## What you can do
The Payment Methods page lets you:
* Add a payment method
* View saved payment methods
* See card ending details
* See default status
* Set a card as the default payment method
* Delete a payment method
## Add a card
Select **Add Card** to open the add-card drawer, then enter your card details. After you add the card, Thrizer saves it for future payments.
## Set a default card
Use **Set as default** to make a saved card the default payment method.
## Delete a card
Use **Delete payment method** to open a confirmation modal. Confirm the deletion to remove the saved card.
## HSA and FSA cards
Thrizer accepts HSA and FSA cards as payment methods. Add an HSA or FSA card the same way you would add any other card under **Client Portal → Settings → Payment Methods**.
If your HSA or FSA administrator asks for documentation to substantiate the expense, generate a superbill from **Client Portal → Payments → Generate Superbill**. You can then submit it for HSA or FSA reimbursement.
Your HSA or FSA plan administrator determines whether a specific session is eligible for HSA or FSA reimbursement, not Thrizer. Thrizer accepts the card as a payment method; your plan determines what qualifies.
## Can I use an HSA or FSA card?
Yes. Thrizer accepts HSA and FSA cards as payment methods. Add the card the same way you would add a regular credit or debit card.
Whether a specific HSA or FSA card successfully pays for a given service depends on your HSA/FSA administrator's rules for eligible expenses. Thrizer does not control HSA/FSA eligibility decisions. If your HSA/FSA administrator declines the charge, add a different card and ask your clinician to retry the charge.
For FSA or HSA reimbursement documentation, generate a superbill from **Client Portal → Payments → Generate Superbill**. See [Viewing payments and generating superbills](/help/client/payments-and-receipts) for how this works.
An HSA or FSA card is a payment method, not an insurance plan. Paying with an HSA or FSA card does not, by itself, submit an insurance claim. Whether a claim is submitted depends on the payment type your clinician selects. Self-Pay does not submit a claim. OON Pay and Thrizer Pay submit a claim when the eligibility requirements are met. See [Which payment types are available?](/help/faq/which-payment-types-are-available) for how each payment type works.
## Failed payments
A charge requires a valid payment method. If your payment method fails, no payment is collected and no claim is submitted for that charge. Add or update a valid payment method before your clinician retries the charge.
Saved payment methods are cards used to pay session charges. A reimbursement bank account (used to receive reimbursement) cannot be used to pay charges. Completed charges cannot be reassigned to a different payment method after the fact. New cards apply to future charges only.
# Viewing payments and generating superbills
Source: https://docs.thrizer.com/help/client/payments-and-receipts
View your Thrizer payment history, filter and open payment details, and generate a superbill for HSA, FSA, records, or insurance reimbursement.
Your Payments page shows every session you have paid for through Thrizer. Use it to review your payment history and to download a superbill for your records or for reimbursement.
## Where to find it
Go to **Client Portal → Payments**.
## Payments list
The payments list shows:
* Transaction Date
* Clinician Name
* Appointment Date
* Charge Type
* Provider fee
* Charged Amount
To find a specific payment, you can:
* **Search** by clinician name.
* Open the **Filter Payments** popover to narrow the list by **Clinician**, **Date range**, or **Charge Type**. The Charge Type filter narrows to a specific payment type, such as OON Pay, Thrizer Pay, or Self-Pay. The Clinician filter is a multi-select. It includes any clinicians who appear in your Thrizer payment history, even if you are no longer connected to them. Filtering by transaction status is not available on the Client Portal.
## Payment details
Select a payment row to open payment details. The details view shows:
* Clinician
* Clinician Email
* Transaction Date
* Charge Type
* Payment Type
* Provider fee
* Charged Amount
* Processing Fee
* Net Charges
* Total Amount
* Appointment Date
* CPT Code
* Description
## Generate superbill
Use **Generate Superbill** on the Payments page to download a superbill you can keep for your records or submit for reimbursement. Whether you can generate a superbill depends on your payment type. For automatic claim payment options such as OON Pay and Thrizer Pay, Thrizer submits claims as part of the charge process, so you do not need a separate superbill.
**Generate Superbill** is disabled when no eligible appointment charges are in scope. For example, the button stays disabled when the filtered list contains no Self-Pay sessions.
The superbill's scope matches the filters currently applied to the Payments page. Adjust the filters first, then generate.
### Using a superbill for HSA or FSA reimbursement
If your HSA or FSA administrator needs documentation to substantiate a session payment, generate a superbill from **Client Portal → Payments → Generate Superbill** and submit it to your administrator. This applies to sessions paid with an HSA or FSA card as well.
Your plan administrator determines HSA or FSA reimbursement eligibility, not Thrizer.
# Profile and account settings
Source: https://docs.thrizer.com/help/client/profile-and-settings
View and edit your Thrizer client profile, manage account preferences from the Settings menu, update contact details, and request a password reset.
## Overview
Use Settings to manage your client account details, insurance, payment methods, and reimbursement bank information.
## Where to go
Go to:
**Client Portal → Settings**
The Settings menu includes:
* My profile
* Insurance plan
* Payment methods
* Reimbursement bank
## My profile
My profile shows:
* First Name
* Last Name
* Email
* Created At
You can edit:
* First Name
* Last Name
## Password reset
Select **Password Reset** on your profile to open a confirmation modal showing your account email. Select **Send Reset Email** to send the reset link, or **Cancel** to close the modal without sending.
## Email address
Your email address is visible in your profile. Thrizer accounts are email-bound, so the email address on an existing account cannot be edited.
## Your account and multiple clinicians
Your Thrizer client account is separate from any clinician or practice account. You can connect to more than one clinician or practice using the same client account. You do not need to create a new Thrizer account to work with a different clinician or practice.
See [Clinician connections](/help/client/clinician-connections) for how to accept and manage connections.
## Claim authorization
The Client Portal has a Claim Authorization screen at **Settings → Claim Authorization**. It shows your current authorization status, who signed it, the date signed, and the consent version.
From this screen you can:
* **Sign claim authorization.** Type your full name and confirm the checkbox to sign. Signing lets Thrizer submit out-of-network claims on your behalf when your clinician uses OON Pay or Thrizer Pay.
* **Revoke authorization.** Revoking stops Thrizer from submitting future claims on your behalf. Claims already submitted are not affected.
If you do not see this screen in your Settings menu, open it directly from the link your clinician or Thrizer support sends you.
## Related settings
Use the other Settings sections to:
* View or edit your insurance plan
* Add, view, set default, or delete payment methods
* Add, edit, or view your reimbursement bank account
# Adding a reimbursement bank account
Source: https://docs.thrizer.com/help/client/reimbursement-bank
Add or update the bank account Thrizer uses to deposit insurance reimbursements routed to you through OON Pay or superbill claims.
## Before you start
Use Reimbursement Bank to manage where Thrizer sends insurance reimbursements to you.
## Where to go
Go to:
**Client Portal → Settings → Reimbursement Bank**
## What you can do
The Reimbursement Bank page lets you:
* Add bank information
* Edit bank information
* Save changes
* Cancel edits
* View masked bank account details
## Bank fields
The form includes:
* Account Type
* Routing number
* Account Number
After you save the bank information, the page displays masked bank account details.
## Why this matters
For OON Pay sessions, reimbursement goes to you, so Thrizer needs a reimbursement bank account to send funds to you. Thrizer Pay reimbursements go to Thrizer because Thrizer advances part of the session fee, so a reimbursement bank is not required for Thrizer Pay sessions.
A reimbursement bank account is for receiving reimbursement only. It cannot be used to pay session charges. Session charges require a saved card under Payment Methods.
## Related articles
Add or manage the cards Thrizer uses to charge sessions.
Understand when reimbursement is sent to you and how estimates work.
See how reimbursement is sent to you when you pay the full session fee upfront.
See why Thrizer Pay reimbursements are sent to Thrizer rather than to your bank account.
# Troubleshooting and support
Source: https://docs.thrizer.com/help/client/troubleshooting-and-support
Get help with benefit-check failures, claim delays, payment issues, account changes, reimbursement bank setup, and support requests.
## What to do first
Use this guide for common client support issues.
## Benefit check does not work
A failed automated benefit check does not mean your plan has no coverage. It usually means Thrizer did not receive enough usable information from the insurer digitally.
Common reasons include:
* the insurance details not exactly matching insurer records
* behavioral health benefits being handled by a separate administrator
* the insurer not exposing out-of-network details digitally
* a recent coverage change
* the plan requiring manual phone verification
Manual verification may still confirm benefits. Support may ask for:
* Front of insurance card
* Back of insurance card
* Date of birth
If a benefit check cannot be completed through automated or manual verification, Thrizer cannot submit claims or use insurance-based payment for that plan. Self-Pay is still available.
For more on benefit-check outcomes and what manual verification can confirm, see [Manual benefit checks](/help/widget/manual-benefit-checks).
## Claim is still processing
Claims typically take 4–6 weeks to process. The insurance carrier controls actual processing time, and an "Approved" claim can either result in a reimbursement or apply to your deductible. For more on outcomes, see [Estimates and reimbursement](/help/client/estimates-and-reimbursement).
## Payment method issue
A successful charge requires a valid payment method. If a payment fails, Thrizer does not capture the payment or submit a claim. Add or update your payment method before retrying the charge. Completed charges cannot be moved to a different card after the fact.
## Refund requests
Thrizer does not initiate refunds. Your clinician issues refunds. Contact your clinician directly for refund requests.
## "I never received my payment"
This question can mean different things depending on who is asking. Before troubleshooting, identify which of the following applies:
* **Client reimbursement not received.** You are a client waiting on an out-of-network insurance reimbursement sent through Thrizer (OON Pay). See [Reimbursement balance or bank deposit questions](#reimbursement-balance-or-bank-deposit-questions) below.
* **Clinician payout not received.** You are a clinician or practice administrator waiting on a payout from Thrizer to your business bank account. Payouts follow the clinician payout schedule and are separate from insurance timing. See [Payments, payouts, and refunds](/help/clinician/payments-payouts-and-refunds) for clinician payouts and arrival timing.
* **Refund not received.** You are expecting a refund from a session your clinician refunded. Your clinician issues refunds, not Thrizer. Contact your clinician for refund status.
If you are unsure which category applies, email [help@thrizer.com](mailto:help@thrizer.com) and describe whether you are expecting a **reimbursement**, a **clinician payout**, or a **refund**.
## Reimbursement balance or bank deposit questions
Add a reimbursement bank account under **Settings → Reimbursement Bank**. If you have a balance and no bank on file, Thrizer holds the funds until you add one. A reimbursement bank cannot be used to pay session charges.
**Bank account added but no deposit yet?** Reimbursements generally deposit around 5 business days after you receive the notification that the reimbursement is on the way. Other reasons you may not see funds:
* The session was a **Thrizer Pay** charge. For Thrizer Pay sessions, reimbursement goes to Thrizer (because Thrizer advanced part of the session fee), so no deposit is expected to your bank account.
* The claim was processed but **applied to your deductible**. An approved claim does not always result in a reimbursement amount. See [Estimates and reimbursement](/help/client/estimates-and-reimbursement).
* The reimbursement bank account was added after the reimbursement was already on its way and needs to be triggered manually. If it has been more than 5 business days since you received the reimbursement notification, email [help@thrizer.com](mailto:help@thrizer.com) and support can take a closer look.
## Need to change your email
You cannot change your Thrizer account email address after creating the account. See [Profile and account settings](/help/client/profile-and-settings) for options.
## Can't find your Thrizer invitation email
If a clinician added you to Thrizer, they trigger an invitation email to the address they have on file for you. If you cannot find it:
* Search your inbox and your spam or junk folder for `Thrizer`, your clinician's name, your practice's name, or `Access your payment portal`.
* The message is sent from an automated Thrizer address (for example, `notifications@thrizer.com`). The exact sender address and subject line can vary.
* If you still cannot find it, sign in to the [Client Portal](https://client.thrizer.com/) using the same email address your clinician used to add you. A pending clinician connection appears there once you sign in.
* If none of that works, confirm the email address with your clinician. You can also ask them to use **Resend Invite** or **Send login link** from your row in their Clinician Portal. See [Clinician connections](/help/client/clinician-connections).
## Sign-in email from your clinician
Your clinician can email you a one-time sign-in link to the Thrizer Client Portal. Thrizer sends the email to the address your clinician has on file for you. If you do not see it, check spam, confirm the email address your clinician has for you, or use the standard sign-in page.
A sign-in link is not a password reset. To reset your password, use the sign-in page or ask your clinician to send a password reset.
## Need to delete your account
Thrizer does not offer self-service account deletion. Email [help@thrizer.com](mailto:help@thrizer.com) to request deletion.
## Need support
Thrizer support is email-based and does not offer phone support. Email [help@thrizer.com](mailto:help@thrizer.com) or use **Help → Request Help** inside the portal. Thrizer typically responds within 2 business days. Resolution time varies by issue.
# Adding and managing clients
Source: https://docs.thrizer.com/help/clinician/add-and-manage-clients
Add new clients to Thrizer, filter the client list, view client details, manage connections and invitations, and access client actions in the Clinician Portal.
## Overview
Use Clients to add clients and manage client relationships.
## Add a client
Go to:
**Clinician Portal → Clients**
Select **Add Client**. Adding a client sends an email invitation to that client.
You can also use **Invite Client** from Home.
## Client list
The Clients page shows:
* Client Name
* Clinician
* Payment Method
* Payment Type
* Status
## Client filters
Use the client list filters to narrow clients by:
* Status
* Payment Type
* Clinician
## Client actions
From the client list, use row actions to:
* Archive or unarchive a client
* Remove a client from your list
* Reassign a client to another clinician (practice admin)
## Client detail page
Open a client to view the client detail page:
**Clinician Portal → Clients → Client**
The client detail page includes:
* Profile
* Clinician
* Charging profile
Profile details include the client's name, email, client since date, diagnoses, and payment type. A separate **Payment Methods** view is available from the client detail page and lists each method's Type, Details, and Status.
## Client detail actions
From the client detail page, you can:
* Edit Profile
* Edit Clinician
* Edit Charging profile
* Add a payment method, remove one, or set one as default
Archive, unarchive, and remove a client from the client list row actions.
## Adding a new provider or clinician
"Provider" can mean a team member, an insurance payer, or a client-to-clinician connection. For the right path in each case, see [How do I add a new provider?](/help/faq/how-do-i-add-a-provider).
## Clients seen by more than one clinician in your practice
Within a team, a single client profile is assigned to one clinician at a time. If the same client sees more than one clinician in your practice, you have two options:
* Keep one client profile assigned to one clinician, and charge under that clinician when appropriate.
* Maintain a separate client profile or clinician connection for each clinician who sees the client. Separate profiles may appear as separate rows in the Clients list.
The client does not need to create multiple Thrizer accounts just because they see more than one clinician in your practice. Duplicate profiles do not merge into a shared client history. Each profile keeps its own records.
The selected clinician on a Charge must be the clinician who rendered the service, since claim submission, NPI attribution, and payout attribution follow the selected clinician.
## Diagnosis information
Insurance claims require a diagnosis on file. Open the client detail page and update the client's diagnosis in their Charging profile before creating an OON Pay or Thrizer Pay charge.
Self-Pay does not require a diagnosis and remains available regardless of the client's diagnosis status.
The Add Charge form gates insurance billing when no diagnosis is on file. For details on how it behaves and which codes are supported, see [Can I use a specific diagnosis code with Thrizer?](/help/claims/diagnosis-codes-and-thrizer).
## Related articles
See charge readiness checks, the Add Charge form, and payment-type selection.
Invite clinicians or staff to your practice from the Team roster.
Pick the right path when "provider" could mean a team member, payer, or client connection.
How clients accept an invitation and appear as a connected client in your list.
# Charging clients
Source: https://docs.thrizer.com/help/clinician/charge-clients
Create session charges in Thrizer, learn what charge details are required, and see how each charge triggers payment processing and out-of-network claims.
## Before you start
Use Add Charge to bill a client through Thrizer.
## Where to add a charge
You can add a charge from:
* **Clinician Portal → Home → Add Charge**
* **Clinician Portal → Clients → Add Charge**
* **Clinician Portal → Clients → Client detail → Add Charge**
## Charge fields
The charge form includes:
* Client
* Payment Method
* Amount
* Appointment Type
Client detail and charge forms can also include:
* Selected clinician
* Appointment date
* Location
* Service
* Duration
## Charge readiness
Before Add Charge will accept a charge, your account must be ready to bill. Add Charge is blocked when any of the following is true:
* **Business verification not approved.** Your practice's business verification status must be **Approved** before you can process any charge type. This applies to Self-Pay as well as OON Pay and Thrizer Pay. If your practice is **Incomplete** or **Pending review**, a Practice Administrator must submit KYB (Know Your Business) information from **Settings → Practice Settings**, then wait for approval. See [Business verification status](/help/clinician/settings-and-profile#business-verification-status) and [Why can't I charge my clients?](/help/faq/why-cant-i-charge-my-clients).
* **Clinician verification not in good standing.** Accounts that are pending administrator verification or suspended cannot process charges. Verified accounts can charge.
* **Missing attribution name.** The selected rendering clinician must have a first and last name on file so payouts and claims can be attributed.
If any of these conditions fail, Submit is disabled and the form shows an inline message explaining what to fix. Update business setup, profile, or contact support to resolve the block, then retry the charge.
### When Individual NPI is required
Individual NPI is only required when the charge bills insurance:
* **OON Pay and Thrizer Pay** require a valid Individual NPI on the rendering clinician. Without one, OON Pay and Thrizer Pay are disabled in Add Charge and the form falls back to Self-Pay.
* **Self-Pay** does not require an NPI. You can submit Self-Pay charges before an NPI has been entered.
## Charge amount limit
Charges submitted from the Clinician Portal are capped at a **session rate of \$2,500** by default. If the amount (or full rate, when set) on the form exceeds the cap:
* An inline error appears on the amount field.
* Submit is disabled until the amount is reduced to the cap or less.
If your practice regularly needs to charge more than \$2,500 per session, contact Thrizer support to request a higher cap for your practice (up to \$25,000). Once approved, the higher cap applies to every clinician on the team. A Thrizer administrator can still process individual one-off oversized charges on your behalf.
## If the client already paid you outside Thrizer
Add Charge is designed to collect a new payment from the client's payment method on file. If you have already collected payment for the session outside Thrizer, do not create a Thrizer charge for that session. Doing so would bill the client a second time.
If the goal is to submit an out-of-network claim for that session, generate a superbill PDF for the client. Go to **Clinician Portal → Transactions** and use **Generate Superbill**. The client can then submit that superbill to their insurer directly, or email it to [help@thrizer.com](mailto:help@thrizer.com).
* OON Pay and Thrizer Pay require the payment to be processed through Thrizer, so those options do not apply when payment happens outside Thrizer.
* Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on August 9, 2026.
See [Claims and superbills](/help/clinician/claims-and-superbills) for how to generate a superbill PDF for the client, and [Client claims and superbills](/help/client/claims-and-superbills) for what clients see today.
## Group practices
In a group practice, the selected clinician on the charge is the provider of record for claim data and payout attribution. The signed-in team member who creates the charge can be different from the selected clinician.
## What happens when a charge succeeds
For OON Pay and Thrizer Pay:
1. Thrizer charges the client payment method.
2. If payment succeeds, Thrizer submits the claim automatically.
3. You do not need to submit a separate manual claim for that charge.
If payment fails, Thrizer does not collect payment or submit a claim. Resolve the payment issue before retrying the charge.
## Date of Service and payment type
OON Pay and Thrizer Pay are only available when the Date of Service 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 must use Self-Pay.
In Add Charge:
* If you select a Date of Service more than one day ahead, OON Pay and Thrizer Pay are disabled in the payment type dropdown. The form switches to Self-Pay and a confirmation message appears.
* If you select OON Pay or Thrizer Pay without a Date of Service, or with a date more than one day ahead, Thrizer does not accept the charge.
* Self-Pay accepts any future Date of Service, so it remains the option for advance billing.
If you charge for tomorrow's session, Thrizer processes the payment but holds the claim until the Date of Service is no longer in the future. Thrizer submits the claim automatically once the session date arrives, so it never reaches insurance with a future date.
To bill insurance through Thrizer for a future session, wait until the day before or the day of the session, then create the charge.
## Charge types and limitations
Charges and claims must follow Thrizer's product constraints:
* One charge corresponds to one claim.
* Each charge supports one CPT code.
* A single charge cannot be split across multiple payment methods.
* No-show and cancellation fees are Self-Pay only and are not submitted to insurance through Thrizer.
* OON Pay and Thrizer Pay require a Date of Service that is today or tomorrow (calendar day, not a rolling 24 hours). Further-out sessions must use Self-Pay.
* The session rate on a charge cannot exceed your practice's session-rate cap (\$2,500 by default, or a higher cap approved for your practice by Thrizer, up to \$25,000).
# Checking client benefits
Source: https://docs.thrizer.com/help/clinician/check-benefits
Use Thrizer's benefit-check tools to estimate a client's out-of-network coverage, see what information is needed, and request manual verification.
## Before you start
Use benefit checks to estimate out-of-network benefits for a client.
## Where to check benefits
Benefit checking has two views, both set up together from **Clinician Portal → Benefits**:
* **Benefits Checker** — the clinician-facing name for the benefits-checking tool inside the Clinician Portal.
* **Thrizer Widget** — the public version of the same tool. A practice can share it as a Thrizer-hosted link or embed it on a website so prospective clients can run their own estimate.
Configuring one configures the other. They are not two separate products.
## Benefit-check inputs
A benefit check can ask for:
* Rate
* Service
* First name
* Last name
* Date of birth
* Insurance company
* Member ID
## What benefit checks support
Benefit checks help estimate:
* Whether benefit information is usable in Thrizer
* Deductible status
* Coinsurance
* Estimated reimbursement
* Estimated out-of-pocket responsibility
Benefit checks and reimbursement estimates help set expectations. Insurance carriers determine final coverage, reimbursement amounts, deductible application, claim approval, and processing time.
## Manual verification
A failed or incomplete automated check is not a coverage denial. When the automated check does not return enough information, manual verification may be needed. To request a manual benefit check, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com). The support team can ask for the front and back of the client's insurance card and the client's date of birth.
If a benefit check cannot be completed through automated or manual verification, Thrizer cannot support claim submission for that client and plan. Self-Pay remains available.
For the full list of common failure causes and what manual verification can confirm, see [Manual benefit checks](/help/widget/manual-benefit-checks).
## Rechecks and a met deductible
Automated eligibility rechecks often report the plan-level deductible remaining and do not reflect the out-of-network payments a client has already made. To avoid silently disabling Thrizer Pay for a client whose deductible is met, Thrizer preserves a previously recorded met deductible across automated rechecks within the same calendar year.
What this means in practice:
* **Same calendar year, recheck shows remaining > 0:** the recorded met value is preserved. Thrizer flags the discrepancy internally for review rather than overwriting the client's status.
* **New calendar year:** most OON plans reset on January 1. A recheck in the new year is allowed to reset the deductible to not met, matching the new plan-year expectation.
* **Payer or plan change:** switching a client to a different payer or plan invalidates the previous OON benefits snapshot. The next benefit check derives the deductible from the new plan, so a met deductible on the prior plan does not carry over.
If you believe a client's deductible status is wrong, email [help@thrizer.com](mailto:help@thrizer.com) to request a manual benefit check so the recorded value can be reviewed.
## Widget and benefit checks
The Thrizer Widget uses the same underlying benefit-check approach, configured with the practice's services and rates.
## Related articles
Learn what a benefit check estimates, what it cannot guarantee, and how to interpret results.
See when manual verification is needed, what information may be required, and what it can confirm.
Run an automated benefit check from the Clinician Portal.
Understand why an estimate may not match the insurer's final claim decision.
# Claims and superbills for clinicians
Source: https://docs.thrizer.com/help/clinician/claims-and-superbills
See how Thrizer submits out-of-network claims automatically after eligible OON Pay and Thrizer Pay charges, and how to generate Self-Pay superbills.
## Overview
Thrizer supports both automatic claim submission and superbill-based claim filing.
## 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.
## 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
## 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.
## Claim filters
Use claim filters for:
* Date range
* Charge type
* Payment type
* Clinician for group practices
## Client superbill uploads
Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on **August 9, 2026**. Superbills and claims already submitted are not affected. If you charge the client through OON Pay or Thrizer Pay, Thrizer continues to submit claims automatically on a successful charge. If a client has a superbill from a provider who is not on Thrizer, they can email it to [help@thrizer.com](mailto:help@thrizer.com). See [Claims and superbills](/help/client/claims-and-superbills).
## 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.
### 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.
#### 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.
#### 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**.
### 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 can email the PDF to [help@thrizer.com](mailto:help@thrizer.com). See [Claims and superbills](/help/client/claims-and-superbills).
## 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.
## 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 entity**: by default, a Thrizer-managed billing entity. Claims submitted through Thrizer use Thrizer's billing structure, including Thrizer's Tax ID and billing address, not your individual practice TIN or practice address.
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.
### 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, using 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, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com). Before you do, confirm your practice name, Tax ID, and group NPI are on file in **Practice Settings**. See [Settings and profile](/help/clinician/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. To resubmit an older claim under the corrected name, contact Thrizer support.
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.
Thrizer does not support supervising-provider NPI or dual provider representation (rendering and supervising) on standard claim submissions.
## Related articles
See how Add Charge selects the rendering clinician and triggers automatic claim submission.
Understand what Thrizer's claim process does and does not support.
# Getting started as a clinician
Source: https://docs.thrizer.com/help/clinician/getting-started
Set up your Thrizer clinician account, complete the key onboarding steps, and learn how to navigate the core areas of the Clinician Portal.
## Before you start
Thrizer helps clinicians and practices manage out-of-network benefit checks, client payments, automatic claim submission, payment records, payouts, and Widget setup.
## Main setup steps
Start with these items:
1. Complete account and profile setup.
2. Complete business and banking setup if you are a practice administrator.
3. Add clients.
4. Add or verify client insurance when using an insurance-based payment type.
5. Add diagnosis and service information needed for claims.
6. Add or confirm the client payment method.
7. Select the client's payment type.
8. Create a charge when ready.
Practice Administrators must submit business information and have it approved by Thrizer before the practice can charge clients. This applies to Self-Pay as well as OON Pay and Thrizer Pay. Your practice moves through **Incomplete → Pending review → Approved** (or **Rejected**), and only **Approved** practices can charge. If your Home checklist or **Business** step shows **Incomplete**, open the Business step, review your details, and submit for review. See [Business verification status](/help/clinician/settings-and-profile#business-verification-status) and [Why can't I charge my clients?](/help/faq/why-cant-i-charge-my-clients).
## Home
The Home page includes quick actions for practice administrators:
* Invite Client
* Invite Teammate
* Add Charge
Practice administrators also see a financial dashboard on Home with today's gross revenue, next payout, and gross revenue trend. Home also includes a welcome hero, stat cards, a volume chart, and a Learning and Resources section.
## Clients
Clients is the main workspace for client management. You can add clients, view the client list, filter clients, open client details, manage client connections, and add charges.
## Benefits
Benefits is the marketing dashboard for the Thrizer Widget. Practice administrators can manage the marketing page settings and profile picture. They can also open the Team page to invite team members who need a service and rate before appearing in the Widget.
## Transactions
Transactions includes:
* Payments — visible to all Clinician Portal roles
* Payouts — Practice Administrators only
Practice Administrators and Staff Members can filter the Payments tab by clinician and by any client in the practice. Clinicians see only their own connected clients, and their Client filter is limited to those connections. The payments summary cards above the table are Practice Administrator only.
## Settings and team
Settings includes the Profile tab (visible to all roles) plus Practice Settings and Banking & Payouts (Practice Administrators only). Every role can edit their own Individual NPI from Profile. The Team page lets practice administrators add team members.
# Clinician help
Source: https://docs.thrizer.com/help/clinician/index
Guides for clinicians and practice administrators on adding clients, checking benefits, charging sessions, managing payments and claims, and the Thrizer Widget.
## Start here
Use these guides to manage clinician and practice tasks in Thrizer.
Learn the core setup steps and main clinician pages.
Walk through the Clinician Portal in a short interactive demo before you set up your account.
Understand what Thrizer does, what it does not do, and how it fits into private-pay care.
Compare Thrizer with other out-of-network billing options before deciding how to use it.
Reusable client-facing language for consult calls, emails, and intake.
Add clients, filter the client list, view client details, and manage client connections.
Use benefit checking tools and understand manual verification.
Understand Self-Pay, OON Pay, Thrizer Pay, and when each option applies.
Create charges and understand how payment and claim submission are triggered.
View transactions, use filters, export records, review payouts, and issue refunds.
Understand automatic claims, client superbill uploads, and Self-Pay superbill generation.
Configure the Widget, manage services, share a link, and embed it on your website.
Review clinician Settings, edit profile details, and use password reset.
Share your referral link, or enter a referral code at onboarding, to waive up to \$2,500 in processing fees.
Add team members and understand role-gated team access.
Review hard product limitations and supported workarounds.
# Payment types and eligibility
Source: https://docs.thrizer.com/help/clinician/payment-types-and-eligibility
Understand Self-Pay, OON Pay, and Thrizer Pay, the fees attached to each, and the eligibility rules that decide which payment type a client can use.
## Overview
Thrizer supports three payment types: **Self-Pay**, **OON Pay**, and **Thrizer Pay**.
## 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.
## 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 after the client's deductible is met. Before the deductible is met, 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.
## 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 at the time of session.
* 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.
## 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 also not currently available for clients on **Anthem BCBS, Carelon, NYSHIP, or Wellpoint** plans. Elevance Health now reimburses these plans by paper check directly to the client. Charge as usual. Thrizer still submits the claim, and the 5% Thrizer Pay and 1% OON Pay fees do not apply to affected claims. See [Elevance Health reimbursement changes](/help/claims/elevance-health-reimbursement).
For a client-friendly explanation of why Thrizer Pay may not appear as an option, share [Why Thrizer Pay may not be available](/help/faq/why-thrizer-pay-may-not-be-available).
## 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.
## 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](/help/clinician/charge-clients) for the inline messages shown when a charge is blocked.
## Charge amount limit
Charges submitted from the Clinician Portal are capped at a session rate of \$2,500. Larger transactions require prior approval. Contact Thrizer support so a Thrizer administrator can review and process the charge.
## Clinician processing fee
Payment transactions processed through Thrizer carry the clinician card-processing fee defined by Thrizer's pricing rules.
## How eligibility and pricing interact
Eligibility rules determine which payment types are available. Pricing rules determine fees after eligibility is established.
# Payments, payouts, and refunds
Source: https://docs.thrizer.com/help/clinician/payments-payouts-and-refunds
Review client payments, export transactions, track payout timing to your bank account, and issue refunds from the Thrizer Clinician Portal.
## Overview
Use Transactions and client payment views to review payment activity, exports, payouts, and refunds. What you see in the Transactions hub depends on your role.
Your practice must have an **Approved** business verification status before you can charge clients or generate payouts. If your practice is **Incomplete** or **Pending review**, a Practice Administrator can submit KYB information from **Settings → Practice Settings**. See [Business verification status](/help/clinician/settings-and-profile#business-verification-status) and [Why can't I charge my clients?](/help/faq/why-cant-i-charge-my-clients).
## Transactions
Go to:
**Clinician Portal → Transactions**
Transactions includes:
* **Payments** — visible to all Clinician Portal roles
* **Payouts** — Practice Administrators only. Staff Members and Clinicians do not see the tab, and deep links to `?tab=payouts` redirect back to Payments.
### What each role sees
| Element | Practice Administrator | Staff Member | Clinician |
| --------------------------- | -------------------------- | -------------------------- | -------------------------------- |
| Payments tab | Yes — facility-wide | Yes — facility-wide | Yes — own clients only |
| Payouts tab | Yes | No | No |
| Payments summary cards | Yes | No | No |
| Clinician column and filter | Yes | Yes | No |
| Client filter | Yes — all practice clients | Yes — all practice clients | Yes — own connected clients only |
### Filters
The Payments tab supports these filters, where the role allows:
* **Client** — available to every role. Clinicians see only the clients they are connected to; Practice Administrators and Staff Members see all clients in the practice.
* **Clinician** — Practice Administrator and Staff Member roles only. Multi-select. The picker includes former or disconnected clinicians who appear in your transaction history, so historical activity stays filterable even after a clinician leaves the practice.
* **Date range** — narrow by transaction date.
* **Status** — filter by transaction status.
* **Charge Type** — filter by the type of charge on the transaction.
* **Billing Type** — filter by billing type (for example, OON Pay, Thrizer Pay, or Self-Pay).
## Client payment details
To review a client's transactions, open the Payments tab and filter by that client. Payment details can include:
* Transaction ID
* Transaction date
* Charge Type
* Payout date
* Clinician
* Client
* Appointment date
* Gross amount
* Processing fee
* Net amount
* Billing Type (for example, OON Pay, Thrizer Pay, or Self-Pay)
* Client paid
* Payment status
* Refund status
The transactions list shows **Charge Type** as a column. The **Billing Type** filter narrows the list to a specific payment type.
## Exports
Use exports from payment or transaction views to download payment records for bookkeeping, tax preparation, reconciliation, and payment review. The export modal summarizes the active filters, and the CSV header matches the on-screen column names.
Three exports are available in the Clinician Portal:
* **Filtered payments export** — from the **Transactions → Payments** tab, download every transaction that matches the currently applied filters. Available to all Clinician Portal roles: Practice Administrators, Team Owners, Staff Members, and Clinicians. The CSV respects what your role can see on the Payments grid, so Clinicians export their own client rows and Staff Members export facility-wide rows. Use this when you want a custom slice of activity, such as a specific client or clinician.
* **Client profile payments export** — from a client's profile **Payments** view, download that client's payments only, still limited to what your role can see. Available to the same roles as the filtered payments export.
* **Per-payout export** — from the **Transactions → Payouts** tab (Practice Administrators and Team Owners only), each row in the payouts summary table has an export action. It downloads a CSV of just the transactions included in that payout week. Use this to reconcile a single payout deposit against the transactions it paid out.
All three exports use the same columns, so a per-payout CSV can be compared directly against a filtered payments CSV without column mapping. Exported files are named `transactions-payout-.csv` for per-payout exports.
For 1099-K tax forms issued by Thrizer, see [1099-K tax forms from Thrizer](/help/faq/1099-k-tax-forms).
## Refunds
If you are a clinician or practice administrator, you can issue refunds from payment or transaction details. A refund creates a refund transaction record.
A refund you initiate can reverse the refunded transaction amount from your payout. This is separate from insurance-related claim outcomes. See [Clinician payout protection and clawbacks](/help/payments/clinician-payout-protection) for more.
### Thrizer Pay refunds are full-refund only
Refunds on Thrizer Pay transactions must be issued for the full charged amount. Partial refunds are not supported for Thrizer Pay.
When you open the refund drawer for a Thrizer Pay transaction:
* There is no amount field to edit. Thrizer refunds the full charge.
* The client's card is refunded the copay portion that was originally charged. If the client was not charged a copay (for example, insurance was expected to cover the full session), nothing is refunded to their card.
* Your payout is reduced by the gross bill amount for the session, so the associated Thrizer Pay claim is canceled cleanly. See [Clinician payout protection and clawbacks](/help/payments/clinician-payout-protection#the-main-exception-clinician-initiated-refunds).
If you need to adjust a Thrizer Pay charge for a smaller amount rather than reverse it entirely, contact [help@thrizer.com](mailto:help@thrizer.com) instead of issuing a partial refund.
If the refund drawer is disabled for a Thrizer Pay transaction, it usually means the underlying bill amount is missing and Thrizer cannot calculate the payout clawback. Contact support before retrying.
OON Pay and other transaction types still support partial refunds from the same drawer.
### Refunds and claim cancellation
When you refund (or successfully cancel) a charge, Thrizer also cancels the associated OON Pay or Thrizer Pay claim at the same time. You do not need to cancel the claim separately.
Common examples:
* **Duplicate charge.** If you accidentally charged the same session twice, refund the duplicate charge from the Clinician Portal. Thrizer cancels the duplicate claim automatically when the refund completes.
* **Wrong client or wrong amount.** Refund the charge. Thrizer cancels the associated claim at the same time.
If you cannot refund or cancel the charge directly from the Clinician Portal, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com). For example, this can happen when the claim has already been submitted and you cannot edit it. See [How do I cancel a charge or a claim?](/help/claims/claim-and-billing-limitations#how-do-i-cancel-a-charge-or-a-claim) for more detail.
For claim-level edits after submission (wrong CPT, wrong diagnosis, denied claim), see [Claim and billing limitations](/help/claims/claim-and-billing-limitations#can-i-correct-the-wrong-cpt-code-or-other-claim-detail-after-submission).
## Payouts
Payouts is a Practice Administrator-only view. Each payout row shows Payout Date, Amount, and Status, and has an Export CSV action for the transactions in that payout. Thrizer's payout schedule determines payout timing. Claim status and insurer reimbursement timing do not affect when Thrizer initiates your payouts.
Thrizer does not claw back clinician payouts because of insurer claim outcomes such as denials, deductible application, or lower-than-expected reimbursement. See [Clinician payout protection and clawbacks](/help/payments/clinician-payout-protection).
### When payouts arrive in your bank account
The day a payout is **initiated** is not the same as the day funds **arrive** in your connected bank account.
* Thrizer initiates payouts on the scheduled payout day.
* After initiation, funds are expected to arrive in the connected bank account within **0–1 business days**.
* In practice, most payouts arrive the next business day after they are initiated.
* A payout initiated on Friday will usually arrive the next business day, not necessarily on Friday.
* Weekends, bank holidays, bank processing delays, or issues with the connected payout account can delay actual arrival.
If Thrizer initiated a payout but funds have not arrived after 1–2 business days, check the connected bank account details. Contact support if the issue continues.
# Referral program: share a link and redeem a code
Source: https://docs.thrizer.com/help/clinician/referral-program
Learn how to share your Thrizer referral link and how new clinicians enter a referral code to receive $2,500 in waived processing fees.
## Overview
The Thrizer referral program waives **\$2,500 in payment processing fees** for both sides of a referral:
* The **new clinician** who signs up with a valid referral code gets the 3% processing fee waived on up to \$2,500 of transaction volume.
* The **referring clinician** gets the same waiver on up to \$2,500 of transaction volume for each clinician they refer.
If you are already on Thrizer and want to refer someone, see [Share your referral link](#share-your-referral-link). If you are a new clinician signing up, see [How to enter a referral code at onboarding](#how-to-enter-a-referral-code-at-onboarding).
## Share your referral link
Existing clinicians and practice administrators can share their referral invite from the Clinician Portal.
1. Sign in to the Clinician Portal.
2. Go to the **Referral** section.
3. Use one of the available actions to share your invite:
* **Share signup code** — copy the referral code for a new clinician to enter manually during onboarding.
* **Share link** — copy a referral link that prefills the code when the new clinician starts sign-up.
* **Email invite to colleague** — send the referral by email from Thrizer.
4. Track your remaining waived balance from the same section.
Your referrer credit activates only after the clinician you referred submits their first charge. The waiver then applies to your own 3% processing fee, on up to \$2,500 of processed transaction volume for that referral. See [Pricing overview](/help/payments/pricing-overview) for how the referrer benefit interacts with standard fees.
You can share your referral link and mention Thrizer freely. For the use of Thrizer logos or branded assets, contact support first.
## How to enter a referral code at onboarding
There are two ways a referral code can be applied during sign-up:
1. **Referral link.** If you started sign-up from a referral link shared by another clinician, the referral code is prefilled on the referral step of onboarding. Leave it as is and continue.
2. **Manual entry.** If you signed up without a link, enter the referral code on the referral step during onboarding.
Referral code matching is case-insensitive, so `ABC123` and `abc123` are treated as the same code.
You must enter the code **during onboarding**. Referral credits cannot be added retroactively after onboarding is complete.
## What you receive
If your referral code is valid when you finish onboarding, your team is automatically granted:
* **\$2,500 in waived payment processing fees.** Thrizer waives the standard 3% clinician processing fee on up to \$2,500 in transaction volume processed through Thrizer.
The credit is applied to your team's remaining waived balance and is consumed on a per-charge basis as you process payments. See [Pricing overview](/help/payments/pricing-overview) for how the 3% clinician processing fee normally works.
## When a referral code is accepted
For the credit to be granted, all of the following must be true at the moment you complete onboarding:
* The referral code exists.
* The referral code is active.
* The referral code has not expired.
* The referral code is under its maximum-uses cap.
* You are not entering your own referral code (self-referrals are not allowed).
* You have not previously redeemed a referral code on this account. Each clinician can redeem only one referral code, ever.
If any of these conditions are not met, onboarding still completes successfully, but no waived-fee credit is granted.
## The credit is granted only once
The waived-fee credit is granted exactly once. If you submit the onboarding step more than once (for example, by refreshing or selecting submit twice), the credit is not applied a second time. Your balance is not double-counted.
## How the credit is used
The \$2,500 waived-fee credit is applied per charge as you process client payments through Thrizer:
* For each Thrizer-processed payment, if the charge amount fits within your remaining waived balance, the 3% clinician processing fee is waived for that charge.
* If a single charge exceeds your remaining waived balance, the waiver is **not** partially applied. The full 3% fee is charged on that charge.
* Once the \$2,500 balance is fully consumed, standard pricing resumes.
See [Pricing overview](/help/payments/pricing-overview) for the standard fee structure that resumes after the waiver is used up.
## Limitations
* The waiver applies only to the 3% clinician payment processing fee. Other fees, including client-facing fees on OON Pay and Thrizer Pay, are unchanged.
* The waiver applies only to payments processed through Thrizer. Superbill-only claim submissions do not consume or benefit from the waiver.
* A clinician can redeem at most one referral code, ever.
* Referral credits cannot be added after onboarding is complete.
## Related articles
Review the standard client and clinician fees, including the 3% processing fee the referral waiver reduces.
Walk through the main clinician onboarding and setup steps.
See how processed payments and payouts appear in the Clinician Portal.
Find the clinician sign-up and dashboard URLs.
# Settings and profile
Source: https://docs.thrizer.com/help/clinician/settings-and-profile
Manage your Clinician Portal profile and Individual NPI, and see which Settings tabs Practice Administrators, Staff Members, and Clinicians can use.
## Overview
Use Settings to review and manage account-level information in the Clinician Portal. The tabs you see depend on your role.
## Where to go
Go to:
**Clinician Portal → Settings**
## Tab visibility by role
| Tab | Practice Administrator | Staff Member | Clinician |
| ----------------- | ---------------------- | ------------ | --------- |
| Profile | Yes | Yes | Yes |
| Practice Settings | Yes | No | No |
| Banking & Payouts | Yes | No | No |
If a Staff Member or Clinician opens a deep link to **Practice Settings** or **Banking & Payouts** (for example `?tab=banking`), the page redirects back to **Profile**.
## Profile
Go to:
**Clinician Portal → Settings → Profile**
The Profile tab is available to every Clinician Portal role and includes:
* First name and last name
* Display name
* Email
* **Individual NPI** — your personal 10-digit National Provider Identifier from CMS, required for insurance claim submissions
The editable rows (First name, Last name, Display name, and Individual NPI) each have their own **Edit** action that opens a modal. Practice Administrators, Staff Members, and Clinicians can all edit their own Individual NPI from Profile.
Your account email is shown for reference but cannot be edited. Thrizer accounts are email-bound, so the sign-in email on an existing account stays the same. If you need to use a different email, create a new account with that address. Where a team-member setup applies, you can also add the new email as a team member on the practice.
From Profile you can also **reset your password**. Select **Password Reset** to open a confirmation modal showing your account email, then select **Send Reset Email** to send the reset link.
## Practice Settings
Practice Administrators only. Combines business and practice identifiers, including the W-9 / KYB (Know Your Business) fields, the practice's **group NPI** (Type-2 NPI), and the practice's **Business address**. Staff Members and Clinicians can ask a practice administrator to update these values.
The group NPI is optional. It's used only when a payer is set to submit claims under your practice instead of Thrizer or the individual clinician. If your practice has a Type-2 group NPI, add it here. Thrizer then uses it as the billing NPI, and your practice name as the billing name, on those claims. If the group NPI is missing, Thrizer falls back to the rendering clinician's Individual NPI as the billing NPI. It also uses the rendering clinician's full name as the billing name. See [Claims and superbills](/help/clinician/claims-and-superbills) for how billing identity appears on claims.
### Missing practice address banner
If your practice is approved on Thrizer but the **Business address** on your Practice Settings is missing or incomplete, Practice Administrators see a yellow **Re-enter your practice address** banner. It appears across the top of every page in the Clinician Portal. Staff Members and Clinicians do not see the banner. Only a Practice Administrator can resolve it.
Why it appears:
* Thrizer needs a complete practice business address to submit out-of-network claims on your behalf. A structured address requires a street, city, state, and ZIP.
* The banner also appears if a data update cleared a partially-filled or unusable address that was previously on file.
The banner does not block charging clients, but insurance claim submission depends on a usable address.
How to resolve it:
1. Select **Add address** on the banner. This opens **Settings → Practice Settings** with the **Business address** editor already open (deep link `?tab=practice&edit=businessAddress`).
2. Enter your full practice business address (street, city, state, and ZIP) and save.
3. The banner clears once a complete address is on file.
### Mailing address (optional)
Practice Settings also has an optional **Mailing Address** field, separate from your **Business Address**.
* If you fill in **Mailing Address** with a complete street, city, state, and ZIP, Thrizer uses it as the practice address on **new claims**. Payers use the practice address on a claim for paper correspondence, denials, and paper checks.
* If **Mailing Address** is blank or incomplete, Thrizer uses your **Business Address** on new claims, exactly as before.
* Your legal **Business Address** stays on file for tax forms in either case.
Use Mailing Address if you want claim correspondence to go somewhere different from your legal business address, such as a PO Box or a billing office. Leave it blank if you want claims to keep using your Business Address.
Claims created before you added or changed a Mailing Address keep the address they were originally stamped with. Only new claims (and claims that are recreated) reflect the update.
### Business verification status
Every practice has a business verification status that gates whether the practice can charge clients. You can see the current status on the Home checklist and on the Business step in the Clinician Portal.
| Status | What it means | Can charge clients? |
| ------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ------------------- |
| **Incomplete** | Business information is missing or has not been submitted for review. New practices start here, along with a small group of legacy practices whose verification was never completed. | No |
| **Pending review** | You have submitted your business information and Thrizer is reviewing it. KYB fields are locked while under review. | No |
| **Approved** | Thrizer has verified your business details. | Yes |
| **Rejected** | Thrizer reviewed your submission and could not approve it. Contact [help@thrizer.com](mailto:help@thrizer.com) to resolve. | No |
Practice Administrators can move an **Incomplete** practice forward without contacting support:
1. Open **Practice Settings** in the Clinician Portal.
2. Fill in every required KYB field (business name, TIN, business address, and any other required fields).
3. Select **Submit for review**.
Submitting moves the practice into **Pending review**. Thrizer will move you to **Approved** or **Rejected** once the review is complete.
A **Rejected** practice can still edit its KYB fields, but Thrizer support handles resubmission rather than the portal.
## Banking & Payouts
Practice Administrators only. Manage the bank account that receives Thrizer payouts and review payout-related practice details. Staff Members and Clinicians do not see this tab.
Each team has one payout bank account. Thrizer does not support multiple payout bank accounts within a single team, sending payouts to different accounts per clinician, or automated revenue splits between clinicians. Practices that need to divide funds between clinicians handle that distribution outside Thrizer.
## Who can change these settings
Profile is available to all Clinician Portal roles. Practice Settings and Banking & Payouts are restricted to Practice Administrators. Staff Members and Clinicians who need a change to either area should contact a practice administrator.
# Team members
Source: https://docs.thrizer.com/help/clinician/team-members
Add team members, understand Team Owner, Practice Administrator, Staff Member, and Clinician roles, and manage a Thrizer practice team.
## Overview
Practice administrators can add and manage team members.
## Where to go
Team member options appear in:
* **Clinician Portal → Team**
* **Clinician Portal → Home → Invite Teammate**
The Benefits page (marketing dashboard) also links to team-member setup so it can invite a clinician who needs a service and rate before appearing in the Widget.
## Using the same email across multiple teams
An email address can be associated with only one Thrizer team at a time. If you try to invite someone whose email is already on another Thrizer team, that invite will not go through. To add them to your team, they need to use a different email, or contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com) to review options.
Team role controls (Practice Role, Role, Change Role) manage a person's permissions within your team. They do not convert an account from one type to another and do not move an account between teams.
## Add a team member
Go to:
**Clinician Portal → Team**
Use **Add Team Member** to open the invitation modal.
The invitation includes:
* Email
* Role
The roles available in the invitation modal depend on your own permissions. The **Team Owner** role can only be assigned by an existing Team Owner. See [Clinician Portal roles](#clinician-portal-roles) for what each role can do.
## Find a team member
The Team page shows each team member's name, email, role, and status. To locate someone quickly:
* **Search** by name or email.
* Use the status filter (**All**, **Active**, **Invited**, or **Disabled**) to narrow the list.
## Manage existing team members
Practice administrators can act on a team member from the Team roster. The available row actions depend on the member's current status.
* **Change Role.** Update the member's role. The roles available depend on your own permissions.
* **Resend Invite.** Resend the original invitation email. Available while the member is in **Invited** status.
* **Remove Member.** Remove someone from the team. The confirmation screen shows the impact and lets you reassign their clients before removal.
* **Reactivate Member.** Restore a member in **Disabled** status. Reactivating re-adds them to the team and sends a new invitation email.
## Clinician Portal roles
The Clinician Portal has these roles:
* **Team Owner** — one designated owner per practice with ultimate authority over the team. A Team Owner can do everything a Practice Administrator can, plus assign or remove the Team Owner role. For rollout details and how the initial owner was chosen for existing practices, see the [July 17, 2026 release notes](/help/changelog/2026-07-17).
* **Practice Administrator** — full access. Sees Practice Settings and Banking & Payouts in Settings, the Payouts tab in Transactions, and the payments summary cards. Can invite team members and manage practice-level configuration.
* **Staff Member** — practice-wide visibility into clients, charges, and the Payments tab, including the clinician and client filters. Staff Members do not see Payouts, the payments summary cards, Practice Settings, or Banking & Payouts.
* **Clinician** — sees only their own connected clients, charges, and payments. The Transactions hub Client filter is scoped to the clinician's own connected clients.
If your practice has multiple members and no Team Owner is assigned yet, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com) to designate one.
## Widget connection
Team member setup also affects the Thrizer Widget. At least one active team member needs a service and rate before the Widget can be used for prospective client benefit checks.
## Who can manage team members
Team management is practice-admin functionality. Staff Members and Clinicians without practice-admin access should ask a practice administrator to invite or update team members or to change practice-level settings.
## I do not see the Team roster or expected controls
The Team roster and full Widget/Benefits controls are visible to practice administrators. Staff Members and Clinicians have more limited access.
If you are a practice administrator and the Team roster or another expected control is missing, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com) with:
* your practice email
* your role
* a screenshot of the page where controls are missing
* the URL or page name in the Clinician Portal
## How do I add a clinician to the Benefits Checker?
Add the clinician as a team member from **Clinician Portal → Team → Add Team Member**, then confirm the clinician has an active service and rate. At least one active team member with a service and rate is required for the Widget and Benefits Checker to function.
See also [Thrizer Widget](/help/clinician/thrizer-widget) for Widget setup requirements.
# Thrizer Widget
Source: https://docs.thrizer.com/help/clinician/thrizer-widget
Configure the Thrizer Widget, manage services and team members, share your unique widget link, and embed the out-of-network benefits calculator on your website.
## Overview
The Thrizer Widget lets prospective clients check estimated out-of-network benefits and costs using your practice's configured services and rates.
## Where to go
Go to:
**Clinician Portal → Benefits**
The Benefits page shows the Thrizer Widget: a live client-facing preview, embed code, and shareable link. Team roster and page appearance are managed from **Widget settings** through the Team and Appearance tabs.
Widget settings are managed by practice administrators and practice staff. Clinicians see a preview only. If you need to make widget or roster changes, ask a practice administrator on your account, or ask them to update your role.
## Widget setup requirements
The Widget requires at least one active team member with a service and rate who is set to **Shown** in Widget settings. Those services and rates determine what prospective clients can select in the public benefits calculator.
## Widget setup checklist
When your widget is not ready to publish, the Benefits page replaces the live preview with a **Finish setting up your benefits widget** card. The card carries an **Action required** badge, highlights what is missing, and gives you a direct action to fix it.
The card shows three states:
| State | What it means | Next step |
| ------------------------------- | ------------------------------------------------------------------------------------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------- |
| No services added | No team member has a publishable service and rate yet. | Use **Add services** to open Widget settings on the Team tab and add a service to a team member. A secondary **Customize** action opens the Appearance tab. |
| All team members hidden | At least one team member has services, but no one is set to **Shown** in the widget. | Use **Manage Team** to open Widget settings and turn on **Show in widget** for a team member. |
| No active clinician on the team | Your practice does not have an active clinician who can be published. | Contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com) if you believe this is an error. |
For a solo team, the relevant team member's drawer opens automatically when you select **Add services** or **Manage Team**. For multi-clinician teams, Widget settings opens on the Team tab so you can select which member to update.
Once at least one team member with services is visible on the widget, the card disappears and the live preview returns.
## What practice administrators can manage
Practice administrators can manage:
* Widget domain
* Page settings
* Profile picture
* Team member setup
* Services and rates
* Page appearance
## Do I have to upload clients, or can I just use the Benefits Checker / Widget?
You do not have to add clients before using the Widget. The Thrizer Widget (Benefits Checker) is designed for **prospective** clients. They can run an out-of-network benefit check on your practice's public benefits page before they become a Thrizer client.
* **No client upload required** to use the Benefits Checker on prospective clients.
* **Adding a client** (invitation) is required later when you want to charge them, submit claims, or use OON Pay / Thrizer Pay.
## How do I add a clinician to the Benefits Checker?
Team members and the Benefits Checker share the same Team roster.
1. Go to **Clinician Portal → Team** and use **Add Team Member** to invite the clinician. See [Team members](/help/clinician/team-members).
2. Configure a service and rate for that clinician so they appear in the Widget's calculator. At least one active team member with a service and rate is required for the Widget.
3. If the Team roster on **Clinician Portal → Benefits** does not immediately reflect the new team member, refresh the page. If they still do not appear after a short wait, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com).
## I do not see the Team roster or expected Widget controls
Widget and Team controls are practice-administrator functionality. If you are the practice administrator and cannot see the expected controls on **Clinician Portal → Benefits** or **Clinician Portal → Team**, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com) with:
* your practice email address
* your role in the practice
* a screenshot of the page where controls are missing
* the URL / page name (for example, Benefits page or Team page)
If you have the **Staff Member** or **Clinician** role, you generally do not see team-management controls. In that case, ask your practice administrator to invite or update team members.
## Widget actions
From **Clinician Portal → Benefits**, practice administrators can:
* Edit marketing page settings
* Manage the profile picture shown on the marketing page
* Open the Team page's invite modal to add a team member
## Sharing the Widget
The Widget supports two formats:
* `iframe`
* `standalone`
Use the iframe option to embed the Widget on a website. Use the standalone option to share a Thrizer-hosted benefit-check page.
## Who can see and configure the Widget?
Practice administrators can see and manage every Widget and Benefits Checker control described above. That includes the Widget domain, page settings, profile picture, team member setup, services and rates, page appearance, Team roster, and the Instant Benefit Checker.
If you are a practice administrator and cannot see expected Widget or Benefits controls, contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com) with the details below. For example, the Team roster may be missing or the Widget may appear read-only.
* your practice email
* your role
* a screenshot of what you are seeing
* the page in the Clinician Portal where controls are missing
Staff Members and Clinicians have more limited access to team and payout-related tools. See [Team members](/help/clinician/team-members) and [Payments, payouts, and refunds](/help/clinician/payments-payouts-and-refunds) for the role breakdown.
## Do I need to upload clients to use the Benefits Checker?
No. The Thrizer Widget and Instant Benefit Checker can be used to check estimated out-of-network benefits without adding those individuals as Thrizer clients first. Adding a client is only required when you want to charge sessions or submit claims through Thrizer for that client.
## Public widget behavior
The public Widget shows the out-of-network benefits calculator for the specified practice or team. If the Widget is inactive, the public page shows an inactive message. If the link is wrong or points to a Widget that no longer exists, the public page shows a not-found message instead. Double-check the link you shared, or open **Clinician Portal → Benefits** to copy the current one.
Benefit checks and reimbursement estimates help set expectations. Insurance carriers determine final coverage, reimbursement amounts, deductible application, claim approval, and processing time.
# Unsupported workflows and limitations
Source: https://docs.thrizer.com/help/clinician/unsupported-workflows
Understand Thrizer product limitations around charges, claims, payment methods, account changes, team payouts, and insurance processes.
## Overview
This page summarizes what Thrizer does not support.
## Payment limitations
Thrizer does not support:
* Splitting one session charge across multiple payment methods
* Reassigning a completed charge to a different payment method
* Automatically retrying failed charges
* Direct ACH or bank-account payment for session charges (charges require a saved card)
* Submitting a charge from the Clinician Portal with a session rate above \$2,500
If a payment fails, the charge fails and no claim is submitted. Add or update the client payment method before retrying.
Charges above the \$2,500 session-rate cap require prior review. Contact Thrizer support so a Thrizer administrator can process the charge on your behalf. See [Charging clients](/help/clinician/charge-clients#charge-amount-limit) for details.
## Claim and billing limitations
Thrizer does not support:
* Combining multiple charges into one claim
* Combining unrelated CPT services into one claim
* Submitting no-show or cancellation fees to insurance
* Applying Thrizer Pay retroactively to past sessions
* Billing insurance for sessions more than one calendar day ahead (OON Pay and Thrizer Pay require a Date of Service of today or tomorrow UTC)
Each charge corresponds to one claim. Each charge supports one primary CPT code; add-on or extension units of the same underlying service may be included with the primary code.
For full claim and billing limitations, see [Claim and billing limitations](/help/claims/claim-and-billing-limitations).
## Insurance limitations
Thrizer supports primary insurance only. Secondary insurance and coordination of benefits are not supported.
## Account limitations
Thrizer account email addresses cannot be edited after account creation.
Client and clinician accounts are separate account types. They cannot be merged, converted, or repurposed into each other. You can use the same email address to create both a client account and a clinician account, but the two accounts remain fully separate. Data, history, and connections do not transfer between them.
Team and practice role controls (such as Practice Role or Change Role) manage permissions within an account. They do not convert an account from one type to another.
An email address can be associated with only one Thrizer team at a time. If you need the same person on more than one team, use a separate email or contact support.
Thrizer does not offer self-service account deletion. Send deletion requests to support.
## Team payout limitations
A team has one payout bank account. Thrizer does not automatically split payouts between clinicians within a team.
## Thrizer's role and failed payments
Thrizer works like a payment processor. Thrizer processes supported charges, sends payouts, and submits claims where the payment type supports claim submission.
Thrizer does not act as a collections service. You are responsible for collecting and maintaining valid client payment methods, and for following up with the client when a charge fails. Thrizer does not automatically retry failed charges.
## Workarounds
Some operational workarounds require support review. Workarounds do not change the underlying product limitation and do not guarantee insurer acceptance, reimbursement, or claim approval.
# 1099-K tax forms from Thrizer
Source: https://docs.thrizer.com/help/faq/1099-k-tax-forms
How clinicians request a 1099-K tax form from Thrizer, which payer TIN to use when filing, and why this TIN may differ from the one on insurance claims.
## Overview
Thrizer issues **1099-K** forms to clinicians for payments processed through the platform. Thrizer support handles 1099-K requests manually. Email [help@thrizer.com](mailto:help@thrizer.com) from the practice email associated with your Thrizer account.
Thrizer does not issue K-1 forms or other tax forms.
## How to request your 1099-K
Email [help@thrizer.com](mailto:help@thrizer.com) with:
* The **practice email** associated with your Thrizer account.
* The **tax year** you need. If you do not specify a year, support will assume the current tax year.
Fulfillment follows standard support response timelines.
## Team Owner is required
Your practice needs a **Team Owner** assigned before Thrizer can generate a 1099-K. The Team Owner is the person named as the payee on the form. If your practice has more than one administrator, Thrizer does not pick a payee for you. The 1099-K is held until you assign a Team Owner.
To assign one, open **Clinician Portal → Team**, select **Change Role** on the person who should be the payee, and select **Team Owner**. See [Team members](/help/clinician/team-members).
## Which tax ID to use when filing
When completing tax filings with a 1099-K issued by Thrizer, the **payer TIN** is Thrizer's TIN:
**863015188**
## What to know
* 1099-K issuance is the **tax reporting** use of Thrizer's TIN. The Tax ID that appears on insurance **claims** depends on your billing configuration and may differ. Do not assume the same TIN applies to both contexts.
* Thrizer cannot provide tax advice. For questions about how to file, consult a tax professional.
* For payment and fee detail you may need at tax time, see [Payments, payouts, and refunds](/help/clinician/payments-payouts-and-refunds). Transaction exports include gross amount, processing fee, and net amount per transaction.
## Related articles
Review transactions and export payment records for bookkeeping and tax preparation.
See how processing fees are applied across Self-Pay, OON Pay, and Thrizer Pay.
Find support, dashboards, and legal documents.
# How do I add a new provider?
Source: https://docs.thrizer.com/help/faq/how-do-i-add-a-provider
Disambiguate what a client, clinician, or practice administrator means when they say "add a new provider" in Thrizer, and find the right path.
## Overview
"Add a new provider" is ambiguous in Thrizer. Depending on who is asking, it usually means one of three different things:
* **Add a clinician or team member to a practice** (practice-admin action).
* **Update the insurance provider or payer on a client's insurance** (client action).
* **Connect a client to a therapist in Thrizer** (invitation-based).
Use this article to send the question to the right path.
## Are you a practice administrator adding a clinician or team member?
Use **Clinician Portal → Team → Add Team Member** to invite a new clinician or staff member to your practice.
See [Team members](/help/clinician/team-members) for the invitation flow, role definitions, and how team members interact with the Thrizer Widget.
## Are you a client updating your insurance provider or payer?
Go to **Client Portal → Settings → Insurance plan** to add, edit, or replace your insurance information (including the insurance company / payer).
See [Linking or editing insurance](/help/client/link-insurance).
## Are you a client trying to add or connect to a new therapist?
In Thrizer, clinician–client connections are invitation-based. Clients generally do not add clinicians from their own portal. Instead:
1. Ask the clinician to send you a Thrizer invitation (or a Thrizer Widget / benefit check link from their practice).
2. When the clinician invites you, a pending connection appears under **Client Portal → Clinicians**.
3. Select **Accept** on that row to connect. See [Clinician connections](/help/client/clinician-connections).
If you have a superbill from a provider who is **not** a Thrizer clinician, you can still pursue out-of-network reimbursement. Email the PDF to [help@thrizer.com](mailto:help@thrizer.com), or submit it directly to your insurer. Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on August 9, 2026. See [Claims and superbills](/help/client/claims-and-superbills).
## If you're still not sure
If the term "provider" is not clear in context, ask which of the three scenarios above applies before selecting a path. If it's still unclear, contact [help@thrizer.com](mailto:help@thrizer.com) with a short description of what you're trying to do.
## Related articles
Practice administrators — invite and manage clinicians and staff.
Clients — update your insurance provider or payer information.
Clients — accept a clinician's invitation to connect in Thrizer.
Clients — what to do with a superbill from a provider who does not use Thrizer.
# Important Thrizer links
Source: https://docs.thrizer.com/help/faq/important-links
Find official Thrizer links for support, the dashboard, legal documents, product walkthrough, clinician sign up, and Thrizer comparison pages.
## Overview
Use this page to find official Thrizer links for support, legal documents, product walkthroughs, and getting started.
These links are pointers to external resources. For questions about payments, claims, reimbursement, eligibility, or product behavior, use the relevant Help Center article instead of relying on external link pages to explain how Thrizer works.
## Support
Thrizer support is email-based and does not offer phone support. You can reach support two ways:
* Email [help@thrizer.com](mailto:help@thrizer.com).
* Use **Help → Request Help** inside your Thrizer portal.
Thrizer typically responds within 2 business days. Resolution time varies by issue.
## Dashboard
* [Client dashboard](https://client.thrizer.com)
* [Clinician dashboard](https://clinician.thrizer.com)
## Legal documents
* [Business Associate Agreement](https://www.thrizer.com/legal/business-associate-agreement)
* [Terms of Service (Clients)](https://www.thrizer.com/legal/terms-of-service-clients)
* [Terms of Service (Providers)](https://www.thrizer.com/legal/terms-of-service-providers)
* [Privacy Policy](https://www.thrizer.com/legal/privacy-policy)
* [Cookies Policy](https://www.thrizer.com/legal/cookies-policy)
## Learn about Thrizer
* [About Thrizer](https://www.thrizer.com/about-us)
* [Product walkthrough](https://app.storylane.io/share/umx8nfjuycom)
## Related articles
Start here for a plain-English explanation of what Thrizer does and how the main pieces fit together.
Learn what needs to be true for a client to use insurance through Thrizer.
Compare Self-Pay, OON Pay, and Thrizer Pay.
Learn the supported ways clients can submit claims through Thrizer.
Learn what happens when automated benefit checks do not return enough information.
# Unsupported workflows and possible workarounds
Source: https://docs.thrizer.com/help/faq/unsupported-workflows-and-workarounds
Common Thrizer processes that aren't supported, the workarounds clients and clinicians can use instead, and when to reach out to Thrizer Support for help.
## Overview
Some requests cannot be completed in Thrizer exactly as described.
Unsupported processes are product limitations, not insurance decisions. In some cases, there may be a supported alternative, such as using one payment method, creating separate charges, selecting Self-Pay, creating a new account, or contacting support.
Insurance carriers still determine final claim outcomes, reimbursement, deductible application, and claim timing.
## How this works
This article covers common processes that Thrizer does not currently support automatically.
Some limitations are strict product constraints. Others may have possible workarounds, but those workarounds may not produce the same claim, payment, or reimbursement result.
## Can I split one session payment across multiple cards?
No. A single session charge cannot be split across multiple payment methods.
Use one payment method for the full session charge. If you need to use more than one payment method, you may need to handle the payment through separate charges.
Use that workaround carefully. Thrizer treats each charge separately and does not automatically combine multiple charges into one insurance claim.
If insurance is involved, separate charges may not combine cleanly into one claim. When reimbursement matters for a session, using a single payment method keeps the charge and claim aligned.
## Can multiple charges be combined into one insurance claim?
No. Each charge corresponds to one claim.
Thrizer does not automatically bundle multiple charges into a single claim. If a session is split into more than one charge, that may result in more than one claim or may require manual review.
Manual workarounds are not guaranteed to produce the same claim outcome.
## Can one charge include multiple CPT codes?
Each charge supports one primary CPT code. You can include add-on or extension units of the same underlying service (for example, time-based add-ons) with the primary code.
If a session includes **unrelated** services that need separate CPT codes, enter those services as separate charges. Each charge creates its own claim.
## Can I change the payment method after a charge is completed?
No. A completed charge cannot be moved to a different payment method.
You can use a new card or payment method for future charges, but you cannot apply it retroactively to past transactions.
## Can Thrizer Pay be applied to past sessions?
No. You can only use Thrizer Pay for future sessions.
Select the payment type before submitting the charge. You cannot convert past sessions into Thrizer Pay after the fact.
Insurance billing (OON Pay and Thrizer Pay) is also restricted to a Date of Service of today or tomorrow (a calendar-day restriction, not a rolling 24-hour window). See [Claim and billing limitations](/help/claims/claim-and-billing-limitations#can-insurance-be-billed-for-sessions-scheduled-far-in-the-future) for details.
## Is there a maximum charge amount from the Clinician Portal?
Yes. Charges submitted from the Clinician Portal are capped at a session rate of \$2,500. If the amount on the form is above \$2,500, Thrizer blocks the charge and disables Submit until you reduce the amount.
If a practice needs to process a larger transaction, contact Thrizer support so a Thrizer administrator can review and process the charge. See [Claim and billing limitations](/help/claims/claim-and-billing-limitations#is-there-a-maximum-charge-amount-in-the-clinician-portal) for details.
## Can no-show or cancellation fees be submitted to insurance?
No. You cannot submit no-show and cancellation fees to insurance through Thrizer.
You can charge clients directly for missed or canceled sessions, but handle these as Self-Pay charges. Insurance reimbursement is not available through Thrizer for no-show or cancellation fees.
## Can clients still upload superbills or manually add a claim?
No. As of **August 9, 2026**, client-side **Upload Superbill** and manual claim entry (**Add Claim**) have been retired from the Client Portal.
* Thrizer still processes superbills and manual claims submitted before August 9, 2026 as before.
* If the client's clinician is on Thrizer, the clinician continues to charge through OON Pay or Thrizer Pay, and Thrizer submits the claim automatically on a successful charge.
* For a superbill from a provider who is not on Thrizer, email the PDF to [help@thrizer.com](mailto:help@thrizer.com), or submit it directly to the insurer.
* Clients can still generate a superbill PDF from **Client Portal → Payments** for a Confirmed Self-Pay session.
See [Claims and superbills](/help/client/claims-and-superbills).
## Can Thrizer use secondary insurance?
No. Thrizer supports primary insurance only.
Thrizer does not support secondary insurance or coordination of benefits. If a claim depends on secondary coverage, do not rely on Thrizer to handle that coordination.
## Can I change my account email?
No. You cannot change account email addresses after account creation.
If you need to use a different email, you may need to create a new account. For clinician or practice access, adding a new email as a team member may be an available workaround depending on the account setup.
You can continue to access the account as long as you can sign in with valid credentials for the original email.
## Can a client account become a clinician account, or the other way around?
No. Client accounts and clinician accounts are separate account types.
You cannot convert a client account into a clinician account, and you cannot convert a clinician account into a client account. Accounts also cannot be merged across roles.
If you need both types of access, you may need separate account setup for each role. You can use the same email address to create both a client account and a clinician account. The two accounts remain fully separate. Data, history, and connections do not transfer between them.
Team or practice role controls, such as Practice Role, Role, or Change Role, manage a person's permissions inside a clinician account. They do not convert an account from one type to another.
## Can I store multiple practice addresses for different state licenses?
No. Practice Settings holds one **Business Address** and one optional **Mailing Address** per practice. Thrizer does not support storing a separate address per state license or per practice location.
* The **Business Address** is your legal practice address on file with Thrizer, used for tax forms and, by default, as the practice address on new claims.
* The optional **Mailing Address** overrides the Business Address as the practice address on **new claims only**. Payers use it for paper correspondence, denials, and paper checks.
* Both fields apply to the whole practice. There is no per-clinician, per-state, or per-location address setting.
If you are licensed in multiple states and need different addresses to appear on different claims, contact [help@thrizer.com](mailto:help@thrizer.com) before creating those charges. Thrizer support can advise on what is possible for your situation.
See [Settings and profile](/help/clinician/settings-and-profile) for how the Business Address and Mailing Address fields work.
## Can payouts be split automatically between clinicians?
No. Thrizer does not support automated payout splits between clinicians.
Each team has one payout bank account. If your practice needs to divide funds between clinicians, handle that outside Thrizer.
## What happens if a client's payment fails?
If the client's payment fails, the charge does not complete and Thrizer does not submit the claim.
Resolve the payment issue with the client and retry the charge once a valid payment method is available. Thrizer does not submit automatic claims without a successful payment.
## What Thrizer does
Thrizer enforces system constraints for payments, claims, accounts, and payouts.
When a process is unsupported, Thrizer may still be able to help identify a supported path. Depending on the situation, that may involve a different payment type, a different charge structure, Self-Pay, or support review.
## What insurance determines
Insurance carriers determine final claim outcomes, reimbursement amounts, deductible application, and claim timing.
A Thrizer-supported workaround does not guarantee any insurer outcome. The insurance carrier still decides whether to accept a claim, reimburse a claim, apply it to the deductible, or process it within a specific timeframe.
## What if my situation is not listed here?
Contact Thrizer support if you are unsure whether a process is supported.
Thrizer support can review some situations manually. This is especially true when a request depends on missing information, a benefit check issue, a failed claim, or a practitioner type that needs additional review.
The support team can help identify whether there is a supported path, but insurance carriers determine final claim outcomes and reimbursement.
## Related articles
Review specific claim, charge, CPT code, diagnosis code, and billing constraints.
Compare Self-Pay, OON Pay, and Thrizer Pay before selecting a payment type.
Learn why Thrizer Pay may be unavailable for certain clients, sessions, or insurance situations.
Understand when Self-Pay is the right path and how superbills work.
See how claims are submitted through Thrizer now that client-side superbill upload is retired.
# Which payment and claim submission options are available?
Source: https://docs.thrizer.com/help/faq/which-payment-types-are-available
Compare when Self-Pay, OON Pay, and Thrizer Pay are available based on insurance, benefit checks, deductible status, and claim history.
## Overview
Thrizer supports different payment options. Availability depends on whether insurance is involved, whether Thrizer has verified benefits, and whether the client's deductible is met. Thrizer Pay also requires enough confirmed claim history.
Self-Pay is available without insurance or a benefit check. OON Pay requires usable benefit information. Thrizer Pay has the strictest requirements because Thrizer advances part of the session cost before the insurance claim is fully resolved.
Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on August 9, 2026. Automatic claim submission for successful OON Pay and Thrizer Pay charges is not affected. See [Claims and superbills](/help/client/claims-and-superbills).
## What options does Thrizer support?
Thrizer supports three ways to pay for out-of-network care through the clinician's portal.
**Self-Pay** means the client pays the full session cost and no insurance claim is submitted through Thrizer.
**OON Pay** means the client pays the full session cost upfront, and Thrizer submits an out-of-network claim. If insurance reimburses the claim, reimbursement is sent to the client.
**Thrizer Pay** means the client pays an estimated out-of-pocket amount upfront, plus the Thrizer Pay fee. Thrizer advances the remaining session cost to the clinician, and insurance reimbursement is sent to Thrizer.
## Which options are available without a benefit check?
Self-Pay is available without a benefit check because no insurance claim is submitted.
OON Pay and Thrizer Pay require usable benefit information. If Thrizer does not have enough benefit information to support claim submission for the client's insurance plan, those payment methods cannot be used for charging.
## Which options are available before the deductible is met?
Before the deductible is met, Thrizer Pay is not available.
If the required benefit information is available, OON Pay may be available before the deductible is met. With OON Pay, the client pays the full session cost upfront. If the claim is approved while the deductible is not yet met, the allowed amount may be applied toward the deductible instead of producing a reimbursement payment.
## Which options are available after the deductible is met?
After the deductible is met, OON Pay may still be available.
Thrizer Pay may also become available, but only if all required conditions are met. A met deductible alone does not qualify a client. Thrizer Pay also requires:
* Primary insurance.
* A completed benefit check.
* At least one successful prior claim.
* A Date of Service of today or tomorrow (a calendar-day restriction, not a rolling 24-hour window).
* A valid Individual NPI on the rendering clinician.
A successful claim helps Thrizer understand how the client's insurance actually processes claims, including allowed amount and coinsurance behavior.
For the full list of reasons Thrizer Pay may not be available even for a post-deductible client, see [Why Thrizer Pay may not be available](/help/faq/why-thrizer-pay-may-not-be-available).
## Are there insurers where Thrizer Pay and OON Pay direct deposit are not available?
Yes. Thrizer Pay and OON Pay direct deposit are not currently available for clients on **Anthem BCBS, Carelon, NYSHIP, or Wellpoint** plans. Elevance Health now reimburses these plans by paper check directly to the client. Claims are still submitted as usual, and the 5% Thrizer Pay and 1% OON Pay fees do not apply while this policy is in effect.
For full details, see [Elevance Health reimbursement changes](/help/claims/elevance-health-reimbursement).
## Why is Thrizer Pay more limited than OON Pay?
Thrizer Pay is more limited because Thrizer advances part of the clinician's session fee before the insurance claim is fully resolved.
Before making Thrizer Pay available, Thrizer needs enough confirmed information about how the client's insurance handles claims and enough charge information to submit a valid, timely claim. Thrizer Pay may be disabled while other claim submission options remain available in these cases:
* Reimbursement behavior is not confirmed.
* Claim outcomes are unreliable.
* The charge is missing required information, such as a valid Individual NPI or an in-window Date of Service.
## Does an available payment type guarantee reimbursement?
No. Insurance determines final coverage, claim approval, deductible application, reimbursement amount, and timing.
A benefit check or successful claim can help determine whether a payment option is available, but it does not guarantee a specific reimbursement outcome. Estimates may differ from the final result after the insurance carrier processes the claim.
## What Thrizer does
Thrizer determines which payment or claim submission options are available based on the client, clinician, and insurance information on file.
Thrizer may support Self-Pay, OON Pay, or Thrizer Pay depending on the client, insurance, deductible status, benefit information, and claim history.
## What insurance determines
The insurance carrier determines final coverage, claim approval, deductible application, reimbursement amount, and claim processing timing.
Thrizer does not guarantee that an available payment or claim submission option will result in reimbursement.
## Related articles
Learn how Thrizer Pay works when a client pays an estimated amount upfront and Thrizer advances the rest.
Understand how OON Pay works when the client pays the full session cost and Thrizer submits the claim.
See how Self-Pay differs from insurance-based payment types and when superbills are used.
Learn how benefit information helps determine which payment and claim processes may be available.
Review the common reasons Thrizer Pay may be unavailable even when other options are supported.
# Why can't I charge my clients?
Source: https://docs.thrizer.com/help/faq/why-cant-i-charge-my-clients
Troubleshoot why Add Charge is blocked in the Clinician Portal, including business verification status, clinician verification, and missing profile details.
## Overview
If Add Charge is disabled for every payment type, your practice or account is not yet ready to bill. The most common cause is that your practice's **business verification** is not yet **Approved**. This applies to Self-Pay as well as OON Pay and Thrizer Pay.
Insurance-specific reasons (like a missing Individual NPI or Date of Service outside the allowed window) only block insurance-based payment types. Self-Pay would still be available in those cases. If every payment type is blocked, it is an account-level issue.
## Check your business verification status first
Practices can only charge clients when their business verification status is **Approved**. You can see the status on the Home checklist and on the **Business** step in the Clinician Portal.
| Status | Meaning | Can charge? | What to do |
| ------------------ | --------------------------------------------------------------------------------------- | ----------- | --------------------------------------------------------------------------------------------------------------------------------------------- |
| **Incomplete** | KYB (Know Your Business) information is missing or has never been submitted for review. | No | Practice Administrator: open **Practice Settings**, fill in the required business fields, then **Submit for review**. |
| **Pending review** | You have submitted your business information and Thrizer is reviewing it. | No | Wait for Thrizer to complete the review. KYB fields are locked during review. |
| **Approved** | Thrizer has verified your business details. | Yes | You are ready to charge. If Add Charge is still blocked, check the other conditions below. |
| **Rejected** | Thrizer reviewed your submission and could not approve it. | No | Contact [help@thrizer.com](mailto:help@thrizer.com) to resolve. You can still edit your KYB fields, but Thrizer support handles resubmission. |
Before July 28, 2026, some practices could charge without completing business verification. On that date, Thrizer moved those practices to **Incomplete**. If your practice suddenly appears **Incomplete** and you were charging clients before, this is why. Submit your business information for review to restore charging.
## Other reasons Add Charge can be blocked
If your business verification is **Approved** and Add Charge is still disabled, check the following:
* **Clinician verification not in good standing.** You can't process charges while your account is pending admin verification or suspended. Verified accounts can charge.
* **Missing name on the rendering clinician.** The selected rendering clinician must have a first and last name on file so Thrizer can attribute payouts and claims correctly.
* **Missing Individual NPI (insurance charges only).** OON Pay and Thrizer Pay require a valid Individual NPI on the rendering clinician. Without one, only Self-Pay is available. See [Settings and profile](/help/clinician/settings-and-profile#profile).
* **Date of Service more than one day in the future (insurance charges only).** OON Pay and Thrizer Pay require the Date of Service to be today or tomorrow (a calendar-day restriction, not a rolling 24-hour window). Sessions two or more calendar days ahead must use Self-Pay. See [Why the Date of Service must be today or tomorrow](/help/faq/why-date-of-service-must-be-today-or-tomorrow).
* **Session rate above \$2,500.** The Clinician Portal caps charges at a session rate of \$2,500. See [Charging clients](/help/clinician/charge-clients#charge-amount-limit).
## The self-service path to restore charging
If your practice is **Incomplete**:
1. Ask a Practice Administrator to open the Clinician Portal.
2. Go to **Settings → Practice Settings**.
3. Fill in every required KYB field, including business name, TIN, business address, and any other required fields.
4. Select **Submit for review**.
5. Wait for Thrizer to move the practice to **Approved**. You cannot charge clients while the status is **Pending review**.
Only Practice Administrators can edit Practice Settings. Staff Members and Clinicians should ask a Practice Administrator to complete these steps.
## Related articles
Review the business verification statuses and what each Settings tab controls.
See the full list of charge readiness checks and charge form requirements.
Walk through onboarding, including business and banking setup for Practice Administrators.
Compare Self-Pay, OON Pay, and Thrizer Pay and when each is offered.
# Why can I only bill for today or tomorrow?
Source: https://docs.thrizer.com/help/faq/why-date-of-service-must-be-today-or-tomorrow
OON Pay and Thrizer Pay require a Date of Service of today or tomorrow. Learn why this is a calendar-day rule and why further-out claims are blocked.
## Overview
When you create an OON Pay or Thrizer Pay charge, the session's Date of Service must be today or tomorrow. This is a calendar-date rule, not a rolling 24-hour window. Sessions two or more calendar days out cannot be charged as OON Pay or Thrizer Pay.
This rule lets you charge the day before a session without submitting a claim to insurance for a session that hasn't happened yet.
## Why does Thrizer allow tomorrow's date at all?
If your practice policy is to charge the client the day before the session, Thrizer supports that.
When you create a charge for tomorrow's Date of Service, Thrizer processes the payment right away. Thrizer holds the resulting claim until the Date of Service is no longer in the future. You can collect payment on your normal schedule, and the claim is never sent to insurance with a future date.
## Why can't I bill further out than tomorrow?
Insurance carriers do not accept claims for dates of service that have not yet occurred. Submitting a claim for a session two or more calendar days in the future would either be rejected by the payer or misrepresent when care was delivered.
To keep every submitted claim accurate, Thrizer blocks OON Pay and Thrizer Pay charges where the Date of Service is more than one calendar day ahead.
## What about no-shows or cancellations after I've already charged?
A claim for a tomorrow-dated session is held until after the Date of Service passes. That gives you a window to correct the charge if the client cancels or does not attend.
If a session does not happen after a charge has been created, refund or adjust the charge as soon as possible. See [Payments, payouts, and refunds](/help/clinician/payments-payouts-and-refunds) for how to refund a charge, and contact Thrizer support if you're unsure whether the claim has already been submitted.
## Does this rule apply to Self-Pay?
No. Self-Pay charges do not generate an insurance claim, so the Date of Service restriction that protects claim accuracy does not apply in the same way. The today-or-tomorrow rule is specific to OON Pay and Thrizer Pay, where a claim is submitted to insurance.
## Related articles
Learn what clients pay upfront with Thrizer Pay and where reimbursement goes.
See how OON Pay works when a client pays the full session fee upfront and Thrizer submits the claim.
Review the clinician-side eligibility checklist, including Date of Service and Individual NPI requirements.
Understand the conditions Thrizer Pay requires, including the today-or-tomorrow Date of Service.
Create session charges in the Clinician Portal and see what details are required.
Refund a charge or reverse a payout if a session doesn't happen.
# Why Thrizer Pay may not be available
Source: https://docs.thrizer.com/help/faq/why-thrizer-pay-may-not-be-available
Learn why Thrizer Pay may not be available for a client based on benefit checks, deductible status, and claim history, and which payment options still apply.
## Overview
Thrizer Pay is only available when Thrizer has enough confirmed insurance information to estimate the client's responsibility and support the payment flow.
If Thrizer Pay is not available, it does not automatically mean the client has no coverage or that something is wrong with their insurance. It usually means one or more required conditions haven't been met yet, such as a completed benefit check, a met deductible, or a prior successful claim.
Other payment options, such as OON Pay or Self-Pay, may still be available depending on the client's situation.
## Why would Thrizer Pay not show as an option?
Thrizer Pay may not be available for several reasons. The client's insurance information may be incomplete, their deductible may not have been met, or Thrizer may not yet have confirmed enough claim history to support Thrizer Pay.
Thrizer Pay requires more confirmation than other payment types because the client pays an estimated responsibility upfront, while Thrizer advances the remaining portion of the clinician's session fee. Insurance then sends reimbursement to Thrizer, not directly to the client.
Because this payment option depends on insurance information, Thrizer Pay is only available when the required eligibility conditions are met.
## What conditions are required for Thrizer Pay?
Thrizer Pay generally requires all of the following:
* The client has primary insurance on file
* A benefit check has been completed
* The client's deductible has been met
* At least one successful claim has already been processed
* Thrizer has enough information to estimate the client's responsibility
* The session's Date of Service is today or tomorrow
* The rendering clinician has a valid Individual NPI on file
A successful claim means the insurance carrier processed and accepted a claim. That claim may result in reimbursement or may be applied to the client's deductible.
Date of Service and NPI are checked when the charge is created in the Clinician Portal. Thrizer Pay is limited to a Date of Service of today or tomorrow. This is a calendar-date rule, not a rolling 24-hour window.
For sessions two or more calendar days in the future, Thrizer Pay is not an option, but standard claim options remain available. OON Pay is available when a benefit check exists, and Self-Pay is always available. Clinicians without a valid Individual NPI cannot use OON Pay or Thrizer Pay.
## Why does Thrizer need a prior successful claim?
Thrizer Pay depends on knowing how the client's insurance actually processes claims. Before a claim is processed, some values are still estimates. After a successful claim, Thrizer has more information about the insurer's actual behavior, including how the plan handles allowed amounts and coinsurance.
This helps Thrizer estimate the client's responsibility more reliably for future sessions. If that claim history does not exist yet, Thrizer Pay may not be available.
## Does an unavailable Thrizer Pay option mean insurance was denied?
No. Thrizer Pay being unavailable does not necessarily mean insurance was denied, coverage is missing, or reimbursement is impossible.
For example, Thrizer Pay may be unavailable because:
* the deductible has not been met
* a benefit check is still missing or incomplete
* the insurance plan did not return enough information automatically
* a prior claim has not been processed yet
* the insurer has reimbursed inconsistently for this plan
* the session's Date of Service is two or more calendar days in the future
* the rendering clinician does not have a valid Individual NPI on file
* the client's insurer only reimburses by paper check (see [Elevance Health reimbursement changes](/help/claims/elevance-health-reimbursement) for Anthem BCBS, Carelon, NYSHIP, and Wellpoint)
Some insurance plans do not return complete benefit information through automated systems. In those cases, manual verification may be needed before Thrizer can safely interpret the benefits.
## What if the benefit check failed or returned incomplete information?
A failed or incomplete benefit check is not the same as a coverage denial. It usually means Thrizer does not yet have enough information to safely interpret the client's benefits.
Common reasons include:
* the client's insurance details do not exactly match insurer records
* the insurer returned only partial information
* behavioral health benefits are managed separately
* out-of-network details were not available digitally
* manual phone verification is required
When benefit information is missing, Thrizer cannot assume missing values or provide a reliable estimate based on incomplete data.
## What payment options may still be available?
If Thrizer Pay is not available, other payment options may still be available.
OON Pay may be available when a completed benefit check exists. With OON Pay, the client pays the full session fee upfront, Thrizer submits the claim, and any reimbursement is returned to the client.
Self-Pay remains available without a benefit check. With Self-Pay, the client pays the full session fee and no insurance claim is submitted through Thrizer.
## Can Thrizer Pay become available later?
Yes. Thrizer Pay may become available later if the required conditions are met.
For example, it may become available after:
* a benefit check is completed
* the client's deductible is met
* a successful claim is processed
* Thrizer has enough confirmed information to estimate the client's responsibility
However, Thrizer Pay may also remain unavailable if reimbursement behavior is unreliable, such as repeated claim denials or inconsistent reimbursement patterns.
## What if my deductible is met but Thrizer Pay still isn't available?
Thrizer does not automatically track a running deductible balance. If new claims have been approved and applied toward the deductible, Thrizer may not yet reflect that the deductible has been met.
To update your benefit information:
1. Go to [client.thrizer.com/settings/insurance](https://client.thrizer.com/settings/insurance).
2. Select **Recheck**.
If the recheck does not work, contact Thrizer support and ask for a manual recheck. Once the updated benefit check confirms the deductible is met, Thrizer Pay may become available if the other required conditions are also met.
## Can a recheck undo a met deductible?
No. Once Thrizer has recorded that a client's deductible is met, an automated recheck cannot switch it back to "not met" within the same calendar year. Many automated eligibility responses report the plan-level deductible remaining and do not reflect the out-of-network payments a client has already made. Treating a recheck as authoritative would incorrectly disable Thrizer Pay.
Instead:
* **Same calendar year:** Thrizer preserves the recorded met deductible. If the automated result disagrees, Thrizer flags it for review by the admin team rather than overwriting the met value.
* **New calendar year:** most OON plans reset on January 1. A recheck in the new year can reset the deductible to not met, which is the correct behavior for the new plan year.
* **Plan or payer change:** switching to a different payer or plan replaces the previous out-of-network benefit information. The new plan's deductible applies from that point on, even if the previous plan's deductible was met.
If you believe your deductible is met but Thrizer Pay is still not available, contact Thrizer support so the team can review the recorded value.
## Who determines the final insurance outcome?
The insurance carrier determines final claim approval, reimbursement amount, deductible application, and coverage outcome. Thrizer helps facilitate payments and claim submission, but Thrizer does not guarantee reimbursement, claim approval, final cost, or claim timing.
## Related articles
Learn what clients pay upfront with Thrizer Pay and where reimbursement goes.
Compare Thrizer Pay, OON Pay, and Self-Pay when Thrizer Pay is not available.
Understand how benefit checks help Thrizer estimate insurance coverage and client responsibility.
Learn what happens when automated benefit checks fail or return incomplete information.
Review the insurance terms that affect whether Thrizer Pay can be used and what clients may owe.
Learn how OON Pay works when a client pays the full session fee upfront and waits for reimbursement.
See the clinician-side eligibility checklist, including Date of Service and Individual NPI requirements.
# Can I use my insurance with Thrizer?
Source: https://docs.thrizer.com/help/getting-started/can-i-use-my-insurance-with-thrizer
When a client can use insurance with Thrizer, how out-of-network benefits work, and why coverage and reimbursement always depend on the insurance carrier.
## Overview
Thrizer works with **out-of-network (OON) benefits**, not in-network insurance. If your plan includes out-of-network coverage for the type of care you receive, Thrizer can check estimated benefits and submit eligible OON claims. Any reimbursement is sent to you.
If your plan does not include out-of-network benefits, you can still use Thrizer as a Self-Pay payment platform. No claim is submitted in that case.
Benefit checks and cost estimates are not guarantees. Your insurance plan determines final coverage, claim approval, deductible application, reimbursement amount, and timing.
## How it works
1. Your clinician shares a Thrizer link or invites you to a Thrizer account.
2. You add your insurance information so Thrizer can run a benefit check.
3. If a usable benefit check comes back, Thrizer shows estimated out-of-network benefits and your estimated session cost.
4. After your clinician charges a session, Thrizer submits the out-of-network claim to your insurance (for OON Pay and Thrizer Pay).
5. The insurance carrier processes the claim and determines the final outcome.
## When insurance can be used with Thrizer
You can typically use your insurance with Thrizer when **all** of the following apply:
* Your plan includes out-of-network benefits for the type of care.
* The provider type and service are within Thrizer's supported scope.
* A usable benefit check completes (either automatically or after manual verification).
* Your insurance information links successfully to your account.
If a benefit check cannot be completed, Thrizer cannot estimate coverage or submit a claim through insurance. Self-Pay remains available in that case.
## When insurance may not work with Thrizer
* **In-network only plans** generally do not work with Thrizer because Thrizer focuses on out-of-network benefits.
* **No out-of-network benefits** on the plan means there is nothing for Thrizer to bill.
* **HMO plans** generally do not include out-of-network benefits, but rare plan-level exceptions exist. If a benefit check returns usable out-of-network benefit information for an HMO plan, the plan can still be considered.
* **Government plans** such as Medicare, Medicaid, and Tricare often do not include the out-of-network benefits Thrizer relies on. They may still be usable if a benefit check returns enough out-of-network benefit information for the plan.
* **Medicare Advantage** and commercially administered Medicare-related plans typically require manual benefit verification. Do not assume support from the plan name alone. Thrizer does not credential clinicians or "make" a clinician out-of-network with any insurer. See [Which insurance companies does Thrizer work with?](/help/claims/supported-insurance#medicare-medicare-advantage-and-medicaid) for details.
* **Secondary insurance** is not currently supported as a billable insurance source.
* **A failed automated benefit check is not a coverage denial.** Manual verification may still confirm benefits.
Plan type alone does not decide whether Thrizer can be used. What matters is whether a benefit check is usable for that specific plan. Insurance carriers determine final coverage and claim outcomes.
## What is estimated vs final
* **Estimated:** benefits returned from a benefit check, estimated session cost, estimated reimbursement.
* **Final:** claim approval, allowed amount, deductible application, reimbursement amount, and processing time. Your insurance carrier determines these.
## Related articles
See which clinicians and clients Thrizer currently supports.
Learn how Thrizer estimates benefits and what happens when a check is incomplete.
Compare Self-Pay, OON Pay, and Thrizer Pay based on insurance and deductible status.
Understand when manual review may be needed if automated benefit checks are incomplete.
# How Thrizer compares with other OON billing tools
Source: https://docs.thrizer.com/help/getting-started/compare-thrizer
Compare Thrizer with other out-of-network billing tools across affordability, payment processing, claim submission, benefit checks, and practice fit.
## Overview
Thrizer is a strong fit for clinicians who want payment processing and out-of-network billing support in one place.
With Thrizer, clinicians can charge clients for sessions and check estimated out-of-network benefits. Thrizer also supports automatic claim submission when applicable and offers eligible clients payment options such as OON Pay or Thrizer Pay.
Other out-of-network billing tools may be a better fit if you want to keep payments entirely outside Thrizer and only help clients submit claims or check benefits.
The best choice depends on what you want to solve:
| If your main goal is... | Consider... |
| ------------------------------------------------------------------------------------------------ | --------------------------------------------------------------------- |
| Helping eligible clients avoid paying the full session fee upfront and waiting for reimbursement | Thrizer |
| Charging clients and submitting eligible claims in one place | Thrizer |
| Keeping your existing payment processor and using a claims-focused service | Mentaya or Reimbursify |
| Letting clients submit superbills themselves | Reimbursify (Thrizer no longer supports client-side superbill upload) |
| A benefits-checking widget for prospective clients | Thrizer or another tool with a benefits calculator |
| A broad app-based claim submission tool across many provider types | Reimbursify |
This guide is designed to help clinicians understand how these tools differ. It does not guarantee insurance coverage, claim approval, reimbursement, deductible application, or final client cost. Insurance carriers determine final claim outcomes.
## Why clinicians compare these tools
Private-pay clinicians often want to make out-of-network benefits easier for clients without joining insurance panels.
Most comparison questions come down to five practical issues:
1. **What does the client pay upfront?**
2. **Who submits the claim?**
3. **Who waits for reimbursement?**
4. **Who handles insurance follow-up?**
5. **What does the clinician need to change in their billing process?**
Thrizer is different because it combines payment processing with out-of-network billing support. Some alternatives focus more narrowly on benefit checks, claim submission, or client superbill filing.
## Comparison at a glance
| Feature | Thrizer | Mentaya | Reimbursify |
| ------------------------------------------------- | -------------------------------------------------------------------- | ------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------- |
| Main focus | Payment platform with built-in out-of-network billing support | Out-of-network claim support for private-pay therapy | App and practice tools for out-of-network claim submission |
| Client payment at session | Depends on payment type: Self-Pay, OON Pay, or Thrizer Pay | Client typically pays the clinician and waits for reimbursement | Client typically pays the provider and waits for reimbursement |
| Lower upfront payment option | Yes, when eligible through Thrizer Pay | Not the core model | Not the core model |
| Automatic claim submission after clinician charge | Yes, for OON Pay and Thrizer Pay after successful charge | Claims are submitted through Mentaya's process | Available depending on Reimbursify plan and setup |
| Client-only superbill option | No (retired August 9, 2026) | Not the primary model | Yes, client app-based claim filing |
| Benefits checker / widget | Available to clinician accounts | Available as optional paid add-on | Available in certain practice plans |
| Clinician payment processing | Built into Thrizer | Optional payment processing available | Payment processing may be available separately depending on setup |
| Where reimbursement goes | OON Pay: client; Thrizer Pay: Thrizer | Client receives reimbursement from insurance | Client receives reimbursement from insurance |
| Best fit | Clinicians who want payments and out-of-network billing in one place | Clinicians who want claims support while keeping their existing billing process | Clinicians or clients who want claim filing and tracking, especially through an app-based tool |
## Why use Thrizer?
Thrizer is built for private-pay clinicians who want to make out-of-network benefits easier without turning insurance into a separate manual process.
### 1. Thrizer combines payment and claim submission
With Thrizer, clinicians can charge clients through the platform.
For OON Pay and Thrizer Pay, Thrizer submits eligible claims automatically after the session charge is successfully processed. The client does not need to upload a superbill for every session with those payment options.
This is different from setups where payment happens in one system and claim submission happens somewhere else.
### 2. Eligible clients may avoid paying the full session fee upfront
With many out-of-network setups, the client pays the clinician's full session fee upfront and waits for insurance reimbursement.
Thrizer Pay is different. When a client is eligible, the client pays an estimated responsibility upfront, Thrizer advances the remaining session fee to the clinician, and insurance reimbursement is sent to Thrizer.
This can make care feel more accessible for clients who have out-of-network benefits but cannot easily front the full session cost.
### 3. Clinicians still receive their session fee
For sessions charged through Thrizer, clinician payout timing is separate from insurance reimbursement timing.
That means the clinician is not waiting for the insurance carrier to process the claim before receiving the session payment through Thrizer's payout process.
### 4. Thrizer supports different client situations
Thrizer supports multiple payment and claim options:
| Payment type | How it works |
| ------------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Self-Pay | Client pays the full session fee. No insurance claim is submitted. |
| OON Pay | Client pays the full session fee upfront. Thrizer submits an eligible out-of-network claim after successful charge processing. Reimbursement is sent to the client when applicable. |
| Thrizer Pay | When eligible, the client pays an estimated upfront amount plus Thrizer's fee. Thrizer advances the remaining session fee, and reimbursement is sent to Thrizer. |
### 5. Thrizer includes benefits-checking tools
Thrizer includes benefits-checking tools clinicians can use with current or prospective clients.
The public Widget lets prospective clients check estimated out-of-network benefits based on the clinician's configured services and rates. The Widget can help reduce back-and-forth about cost before a first appointment.
Benefit checks and Widget results are estimates. They do not guarantee coverage, reimbursement, claim approval, allowed amount, deductible application, or final client cost.
## When Mentaya may be a good fit
Mentaya may be a good fit if you want a claims-focused service for private-pay therapy and prefer to keep your current payment processor.
Mentaya's public materials describe:
* out-of-network claim submission support
* a client fee based on a percentage of the session cost
* an optional benefits calculator
* optional payment processing
* support for denied claims and resubmissions
Mentaya may be worth considering if:
* you do not want to switch your payment processor
* your clients are comfortable paying the full session fee upfront
* your primary need is claim submission and reimbursement support
* you want an out-of-network claim service designed specifically around therapy
The main tradeoff is that Mentaya's core model is still reimbursement-based. Clients generally pay the full session cost first and wait for insurance reimbursement.
## When Reimbursify may be a good fit
Reimbursify may be a good fit if you want an app-based claim submission tool or if your clients prefer to submit claims themselves.
Reimbursify's public materials describe:
* client claim filing through an app
* claim tracking
* support for rejected claims
* practice plans for clinicians who want more claim-filing and benefit-verification features
* support across a broader range of outpatient provider types
Reimbursify may be worth considering if:
* your clients want a standalone app for claim filing
* you want clients to handle claim submission themselves
* you want a broader outpatient claim-filing tool, not just a therapy-focused service
* you are comfortable with clients paying upfront and waiting for reimbursement
* your practice prefers a subscription plan for claim and benefit-verification features
The main tradeoff is that Reimbursify is more claim-submission-centered than payment-platform-centered. It may not solve upfront affordability in the same way as Thrizer Pay.
## Where Thrizer may not be the best fit
Thrizer is not the best fit for every practice.
Thrizer may not be the right choice if:
* you do not want to process client payments through Thrizer
* you want clients to pay for sessions by direct ACH or bank transfer
* you need secondary insurance or coordination of benefits
* you want to submit claims without a successful session charge in OON Pay or Thrizer Pay
* you need to combine unrelated CPT codes into one claim
* you want Thrizer Pay for a client who has not met the eligibility requirements
* your client only wants a standalone claim-filing app and does not want a payment platform involved
In those cases, a client-submitted superbill option or another claims-focused tool may be more appropriate.
## How to choose
### Choose Thrizer if...
Thrizer is likely the best fit if you want:
* one system for client payment and out-of-network billing support
* automatic claim submission after successful OON Pay or Thrizer Pay charges
* a lower upfront payment option for eligible clients
* a benefits-checking Widget for prospective clients
* clients to avoid uploading superbills every session for recurring billing
* clinician payment timing that is separate from insurer reimbursement timing
### Consider Mentaya if...
Mentaya may be a fit if you want:
* claim support while keeping your existing payment processor
* a therapy-focused reimbursement service
* a percentage-based client claim fee
* optional payment processing
* optional benefits calculator functionality
### Consider Reimbursify if...
Reimbursify may be a fit if you want:
* client app-based claim filing
* claim tracking outside your payment platform
* support across a broader range of outpatient provider types
* practice subscription options for benefit verification and courtesy claim submission
* an option for clients to self-submit superbills
## Questions to ask before choosing a tool
Before choosing Thrizer or another out-of-network billing tool, ask:
1. Do I want to process payments through this platform?
2. Do I want the claim submitted automatically after a charge?
3. Do I want clients to upload superbills themselves?
4. Are my clients comfortable paying the full fee upfront?
5. Do I need a benefits checker for prospective clients?
6. Do I want to avoid a monthly subscription?
7. Who handles denials, resubmissions, and insurer follow-up?
8. Who receives reimbursement from the insurer?
9. What happens if the claim is denied?
10. What does the client pay before and after their deductible is met?
## What to avoid saying to clients
Avoid saying:
* "Thrizer guarantees reimbursement."
* "Thrizer guarantees your insurance will cover this."
* "You will only pay a copay."
* "You will definitely save money."
* "Your claim will be approved."
* "The benefit check is final."
* "Thrizer works like an in-network insurance plan."
* "All out-of-network billing tools do the same thing."
Instead, use safer language:
> Thrizer helps our practice process payments and can support eligible out-of-network claim submissions. Benefit checks and cost estimates are estimates only. Your insurance plan determines final coverage, reimbursement, deductible application, and claim outcomes.
## Frequently asked questions
### Is Thrizer an insurance panel?
No. Thrizer is not an insurance panel and does not make a clinician in-network with a client's insurance plan.
Thrizer supports private-pay and out-of-network billing.
### Does Thrizer replace my EHR?
No. Thrizer is focused on payments, benefits checking, out-of-network claim submission, and related client billing support. It does not replace your clinical documentation system.
### Do clients need to upload a superbill after every session?
Not for OON Pay or Thrizer Pay.
For those payment options, the clinician creates a charge in Thrizer, and Thrizer submits the eligible claim automatically after the charge is successfully processed.
### Can clients use Thrizer if I do not charge through Thrizer?
Not for new claim submission. Client-side **Upload Superbill** and **Add Claim** were retired from the Client Portal on August 9, 2026.
If a client has a superbill from a provider who is not on Thrizer, they can email it to [help@thrizer.com](mailto:help@thrizer.com), or submit it to their insurer directly.
OON Pay and Thrizer Pay require the charge to be processed through Thrizer.
### Does Thrizer Pay apply to every client?
No. Thrizer Pay is only available when eligibility requirements are met.
If Thrizer Pay is not available, other options such as OON Pay or Self-Pay may still be available depending on the client and session.
### Does using Thrizer guarantee reimbursement?
No. Insurance carriers determine claim approval, reimbursement amount, deductible application, allowed amount, and processing time.
Thrizer can support payment and claim processes, but it does not control insurer decisions.
## Related articles
Learn how to check estimated out-of-network benefits before charging a client.
Learn how insurer support works and why plan-level benefits still need to be checked.
Learn how CPT code support works and how to handle add-on codes or multiple services.
Learn how diagnosis-code support works in Thrizer and what diagnosis-code support does not guarantee.
# How can I explain Thrizer to my clients?
Source: https://docs.thrizer.com/help/getting-started/how-to-explain-thrizer-to-clients
Client-friendly language clinicians can use to explain Thrizer as a payment platform for private-pay sessions with embedded out-of-network billing support.
## Simple way to explain this
Thrizer is a payment platform for private-pay practices with embedded out-of-network billing support.
You can use Thrizer as your centralized payment platform for private-pay sessions, whether a client is paying fully out of pocket or using out-of-network benefits. Clients can check benefits during onboarding and get support with out-of-network billing when applicable, but using insurance is not required.
## Simple way to describe Thrizer
You can use this short explanation in consult calls, emails, or FAQs:
> I use Thrizer as my payment platform for private-pay sessions. If you have out-of-network benefits, Thrizer can also help check your benefits, estimate your session cost, and submit eligible out-of-network claims after sessions are charged. Any cost or reimbursement estimate is based on available benefit information, and the final outcome is determined by your insurance plan.
## Website or FAQ language
I am a private-pay provider. I use Thrizer as my payment platform for private-pay sessions.
If you have out-of-network benefits, Thrizer can also help make the out-of-network billing process easier. Through Thrizer, you can check your estimated out-of-network benefits, see an estimated session cost, pay for sessions, and have eligible out-of-network claims submitted for you.
If your plan reimburses for out-of-network care, reimbursement is determined by your insurance after the claim is processed. If you are eligible, you may also have the option to pay an estimated upfront amount instead of paying my full session fee and waiting for reimbursement.
You can use the widget below to check your estimated out-of-network benefits and session cost.
(widget link)
## Consult call language
I am a private-pay provider, so I do not bill insurance directly. I use Thrizer as my payment platform for sessions.
If your plan has out-of-network benefits, Thrizer can also help check your estimated benefits, estimate your session cost, and submit eligible out-of-network claims after sessions are charged.
Any reimbursement is determined by your insurance after the claim is processed, so the benefit check is not a guarantee. If you have your insurance card handy, we can check your estimated out-of-network benefits.
## If the plan needs manual verification
Your insurance plan may need manual verification before we can estimate your out-of-network benefits.
Please send the front and back of your insurance card and your date of birth, and we can use that information to help verify your benefits. Once verification is complete, we can share the available estimate for your out-of-network coverage and expected session cost.
## Directory profile language
I am a private-pay provider and use Thrizer as my payment platform. If you have out-of-network benefits, Thrizer can also help estimate your benefits and support eligible out-of-network claim submission.
You can use my Thrizer link to check your estimated benefits and session cost before getting started:
(widget link)
## Onboarding email for clients
I use Thrizer as my payment platform for sessions.
If your insurance plan includes out-of-network benefits, Thrizer can also help check your benefits, estimate your session cost, and submit eligible out-of-network claims after sessions are charged. Reimbursement is not guaranteed and is determined by your insurance plan after claims are processed.
To get started, please use this link to check your estimated out-of-network benefits:
(widget link)
You can also send a photo of the front and back of your insurance card and your date of birth if you would like help checking your benefits.
Once your account is set up, I will charge sessions through Thrizer moving forward.
Depending on your eligibility, you may have different payment options:
* OON Pay: You pay the full session fee upfront, and Thrizer submits the out-of-network claim. Any reimbursement goes back to you.
* Thrizer Pay: If eligible, you pay an estimated upfront amount, and Thrizer advances the rest of the session fee.
* Self-Pay: You pay the full session fee, and no insurance claim is submitted.
Thrizer fees depend on the payment option. If you use Thrizer Pay, the client fee is 5% of the session fee. If you use OON Pay, the client fee is 1% of the session fee and only applies after your deductible is met. Before your deductible is met, OON Pay does not include a client fee.
If you have questions or need help with claims, you can contact Thrizer support through your Thrizer account.
## Consent form language
By signing this form, you authorize Thrizer to support payment processing and out-of-network billing processes related to services rendered, including benefit checks and claim submissions when applicable.
Charges processed through Thrizer may appear on your bank or credit card statement as Thrizer.
Optional language:
For billing-related questions, you can reach out through your Thrizer account for support.
## What to avoid saying
Avoid language that may sound like a guarantee.
Instead of:
* "Your insurance will reimburse you"
* "You will save money"
* "Thrizer confirms your coverage"
* "Thrizer submits superbills automatically"
* "You will pay a reduced fee"
Use:
* "Your plan may include out-of-network benefits"
* "Thrizer can estimate your session cost"
* "Your insurance determines the final outcome"
* "Thrizer can submit eligible out-of-network claims"
* "You may be able to pay an estimated upfront amount, if eligible"
## Related articles
Learn how Thrizer uses benefit information to estimate coverage and which payment options may apply.
Understand when manual review may be needed if automatic benefit checks are incomplete.
Compare Self-Pay, OON Pay, and Thrizer Pay based on insurance and deductible status.
See why Thrizer Pay depends on verified benefits, deductible status, and claim history.
Learn how out-of-network reimbursement is affected by deductibles, coinsurance, and allowed amounts.
# Onboarding demo for clients
Source: https://docs.thrizer.com/help/getting-started/onboarding-demo-client
Interactive walkthrough of the Thrizer client experience covering account setup, linking insurance, benefit checks, payments, and reimbursement.
Use the walkthroughs below to see how Thrizer works for clients.
## Related articles
Learn how Thrizer uses benefit information to estimate coverage and which payment options may apply.
Understand when manual review may be needed if automatic benefit checks are incomplete.
Compare Self-Pay, OON Pay, and Thrizer Pay based on insurance and deductible status.
See why Thrizer Pay depends on verified benefits, deductible status, and claim history.
Learn how out-of-network reimbursement is affected by deductibles, coinsurance, and allowed amounts.
# Onboarding demo for clinicians
Source: https://docs.thrizer.com/help/getting-started/onboarding-demo-clinician
Interactive walkthrough of the Thrizer clinician experience covering account setup, adding clients, benefit checks, charging sessions, and claim submission.
Use the walkthroughs below to see how Thrizer works for clinicians.
## Related articles
Learn how Thrizer uses benefit information to estimate coverage and which payment options may apply.
Understand when manual review may be needed if automatic benefit checks are incomplete.
Compare Self-Pay, OON Pay, and Thrizer Pay based on insurance and deductible status.
See why Thrizer Pay depends on verified benefits, deductible status, and claim history.
Learn how out-of-network reimbursement is affected by deductibles, coinsurance, and allowed amounts.
# Getting started with Thrizer
Source: https://docs.thrizer.com/help/getting-started/overview
Learn what Thrizer does for out-of-network mental health care and how clients and clinicians use Thrizer Pay, OON Pay, and Self-Pay payment options.
## Overview
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 the claim process.
Insurance still makes the final decision on coverage, claim approval, reimbursement, deductible application, and timing.
## How this works
Thrizer supports three main payment and claim options:
| Option | How it works |
| ----------- | ------------------------------------------------------------------------------------------------------------------------------- |
| Self-Pay | The client pays for care without using Thrizer to submit an insurance claim |
| OON Pay | The client pays the full session fee upfront, and Thrizer submits the out-of-network claim when claim submission is supported |
| Thrizer Pay | When available, the client pays an estimated amount upfront while Thrizer advances the rest of the session fee to the clinician |
The right option depends on the client's insurance information, deductible status, available benefit details, and whether the option is supported for that client and session.
## What Thrizer helps with
Thrizer can help with:
* checking out-of-network benefits
* estimating reimbursement
* collecting client payments
* submitting supported claims
* tracking claim status
* sending 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.
## If you are a client
You 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 and reimbursement goes to you
A good first step is to make sure your insurance, payment method, and reimbursement account are up to date.
## If you are a clinician
You use Thrizer to manage clients, payments, benefits, and the claim process.
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. When claim submission is supported, 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.
## How the main payment options differ
### Self-Pay
With Self-Pay, the client pays for care without using Thrizer to submit an insurance claim.
Use Self-Pay when the client is not using insurance for the session, when no claim should be submitted, or when the session does not involve out-of-network reimbursement through Thrizer.
### 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 claim submission is supported. 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.
### 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 sent 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.
## What to check before using Thrizer
Before creating a charge or submitting a claim, 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
## What happens after a charge or claim
What happens next depends on the payment option.
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 automatic claim submission is supported.
Insurance then processes the claim. The final result may be reimbursement, deductible application, denial, or another carrier-determined outcome.
## What Thrizer does
Thrizer helps with supported payment, claim, benefit check, and reimbursement processes.
Depending on the payment option, Thrizer may:
* process the client's payment
* submit an out-of-network claim
* track claim status
* send reimbursement based on the payment type
* update claim and reimbursement information after insurance processes the claim
## 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
## Related articles
Learn which clients, clinicians, and practitioner types may be able to use Thrizer.
Understand when insurance can be used with Thrizer and why coverage still depends on the insurer.
Compare Self-Pay, OON Pay, and Thrizer Pay before choosing a payment option.
Learn how benefit checks help estimate out-of-network costs and reimbursement.
See how clients pay upfront while Thrizer submits the out-of-network claim.
Learn how Thrizer Pay works when the client pays an estimated amount upfront.
# Who can use Thrizer
Source: https://docs.thrizer.com/help/getting-started/who-can-use-thrizer
See which clinicians may use Thrizer, including mental health providers, supervised clinicians, and other licensed healthcare providers.
## Overview
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 and whether they are legally allowed to provide the service. It also depends on 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.
## 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.
## 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.
## 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
* Speech Language Pathologists
* 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 confirming whether the provider can be supported.
Thrizer is still expanding support for some non-mental-health provider types, including occupational therapists, physical therapists, registered dietitians, and medical specialists. Claims for these provider types may see higher initial denial rates while Thrizer learns how each insurance carrier handles them.
Support for a provider type does not guarantee insurance reimbursement.
## 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, do not treat Thrizer as a guarantee that insurance will reimburse claims for supervised clinicians.
## 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.
## 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. Thrizer does not submit them 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 processes 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. The insurance carrier determines final claim processing, reimbursement, and insurer acceptance.
## Can clinicians practice across state lines?
Thrizer does not determine whether a clinician is legally permitted to practice across state lines.
Individual state and territorial licensing boards issue healthcare licenses. Practitioners may be licensed in any U.S. state, the District of Columbia, or U.S. territories such as Puerto Rico, which is the territory most commonly encountered.
Some clinicians can practice across multiple states through interstate licensure compacts. Examples include:
* PSYPACT, for psychologists
* The Counseling Compact, for professional counselors
* The Nurse Licensure Compact, for nurses and nurse practitioners
* The Social Work Compact, for social workers
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.
## Which provider types are not currently supported?
Thrizer does not currently support chiropractors or massage therapists.
## 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.
## What Thrizer does
Thrizer helps determine whether a provider can be supported based on provider type, claim requirements, available service information, and insurance-related constraints.
Thrizer may ask for additional information, such as commonly used CPT codes, to better understand whether the provider's services fit supported claim processes.
## 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.
## 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 music-based therapy does not guarantee that a claim will be approved or reimbursed.
## Related articles
Learn what affects whether a client's insurance can be used with Thrizer.
Understand how service codes fit into Thrizer claim processes.
Learn why diagnosis codes are needed for insurance claims.
See how Thrizer checks insurance benefits before estimating costs or reimbursement.
Review claim, billing, and payment options that Thrizer does not automatically support.
Learn what to do when a requested process does not fit Thrizer's supported structure.
# Thrizer Help Center
Source: https://docs.thrizer.com/help/index
Help articles for Thrizer clinicians and clients covering account setup, insurance, payments, claims, reimbursement, benefit checks, and the Thrizer Widget.
## What Thrizer is
Thrizer is the payment platform for private-pay care, with out-of-network billing built in when insurance applies.
For clinicians: Thrizer gives private-pay clinicians one place to charge clients for sessions, whether clients are fully self-pay or using out-of-network benefits. When out-of-network (OON) benefits apply, Thrizer can also help with benefit checks, estimated costs, eligible claim submission, and reimbursement support.
For clients: Thrizer is the platform your clinician uses to collect payment for sessions. If you have out-of-network benefits, Thrizer can also help check your estimated benefits, show an estimated session cost, and submit eligible claims for you.
Use these guides to set up your account, manage payments and claims, check out-of-network benefits, and understand what Thrizer supports.
Thrizer shows benefit and reimbursement estimates to help you plan. Insurance carriers make final decisions about coverage, claim approval, reimbursement, deductible application, and timing.
## Start by role
Add clients, check benefits, choose payment types, charge clients, review payments and payouts, manage claims, configure the Widget, and manage team members.
Set up your account, link insurance, add payment methods, generate superbills, view claims, export payments, and manage reimbursement bank details.
## New to Thrizer
Understand what Thrizer does, what it does not do, and how it works for clients and clinicians.
See which clients, clinicians, and practitioner types may be able to use Thrizer.
Learn when insurance can be used with Thrizer and why coverage still depends on the insurer.
Compare Thrizer with other out-of-network billing options before choosing an approach.
## Popular clinician guides
Learn simple ways to communicate Thrizer's value to your clients.
Learn the main clinician and practice-admin setup steps.
Add clients, filter the client list, view client details, and manage client connections.
Use benefit checks, request manual verification, and understand estimate limits.
Configure the Widget, manage services and team members, share a link, and embed the benefits calculator.
Create charges and understand how payment and automatic claim submission work.
## Popular client guides
Learn the main client setup steps and how the Client Portal is organized.
Add insurance details, edit plan information, and understand benefit checks.
Add cards, view saved cards, set a default card, and delete saved payment methods.
Understand allowed amounts, deductibles, coinsurance, claim outcomes, and why estimates can change.
## Common topics
### Insurance and benefit checks
* [Clinician: checking client benefits](/help/clinician/check-benefits)
* [Clinician: Thrizer Benefits Checker (Widget)](/help/clinician/thrizer-widget)
* [Client: linking or editing insurance](/help/client/link-insurance)
* [Client: estimates and reimbursement](/help/client/estimates-and-reimbursement)
### Payments and reimbursement
* [Clinician: payment types and eligibility](/help/clinician/payment-types-and-eligibility)
* [Clinician: charging clients](/help/clinician/charge-clients)
* [Clinician: payments, payouts, and refunds](/help/clinician/payments-payouts-and-refunds)
* [Client: adding payment methods](/help/client/payment-methods)
* [Client: adding a reimbursement bank account](/help/client/reimbursement-bank)
* [Client: viewing payments and generating superbills](/help/client/payments-and-receipts)
### Claims and superbills
* [Clinician: claims and superbills](/help/clinician/claims-and-superbills)
* [Clinician: unsupported workflows and limitations](/help/clinician/unsupported-workflows)
* [Client: claims and superbill uploads](/help/client/claims-and-superbills)
### Account and support
* [Clinician: settings and profile](/help/clinician/settings-and-profile)
* [Clinician: team members](/help/clinician/team-members)
* [Clinician: unsupported workflows and limitations](/help/clinician/unsupported-workflows)
* [Client: profile and account settings](/help/client/profile-and-settings)
* [Client: clinician connections](/help/client/clinician-connections)
* [Client: troubleshooting and support](/help/client/troubleshooting-and-support)
### Frequently asked questions
* [Which payment types are available?](/help/faq/which-payment-types-are-available)
* [Why Thrizer Pay may not be available](/help/faq/why-thrizer-pay-may-not-be-available)
* [Unsupported workflows and workarounds](/help/faq/unsupported-workflows-and-workarounds)
## Need help?
Contact [help@thrizer.com](mailto:help@thrizer.com).
# Clinician payout protection and clawbacks
Source: https://docs.thrizer.com/help/payments/clinician-payout-protection
How Thrizer protects clinician payouts from insurance outcomes, how payout timing differs from insurer reimbursement, and when refunds reverse a payout.
## No clinician clawbacks for insurance outcomes
Thrizer's policy is **no clinician clawbacks for insurance outcomes**.
A claim may be denied, reimburse less than expected, apply to the client's deductible, or result in \$0 reimbursement. Thrizer does not reverse your payout because of that claim outcome.
## Can Thrizer claw back a clinician payout if a claim is denied?
No. Thrizer does not reverse your payout because of:
* a claim denial
* a reimbursement shortfall
* reimbursement variance from the original estimate
* \$0 reimbursement (for example, when the claim was applied to the client's deductible)
This protection covers insurer-driven outcomes. It does **not** apply to a refund you initiate. A refund you initiate can still reverse the refunded transaction amount from your payout. See [The main exception: clinician-initiated refunds](#the-main-exception-clinician-initiated-refunds) below.
Your payout timing is also separate from insurer reimbursement timing. You do not wait for insurance to process a claim before receiving payout through Thrizer.
## How this works for Thrizer Pay
This is especially important for Thrizer Pay, because Thrizer advances part of the session fee before insurance finishes processing the claim.
With Thrizer Pay:
* the client pays an estimated out-of-pocket responsibility upfront
* Thrizer advances the rest of the session fee to you
* Thrizer submits the claim and receives any insurance reimbursement
* Thrizer carries the reimbursement risk relative to you
If the final insurance result differs from the estimate, your payout is still protected. Where applicable, Thrizer handles any adjustment on the client side, for example with an additional client charge, a client refund, or updated estimates for future sessions. Thrizer does not handle it by clawing back your payout.
Your payout is not reduced later if insurance:
* denies the claim
* reimburses less than expected
* reimburses \$0
* applies the claim to the client's deductible
## How this works for OON Pay
With OON Pay, the client pays the full session fee upfront and Thrizer sends any insurance reimbursement back to the client.
Because you are paid from the client's upfront payment rather than from a Thrizer advance, insurance outcomes also do not reverse your payout under OON Pay.
## The main exception: clinician-initiated refunds
The main exception to payout protection is a refund you initiate.
If you refund a transaction, the refund can reverse the refunded transaction amount from your payout. The client receives a refund for the amount originally charged, and Thrizer reduces your payout by the refunded amount.
This is separate from an insurance-related clawback. It is driven by your own refund action, not by an insurer claim outcome.
Thrizer Pay refunds are full-refund only. Thrizer Pay does not support partial refunds. The refund drawer refunds the full charge, reduces your payout by the full gross bill amount, and cancels the associated claim. See [Thrizer Pay refunds are full-refund only](/help/clinician/payments-payouts-and-refunds#thrizer-pay-refunds-are-full-refund-only) for details.
## Common clawback questions
**Can Thrizer claw back a clinician payout if a claim is denied?** No. A denied claim does not reverse your payout.
**What if the claim reimburses less than expected, or reimburses \$0?** No clawback. Reimbursement shortfalls, reimbursement variance, deductible application, and \$0 reimbursement do not reduce your payout.
**What if the insurer applies the claim to the client's deductible?** No clawback. Deductible application is an insurance outcome, not a payout reversal event.
**What is the exception?** A refund you initiate. If you refund a transaction, Thrizer reverses the refunded amount from your payout. This is not an insurance-driven clawback. It is your own refund action.
## What this does not cover
Payout protection is specifically about insurer claim outcomes. It does not mean Thrizer never reverses a transaction under any circumstance.
Other situations, such as refunds you initiate (described above), can still reduce your payout. If you have a question about a specific transaction, contact [help@thrizer.com](mailto:help@thrizer.com).
## Related articles
See how Thrizer advances the session fee, submits the claim, and receives any insurance reimbursement.
See how the client pays the session fee upfront and reimbursement is sent back to the client.
Review payouts, transactions, and how to issue a refund from the Clinician Portal.
Understand why final insurance results may differ from Thrizer's initial estimate.
# Deductibles, coinsurance, and allowed amounts explained
Source: https://docs.thrizer.com/help/payments/deductibles-coinsurance-and-allowed-amounts
Understand how deductibles, coinsurance, and allowed amounts affect out-of-network insurance reimbursement estimates and final claim outcomes in Thrizer.
## Overview
Insurance reimbursement is usually not based only on the amount you paid your clinician.
It usually depends on three things:
1. The amount your insurance plan recognizes for the service
2. Whether your deductible has been met
3. What share of the recognized amount your plan says you are responsible for
That is why an approved claim can still pay less than expected, or even pay \$0. In some cases, the claim is approved but the amount is applied to your deductible instead of being reimbursed to you.
Thrizer can help estimate these amounts before a claim is processed, but your insurance carrier determines the final allowed amount, reimbursement, deductible application, and claim outcome.
## How this works
Think of the process in three steps:
1. Your clinician sets a session fee.
2. Your insurance plan determines what amount it recognizes for that service.
3. Your deductible and coinsurance determine whether any of that amount is reimbursed.
If your deductible has not been met, the claim may be approved but still result in \$0 reimbursement. If your deductible has been met, reimbursement generally depends on your coinsurance and the allowed amount.
## Why does insurance use a different amount than your clinician charges?
Your clinician's session fee is the amount they charge for the appointment.
The allowed amount is the amount your insurance plan recognizes for that service. For out-of-network claims, insurance reimbursement is generally calculated from the allowed amount, not necessarily from the full session fee.
If your clinician charges more than the allowed amount, the difference may still be your responsibility. Insurance generally calculates reimbursement from the amount it recognizes, not from the full amount charged.
If your clinician charges less than the allowed amount, reimbursement is generally limited by the amount actually charged.
Before a claim is processed, the allowed amount is estimated. After the claim is processed, the insurance carrier determines the final allowed amount.
## Why might your claim go toward your deductible instead of reimbursing you?
A deductible is the amount you must pay out of pocket before your insurance starts reimbursing eligible services.
If your deductible has not been met, your insurance may apply the allowed amount toward your deductible instead of sending reimbursement.
That means the claim can still be processed and approved, even if no money is paid back to you.
## What happens after your deductible is met?
After your deductible is met, reimbursement usually depends on coinsurance.
Coinsurance is the percentage of the allowed amount that you are responsible for after your deductible has been met.
For example, if your plan says you are responsible for part of the allowed amount, insurance may reimburse the remaining portion. The exact amount depends on your plan and the final claim outcome.
Coinsurance is calculated from the allowed amount, not necessarily from your clinician's full session fee.
## Why can an approved claim pay \$0?
An approved claim means the insurance carrier accepted the claim. It does not always mean the carrier will pay reimbursement.
A claim may be approved and still pay \$0 if the allowed amount is applied to your deductible. This is common when your deductible has not been met.
A denied claim is different. If a claim is denied, there is no reimbursement and no deductible credit.
## Why can the estimate differ from the final amount?
Before a claim is processed, Thrizer may estimate reimbursement using available benefit information. These estimates can help set expectations, but they are not final.
Final reimbursement may differ because the insurance carrier determines:
* the final allowed amount
* whether the claim is approved or denied
* whether money is reimbursed or applied to deductible
* how much deductible remains
* how coinsurance applies
After a claim is processed, the insurer's response gives a more accurate picture of how that plan handles the service.
## What Thrizer does
Thrizer may use available benefit information to estimate reimbursement, deductible behavior, coinsurance, and expected out-of-pocket responsibility before the claim is processed.
These estimates are meant to help explain likely costs and reimbursement. They are not final claim outcomes.
## What insurance determines
The insurance carrier determines the final allowed amount, claim approval or denial, deductible application, reimbursement amount, and claim processing timing.
Thrizer does not guarantee reimbursement amount, coverage, claim approval, deductible application, claim timing, or final cost.
## What should you rely on?
You can use Thrizer's estimates to understand likely costs and reimbursement, but they should be treated as estimates.
The final outcome depends on the insurance carrier's claim processing.
## Related articles
Learn how out-of-network reimbursement generally works through Thrizer.
Understand why an approved claim can still result in \$0 reimbursement.
Learn why estimated reimbursement may not match the final insurer-determined amount.
Walk through simple examples showing how deductible, coinsurance, and allowed amount affect payment.
Learn how benefit checks help estimate reimbursement before a claim is processed.
# How OON Pay works
Source: https://docs.thrizer.com/help/payments/how-oon-pay-works
See how Thrizer OON Pay works: clients pay the session fee upfront, Thrizer submits the out-of-network claim, and any reimbursement returns to the client.
## How this works
OON Pay is for out-of-network care where the client pays the full session fee upfront and Thrizer submits the insurance claim.
If insurance reimburses the claim, Thrizer sends the reimbursement back to the client.
The client can use OON Pay before or after they have met their deductible. Deductible status affects whether reimbursement is likely and whether Thrizer's OON Pay fee applies. Insurance still decides reimbursement.
Thrizer does not guarantee that a claim will be approved, reimbursed, or paid by a certain date.
## How OON Pay works
With OON Pay:
* the client pays the full session fee upfront
* Thrizer submits the out-of-network claim after payment succeeds
* insurance processes the claim
* Thrizer sends any reimbursement back to the client
* Thrizer's OON Pay fee applies only after the client's deductible is met
* the clinician does not wait for insurance to process the claim before receiving payout through Thrizer
OON Pay is different from Thrizer Pay. With OON Pay, the client pays the full fee upfront and receives any reimbursement. With Thrizer Pay, the client pays an estimated amount upfront, and Thrizer receives the reimbursement because Thrizer advanced part of the session fee.
## Why clients use OON Pay
OON Pay is useful when a client wants Thrizer to handle the out-of-network claim but is still paying the clinician's full session fee upfront.
Without OON Pay, the client may need to pay the clinician directly, collect a superbill, submit the claim to insurance, and track the reimbursement process on their own.
With OON Pay, Thrizer helps submit and track the claim after the payment is processed.
## How an OON Pay session works
A typical OON Pay session works like this:
1. The clinician creates a charge for the session.
2. The client pays the full session fee.
3. Thrizer submits the out-of-network claim after the payment is successfully processed.
4. Insurance processes the claim.
5. If insurance reimburses the claim, Thrizer sends the reimbursement to the client.
The client does not need to submit a separate claim for an OON Pay session.
## What the client pays
With OON Pay, the client pays the clinician's full session fee upfront.
The client may later receive reimbursement if insurance reimburses the claim.
The final reimbursement depends on the client's plan, deductible, coinsurance, the amount insurance recognizes for the service, and the final claim result.
## Where reimbursement goes
For OON Pay, any insurance reimbursement belongs to the client.
That is because the client already paid the full session fee upfront.
If insurance reimburses the claim, Thrizer sends the reimbursement to the client's reimbursement account.
OON Pay direct deposit is not currently available for **Anthem BCBS, Carelon, NYSHIP, or Wellpoint** clients. Elevance Health has updated its guidelines so reimbursement for these plans is sent by paper check directly from the insurance company to the client. The 1% OON Pay fee does not apply to these claims. See [Elevance Health reimbursement changes](/help/claims/elevance-health-reimbursement) for details.
## When the OON Pay fee applies
Thrizer's OON Pay fee is 1% of the clinician's full session fee.
The fee applies only when Thrizer sends reimbursement to the client. If insurance pays \$0 on the claim, Thrizer does not charge an OON Pay fee. After the deductible is met and Thrizer sends reimbursement, Thrizer deducts the fee from that reimbursement.
For example, if the session fee is \$200, the OON Pay fee is based on \$200. It is not based on the amount insurance reimburses.
### When the OON Pay fee is not charged
Thrizer does not charge the 1% OON Pay fee when:
* insurance reimburses \$0 on the claim
* the insurer sends reimbursement directly to the client instead of sending it through Thrizer (for example, a paper check mailed to the client by the insurer)
Reimbursement checks that an insurer mails directly to the client are free and do not trigger the 1% OON Pay fee. Some insurers handle out-of-network reimbursement this way. Thrizer cannot control how an insurer chooses to send reimbursement.
## What the clinician receives
OON Pay lets the clinician collect payment without waiting for insurance.
The clinician receives payout through Thrizer's payout process. Standard payment processing fees may apply to clinician payment transactions.
The clinician's payout is not reduced later if insurance:
* denies the claim
* reimburses less than expected
* reimburses \$0
* applies the claim to the client's deductible
## What happens if the client has not met their deductible
If the client has not met their deductible, insurance may approve the claim but pay \$0.
That usually means the amount insurance recognizes for the session was applied toward the client's deductible instead of being reimbursed.
This does not always mean something went wrong. The claim may still help the client move closer to meeting their deductible.
## What happens after the deductible is met
After the deductible is met, reimbursement usually depends on:
* the amount insurance recognizes for the session
* the client's coinsurance
* the final claim result
* any other plan rules
Insurance usually calculates reimbursement from the amount it recognizes for the service, not necessarily the clinician's full session fee.
If the clinician's fee is higher than the amount insurance recognizes, the difference may remain the client's responsibility.
## Why reimbursement can differ from the estimate
Any reimbursement amount shown before insurance finishes processing the claim is an estimate.
The final result can change because insurance decides:
* whether the claim is approved or denied
* what amount it recognizes for the service
* whether the claim is reimbursed or applied to deductible
* how much reimbursement is paid
* when the claim is processed
An approved claim can still result in \$0 reimbursement if insurance applies the amount to the client's deductible.
## Important limits
OON Pay is not a guarantee that insurance will reimburse the claim.
Thrizer does not guarantee:
* claim approval
* reimbursement amount
* reimbursement timing
* final out-of-pocket cost
OON Pay also depends on complete claim information. A claim generally needs provider information, service information, diagnosis code, CPT code, and billed amount.
A single charge generally creates a single claim. Multiple services may need to be handled as separate charges or claims.
## How to explain OON Pay simply
A simple explanation is:
> OON Pay lets the client pay the full session fee upfront while Thrizer submits the out-of-network claim. If insurance reimburses the claim, Thrizer sends the reimbursement back to the client. The final reimbursement still depends on the insurance company's claim decision.
## Related articles
Compare OON Pay, Thrizer Pay, and Self-Pay before choosing a payment option.
Learn how Thrizer Pay differs from OON Pay when the client does not pay the full session fee upfront.
Understand the insurance terms that affect whether an OON Pay claim results in reimbursement.
Learn why final reimbursement may differ from the amount shown before insurance processes the claim.
See what happens after a claim is submitted and why insurer processing time can vary.
How Thrizer protects clinician payouts from insurance outcomes and when a clinician-initiated refund can reverse a payout.
# How Thrizer Pay works
Source: https://docs.thrizer.com/help/payments/how-thrizer-pay-works
Learn how Thrizer Pay lets eligible clients pay an estimated amount upfront while Thrizer advances the rest of the session fee to the clinician.
## How this works
Thrizer Pay helps eligible clients avoid paying the full session fee upfront for out-of-network care.
Instead, the client pays an estimated out-of-pocket amount based on available insurance and claim information. Thrizer advances the remaining portion of the session fee to the clinician, submits the claim, and receives any insurance reimbursement for that claim.
Thrizer Pay can make out-of-network care easier to afford upfront, but it is still based on estimates. Insurance makes the final decision on claim approval, deductible application, reimbursement amount, and timing.
Thrizer does not guarantee the final out-of-pocket cost, reimbursement amount, claim approval, or claim timing.
## How Thrizer Pay works
With Thrizer Pay:
* the client pays an estimated out-of-pocket amount upfront
* the client also pays a 5% Thrizer Pay fee
* Thrizer advances the rest of the session fee to the clinician
* Thrizer submits the insurance claim after payment succeeds
* any insurance reimbursement for that claim goes to Thrizer
* the clinician does not wait for insurance to process the claim before receiving payout through Thrizer
Thrizer Pay is not available for every client or every session. It requires enough reliable insurance and claim history for Thrizer to estimate the client's responsibility.
## Why clients use Thrizer Pay
Without Thrizer Pay, out-of-network clients often have to pay the full session fee upfront and wait for insurance reimbursement later.
Thrizer Pay changes that experience for eligible clients.
Instead of paying the full session fee upfront, the client pays an estimated responsibility at the time of service. Thrizer advances the rest upfront and waits for insurance reimbursement.
This can reduce the client's upfront cost when Thrizer Pay is available.
## How a Thrizer Pay session works
A typical Thrizer Pay session works like this:
1. The clinician creates a charge for the session.
2. The client pays their estimated responsibility plus the Thrizer Pay fee.
3. Thrizer submits the insurance claim after the payment is successfully processed.
4. Thrizer advances the remaining portion of the session fee to the clinician.
5. Insurance processes the claim.
6. Thrizer receives any insurance reimbursement for that claim.
7. If the final insurance result differs from the estimate, Thrizer may adjust the client's balance.
The client does not need to submit a separate claim for a Thrizer Pay session.
## What the client pays
With Thrizer Pay, the client pays:
* their estimated out-of-pocket responsibility
* a 5% Thrizer Pay fee
The 5% fee is based on the clinician's full session fee, not on the amount insurance eventually reimburses.
For example, if the clinician's session fee is \$200, the Thrizer Pay fee is based on \$200.
The estimated responsibility is based on available insurance and claim information. It may use details such as deductible status, coinsurance, and the amount insurance is expected to recognize for the service.
Because insurance has not finished processing the claim yet, this amount is still an estimate.
## What the clinician receives
Thrizer Pay is designed so the clinician can receive payout without waiting for insurance.
The clinician receives payout through Thrizer's payout process. Standard payment processing fees may apply to clinician payment transactions.
The clinician's payout is not reduced later if insurance:
* denies the claim
* reimburses less than expected
* reimburses \$0
* applies the claim to the client's deductible
This protection covers insurance-driven outcomes. It does not apply to refunds the clinician initiates. If the clinician issues a refund for a Thrizer Pay transaction, Thrizer reverses the clinician's payout for the refunded amount and refunds the client the amount originally charged.
Thrizer Pay refunds are full-refund only. Partial refunds are not supported. See [Thrizer Pay refunds are full-refund only](/help/clinician/payments-payouts-and-refunds#thrizer-pay-refunds-are-full-refund-only) for how the drawer behaves and what the client and clinician each see.
## Why reimbursement goes to Thrizer
With Thrizer Pay, Thrizer advances part of the session fee before insurance finishes processing the claim.
Because Thrizer advanced that amount, Thrizer receives any insurance reimbursement for the claim.
This is different from OON Pay. With OON Pay, the client pays the full session fee upfront, so Thrizer sends any insurance reimbursement back to the client.
## When Thrizer Pay may be available
Thrizer Pay is not available for every client or every session. It generally requires primary insurance, a completed benefit check, a met deductible, and at least one successful prior claim. The Date of Service must also be today or tomorrow. This is a calendar-day restriction, not a rolling 24-hour window. The rendering clinician must also have a valid Individual NPI.
If Thrizer does not yet have enough reliable information, or the charge does not meet those conditions, Thrizer Pay may not appear as an option. Other claim submission options may still be available.
Thrizer Pay is also not available for clients on **Anthem BCBS, Carelon, NYSHIP, or Wellpoint** plans. Elevance Health now reimburses these plans by paper check only, so Thrizer Pay cannot advance the session fee. See [Elevance Health reimbursement changes](/help/claims/elevance-health-reimbursement).
For the full list of reasons Thrizer Pay may not appear, see [Why Thrizer Pay may not be available](/help/faq/why-thrizer-pay-may-not-be-available).
## Why the estimate can change
Thrizer Pay uses an estimate before insurance finishes processing the claim.
The final result can change because insurance decides:
* whether the claim is approved or denied
* what amount it recognizes for the service
* whether the claim is reimbursed or applied to deductible
* how much reimbursement is paid
* when the claim is processed
An approved claim can still result in \$0 reimbursement if insurance applies the amount to the client's deductible.
After insurance processes a claim, Thrizer may use the actual result to improve future estimates.
## What happens if the final amount is different from the estimate
If the final insurance result differs from the estimate, Thrizer may adjust the client's balance.
Depending on the result, this may lead to:
* an additional client charge, if insurance reimbursed less than estimated
* a client refund of the difference, if insurance reimbursed more than estimated
* updated estimates for future sessions
The clinician's payout is not affected by these adjustments.
These adjustments are based on insurer-determined claim results. They are not changes to the clinician's payout.
## What happens if the claim is denied
If the claim is denied, Thrizer refunds the Thrizer Pay fee to the client.
If the claim is approved (including when insurance applies the claim to the client's deductible), Thrizer retains the Thrizer Pay fee.
The clinician's payout is not reduced because of the denial.
Insurance determines whether a claim is approved or denied. Thrizer helps submit and track the claim, but Thrizer does not control the final insurance decision.
## Important limits
Thrizer Pay is not a guarantee that insurance will reimburse the claim.
Thrizer does not guarantee:
* claim approval
* reimbursement amount
* reimbursement timing
* final out-of-pocket cost
* availability of Thrizer Pay for every client
Thrizer Pay also depends on complete claim information. A claim generally needs provider information, service information, diagnosis code, CPT code, and billed amount.
## How to explain Thrizer Pay simply
A simple explanation is:
> Thrizer Pay lets eligible clients pay an estimated amount upfront instead of the full session fee. Thrizer advances the rest to the clinician, submits the claim, and receives any insurance reimbursement. The final insurance result can still differ because insurance makes the final claim decision.
## Related articles
Learn why Thrizer Pay may not appear as an option for every client or session.
Compare Thrizer Pay with OON Pay, where the client pays the full session fee upfront and receives reimbursement through Thrizer.
Understand the insurance terms that affect estimated responsibility and reimbursement.
Learn why final insurance results may differ from Thrizer's initial estimate.
See why an approved claim can still result in \$0 reimbursement when deductible rules apply.
How Thrizer protects clinician payouts from insurance outcomes and when a clinician-initiated refund can reverse a payout.
# Insurance and payment glossary
Source: https://docs.thrizer.com/help/payments/insurance-and-payment-glossary
Plain-English Thrizer glossary covering deductible, allowed amount, coinsurance, reimbursement, claim status, and OON Pay, Thrizer Pay, and Self-Pay terms.
## Overview
Insurance language can be confusing, especially when you are trying to understand what you may pay or what insurance may reimburse. This glossary explains common insurance and payment terms you may see in Thrizer.
These definitions are meant to help you understand the process. They do not guarantee what your insurance plan will cover or pay.
Insurance carriers determine final coverage, claim approval, reimbursement amounts, deductible application, and claim outcomes.
## Payment types
### Thrizer Pay
Thrizer Pay is a payment type where an eligible client pays an estimated out-of-pocket amount at the time of service instead of paying the full session fee upfront.
Thrizer advances the remaining portion of the session fee to the clinician. Because Thrizer advances that amount, any insurance reimbursement for that claim is sent to Thrizer.
The client's upfront amount is based on available insurance and claim information. Because it is an estimate, the final amount may differ after insurance processes the claim.
### OON Pay
OON Pay is a payment type where the client pays the full session fee upfront and Thrizer submits the out-of-network insurance claim.
If insurance reimburses the claim, the reimbursement is sent back to the client through Thrizer.
With OON Pay, reimbursement depends on the insurance carrier's final processing decision.
### Self-Pay
Self-Pay means no insurance claim is submitted through Thrizer.
The client pays for the service without using Thrizer for insurance claim submission or reimbursement.
## Cost and reimbursement terms
### Provider fee
The provider fee is the full session rate charged for a service.
Insurance reimbursement is not always based on the full provider fee. Insurance may use a different amount, called the allowed amount, when calculating reimbursement.
### Allowed amount
The allowed amount is the maximum amount an insurance plan recognizes for a covered service.
Insurance reimbursement is based on the allowed amount, not necessarily the provider fee. If the provider fee is higher than the allowed amount, the client may be responsible for the difference.
Before a claim is processed, the allowed amount may be estimated. After the claim is processed, the final allowed amount is determined by the insurance carrier.
### Deductible
A deductible is the amount a client must pay out of pocket before insurance begins reimbursing eligible claims.
If the deductible has not been met, an approved claim may still result in \$0 reimbursement. In that case, the allowed amount may be applied toward the deductible instead of being paid back to the client.
### Deductible status
Deductible status means whether the deductible has been met or not met at the time the claim is processed.
Deductible status may first be estimated from benefit information. After a claim is approved, deductible status may be updated based on the insurer's claim result.
### Coinsurance
Coinsurance is the portion of the allowed amount that the client is responsible for after the deductible is met.
Coinsurance is calculated from the allowed amount, not the provider fee.
### Estimated reimbursement
Estimated reimbursement is a predicted insurance payment amount based on available information.
It is not guaranteed. The final reimbursement amount is determined by the insurance carrier after the claim is processed.
### Estimated out-of-pocket responsibility
Estimated out-of-pocket responsibility is a predicted amount the client may pay for a service.
This estimate is usually based on available insurance information, including deductible status, coinsurance, and estimated reimbursement. It is not guaranteed.
### Reimbursement
Reimbursement is the amount an insurance carrier pays after processing the claim.
Reimbursement may go to the client, or it may follow the payment type being used. The insurance carrier determines the amount and timing.
## Claims terms
### Insurance claim
An insurance claim is a submission to an insurance company requesting reimbursement or deductible credit for a healthcare service.
A claim usually includes information about the client, provider, service, billed amount, diagnosis code, and insurance plan.
### Claim status
Claim status is the current processing state of a claim.
Common claim statuses are:
* Processing
* Investigating
* Approved
* Denied
An approved claim does not always mean the client receives money back. A claim may be approved and still result in \$0 reimbursement if the amount is applied to the deductible.
### Claim result
Claim result describes the financial outcome of a processed claim.
A claim result may include information such as reimbursement amount, deductible credit, or payment method.
### Reimbursed
A claim is reimbursed when insurance pays a portion of the allowed amount.
The reimbursement amount is determined by the insurance carrier.
### Applied to deductible
Applied to deductible means the claim was approved, but the reimbursement amount was \$0 because the allowed amount was applied toward the client's deductible.
This commonly happens when the deductible has not been met.
### Denied
Denied means the insurance carrier did not approve the claim for reimbursement or deductible credit.
If a claim is denied, reimbursement is \$0 and no deductible amount is applied.
## Coverage and benefit terms
### Out-of-network benefits
Out-of-network benefits are insurance benefits for services provided by providers who are not contracted with the client's insurance plan.
Having out-of-network benefits does not guarantee reimbursement. Coverage and reimbursement vary by plan and are determined by the insurance carrier.
### Coverage estimate
A coverage estimate is a predicted reimbursement or cost value based on benefit information available at the time of verification.
Coverage estimates are not guarantees. Final claim outcomes are determined by the insurance carrier.
### Primary insurance on file
Primary insurance on file means the client's insurance has been verified within Thrizer.
This does not guarantee specific coverage details, reimbursement amounts, or payment type availability.
### Eligibility
Eligibility means the client's insurance has been confirmed through a usable benefit check.
Eligibility does not determine coverage details, reimbursement amounts, or which payment types are available. Those depend on other rules and insurer processing.
### Usable benefit check
A usable benefit check means Thrizer has received enough benefit information to support claim submission and reimbursement estimates.
A usable benefit check can help estimate costs, but it does not guarantee final reimbursement or claim approval.
### Successful claim
A successful claim is a processed claim that results in either reimbursement or deductible application.
A successful claim helps confirm how insurance handled the claim, but future claims may still depend on the insurance carrier's rules and processing.
## Why estimates can change
Estimates are based on the information available before insurance finishes processing the claim.
Final outcomes may differ because the insurance carrier determines:
* the allowed amount
* whether the claim is approved or denied
* how much applies to the deductible
* whether reimbursement is issued
* the final reimbursement amount
Thrizer can help estimate and explain these values, but insurance determines the final outcome.
## Related articles
Learn how deductible status, coinsurance, and allowed amounts affect what a client may pay or receive back.
Understand how out-of-network reimbursement works and why insurance determines the final amount.
Learn why an approved claim can still result in \$0 reimbursement when deductible rules apply.
See why estimated reimbursement may change after insurance processes a claim.
Compare Self-Pay, OON Pay, and Thrizer Pay in plain language.
# Insurance payment examples
Source: https://docs.thrizer.com/help/payments/insurance-payment-examples
Simple examples that explain how session fees, allowed amounts, deductibles, coinsurance, reimbursement, OON Pay, and Thrizer Pay can work.
## Overview
These examples show how out-of-network insurance payments can work in common Thrizer situations.
They use simple numbers to explain the relationship between:
* the clinician's session fee
* the insurance allowed amount
* the client's deductible
* coinsurance
* reimbursement
* OON Pay
* Thrizer Pay
These examples are educational only. They do not guarantee what any specific insurance plan will cover, approve, apply to a deductible, or reimburse. Insurance determines the final allowed amount, deductible application, reimbursement amount, claim outcome, and claim timing.
## Before you read the examples
A few terms matter most.
**Session fee** is the clinician's full charge for the session.
**Allowed amount** is the amount the insurance plan uses to calculate reimbursement. Insurance reimbursement is based on the allowed amount, not necessarily the full session fee.
**Deductible** is the amount a client must pay before insurance begins reimbursing eligible services.
**Coinsurance** is the client's share of the allowed amount after the deductible has been met.
**Client responsibility**, in these examples, means the amount the client is responsible for after any reimbursement is considered. This may include deductible application, coinsurance, and any difference between the session fee and the allowed amount.
## Example 1: The deductible has not been met
A client has a \$200 session.
For this example:
* Session fee: \$200
* Insurance allowed amount: \$120
* Deductible remaining: \$500
* Claim status: Approved
Because the client still has more deductible remaining than the allowed amount, the insurer may apply the \$120 allowed amount toward the deductible.
In this example:
* Insurance reimbursement: \$0
* Amount applied to deductible: \$120
* Client responsibility: \$200
What this means: an approved claim can still result in \$0 reimbursement when the client's deductible has not been met.
## Example 2: The deductible is partly met during the claim
A client has a \$200 session.
For this example:
* Session fee: \$200
* Insurance allowed amount: \$120
* Deductible remaining: \$50
* Client coinsurance after deductible: 20%
* Insurer share after deductible: 80%
* Claim status: Approved
The first \$50 of the allowed amount is applied to the remaining deductible. That leaves \$70 of the allowed amount after the deductible is met.
The insurer then reimburses 80% of the remaining \$70.
In this example:
* Amount applied to deductible: \$50
* Remaining allowed amount after deductible: \$70
* Insurance reimbursement: \$56
* Client responsibility: \$144
What this means: a claim can produce partial reimbursement when part of the allowed amount goes to the deductible and the rest is reimbursed based on coinsurance.
## Example 3: The deductible has already been met
A client has a \$200 session.
For this example:
* Session fee: \$200
* Insurance allowed amount: \$120
* Deductible remaining: \$0
* Client coinsurance: 20%
* Insurer share: 80%
* Claim status: Approved
Because the deductible has already been met, reimbursement is based on the allowed amount and coinsurance.
In this example:
* Insurance reimbursement: \$96
* Client responsibility: \$104
What this means: even after the deductible is met, the client may still be responsible for part of the session fee. That can include the client's coinsurance and any difference between the session fee and the allowed amount.
## Example 4: The session fee is lower than the allowed amount
A client has a \$100 session.
For this example:
* Session fee: \$100
* Insurance allowed amount: \$120
* Deductible remaining: \$0
* Client coinsurance: 20%
* Insurer share: 80%
* Claim status: Approved
When the session fee is lower than the allowed amount, reimbursement is based on the lower amount.
In this example:
* Effective amount used for reimbursement: \$100
* Insurance reimbursement: \$80
* Client responsibility: \$20
What this means: insurance does not reimburse more than the amount charged for the session.
## Example 5: OON Pay after the deductible has been met
A client uses OON Pay for a \$200 session.
For this example:
* Session fee: \$200
* Assumed insurance reimbursement: \$96
* OON Pay client fee: 1% of the session fee
* Claim status: Approved
* Reimbursement amount: \$96
With OON Pay, the client pays the full session fee upfront. Thrizer submits the claim automatically after the clinician creates the charge and the payment is successfully processed. If the insurer reimburses the claim, reimbursement is sent to the client.
In this example:
* Client pays upfront: \$200
* Insurance reimbursement: \$96
* OON Pay fee: \$2
* Net reimbursement sent to client: \$94
What this means: with OON Pay, the client pays first and waits for reimbursement. The OON Pay fee is deducted from the reimbursement only when there is reimbursement.
## Example 6: OON Pay before the deductible has been met
A client uses OON Pay for a \$200 session.
For this example:
* Session fee: \$200
* Insurance allowed amount: \$120
* Deductible remaining: \$500
* Claim status: Approved
* Reimbursement amount: \$0
The client pays the full session fee upfront. The insurer approves the claim, but the allowed amount is applied to the client's deductible instead of being reimbursed.
In this example:
* Client pays upfront: \$200
* Insurance reimbursement: \$0
* Amount applied to deductible: \$120
* OON Pay fee: \$0
What this means: before the deductible is met, OON Pay can still include claim submission and tracking, but the client may not receive reimbursement.
## Example 7: Thrizer Pay when available
A client uses Thrizer Pay for a \$200 session.
This example assumes Thrizer Pay is available for the client.
For this example:
* Session fee: \$200
* Estimated client responsibility: \$104
* Thrizer Pay fee: 5% of the session fee
* Estimated insurance reimbursement: \$96
* Claim status: Approved
With Thrizer Pay, the client pays the estimated responsibility plus the Thrizer Pay fee at the time of service. Thrizer advances the remaining portion of the clinician's session fee. Insurance reimbursement is sent to Thrizer.
In this example:
* Estimated client responsibility: \$104
* Thrizer Pay fee: \$10
* Client pays upfront: \$114
* Estimated amount advanced by Thrizer: \$96
* Insurance reimbursement route: Insurance → Thrizer
What this means: with Thrizer Pay, the client does not pay the full session fee upfront. The final insurer outcome may still differ from the estimate, and that difference may result in an additional client charge or a refund.
## Example 8: The claim is denied
A client has a \$200 session.
For this example:
* Session fee: \$200
* Claim status: Denied
When a claim is denied, there is no reimbursement and no deductible credit from that claim.
In this example:
* Insurance reimbursement: \$0
* Amount applied to deductible: \$0
What this means: a denied claim is different from an approved claim that is applied to the deductible. An approved claim may still affect the deductible even if no money is reimbursed. A denied claim does not create reimbursement or deductible application.
## Why estimates can differ from the final result
Before a claim is processed, allowed amounts and reimbursement are based on available information. After the insurer processes the claim, the insurer determines the final allowed amount, deductible application, reimbursement amount, and claim outcome.
Estimates may differ from the final result because:
* the allowed amount changes after the insurer processes the claim
* deductible information changes
* the insurer approves or denies the claim
* the insurer applies the claim to the deductible instead of reimbursing money
This is why estimated reimbursement and estimated out-of-pocket responsibility should be treated as guidance, not a guarantee.
## Related articles
Learn the core insurance terms used throughout these examples.
Understand how out-of-network reimbursement is generally calculated.
Learn why estimated reimbursement may not match the final insurer result.
See why an approved claim can still result in \$0 paid to the client.
Learn how OON Pay works when the client pays upfront and waits for reimbursement.
Learn how Thrizer Pay works when the client pays an estimated responsibility upfront.
# Pricing overview
Source: https://docs.thrizer.com/help/payments/pricing-overview
Understand what Thrizer costs for clients and clinicians, including OON Pay client fees, Thrizer Pay financing fees, and clinician payment processing rates.
## Overview
Thrizer does not charge monthly subscription fees, minimum usage fees, or long-term contract fees.
Costs depend on how the session or claim is handled. Some fees apply to clients. Some fees apply to clinicians. In some cases, both a client fee and a clinician processing fee may apply.
Insurance reimbursement is separate from Thrizer pricing. Paying a Thrizer fee does not guarantee that insurance will approve a claim, reimburse a claim, or pay a specific amount.
| Payment type | Client fee | Clinician fee | What happens with insurance |
| ------------ | ------------------------------------------------------------------------------------ | ----------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------- |
| Self-Pay | No client Thrizer fee | 3% payment processing fee if payment is processed through Thrizer | No insurance claim is submitted through Thrizer |
| OON Pay | 1% of the session fee, only when reimbursement is sent to the client through Thrizer | 3% payment processing fee | Thrizer submits the claim and sends reimbursement to the client if insurance pays |
| Thrizer Pay | 5% of the session fee, charged upfront | 3% payment processing fee | Thrizer advances part of the session fee to the clinician and receives insurance reimbursement if insurance pays |
## Client fees
Client fees depend on the payment type being used.
### OON Pay
With OON Pay, the client pays the full session fee upfront.
Thrizer submits the out-of-network claim after the payment is successfully processed. If insurance reimburses the claim, the reimbursement is sent back to the client through Thrizer.
The OON Pay fee is 1% of the clinician's full session fee.
This fee only applies when reimbursement is actually sent to the client through Thrizer. If insurance reimburses \$0, no OON Pay fee is charged.
The fee also does not apply when an insurer sends reimbursement directly to the client instead of through Thrizer. For example, if the insurer mails a reimbursement check straight to the client, that reimbursement is free and does not trigger the 1% OON Pay fee.
For example, if the session fee is \$200, the OON Pay fee is based on \$200. It is not based on the amount insurance reimburses.
### Thrizer Pay
With Thrizer Pay, the client pays an estimated responsibility upfront instead of paying the full session fee.
Thrizer advances the remaining portion of the session fee to the clinician. Because Thrizer advanced that amount, insurance reimbursement for the claim is sent to Thrizer if insurance pays reimbursement.
The Thrizer Pay fee is 5% of the clinician's full session fee.
This fee is charged at the time of service.
If the claim is denied, the Thrizer Pay fee is refunded. If the claim is approved, the fee is retained. This includes claims that are approved but applied to the client's deductible.
Thrizer Pay is not available for every client or session. It depends on eligibility, deductible status, insurance information, prior claim history, and whether Thrizer Pay is supported for that situation.
### Self-Pay
With Self-Pay, no insurance claim is submitted through Thrizer.
There is no client Thrizer fee for Self-Pay.
If the payment itself is processed through Thrizer, the clinician payment processing fee may still apply to the clinician.
## Clinician fees
Clinicians pay a 3% payment processing fee when client payments are processed through Thrizer.
This fee is separate from any client fee.
The clinician processing fee is tied to the payment transaction. It does not depend on whether insurance later approves the claim, denies the claim, reimburses the claim, or applies the claim to the client's deductible.
## Why client and clinician fees are separate
Client fees and clinician fees pay for different parts of the process.
Client fees are tied to the client-facing payment or claim type, such as OON Pay or Thrizer Pay.
Clinician fees are tied to payment processing when a payment is run through Thrizer.
Because these are separate, more than one fee may apply to the same session.
## How claim outcomes affect fees
Insurance claim outcomes can affect some client fees.
| If this happens | Fee result |
| ---------------------------------------------------------------- | ------------------------------------------------- |
| OON Pay claim is processed before the client's deductible is met | The 1% OON Pay fee is not charged |
| Thrizer Pay claim is denied | The 5% Thrizer Pay fee is refunded |
| Claim is approved and applied to deductible | The claim is treated as approved for fee purposes |
An approved claim does not always mean money is reimbursed. Insurance may approve the claim and apply the amount to the client's deductible instead.
## Clinician-initiated refunds
If a clinician issues a refund for a Thrizer Pay transaction, the clinician's payout for that transaction is reversed, and the client is refunded the amount originally charged.
Thrizer Pay refunds are full-refund only. Partial refunds are not supported for Thrizer Pay transactions. The refund drawer refunds the full charge and cancels the associated claim. See [Thrizer Pay refunds are full-refund only](/help/clinician/payments-payouts-and-refunds#thrizer-pay-refunds-are-full-refund-only) for how this works from the Clinician Portal.
This is separate from claim-outcome handling. Thrizer Pay protections keep the clinician's payout from being reduced by a claim denial, a lower reimbursement, or a \$0 reimbursement. Those protections do not apply to refunds the clinician chooses to issue.
## Referral program fee waivers
The clinician referral program can waive the 3% clinician processing fee for eligible transactions, up to a set volume cap.
* **Referred clinician.** A new clinician who signs up with a valid referral code during onboarding gets the 3% processing fee waived. The waiver applies to up to \$2,500 of transaction volume processed through Thrizer.
* **Referring clinician.** The referring clinician gets the 3% processing fee waived on up to \$2,500 of transaction volume for each clinician they refer. The waiver activates after the referred clinician submits their first charge.
The waiver applies only to the 3% clinician processing fee on payments processed through Thrizer. It does not apply to client fees or other charges. After the \$2,500 cap is reached, standard pricing resumes.
Thrizer applies the waiver per charge. If a single charge is larger than the remaining waived balance, Thrizer does not apply the waiver to that charge and charges the full 3% fee. Thrizer does not split the waiver across part of a charge.
For how to share your referral link or enter a referral code at sign-up, see [Referral program](/help/clinician/referral-program).
## What Thrizer fees do not guarantee
Thrizer fees do not guarantee:
* insurance coverage
* claim approval
* reimbursement amount
* reimbursement timing
* final out-of-pocket cost
* availability of every payment type
Insurance makes the final decision on claim approval, reimbursement, deductible application, and timing.
## What affects payment type availability
Pricing does not determine whether a payment type is available.
Payment type availability may depend on:
* insurance information
* deductible status
* whether benefits can be verified
* whether prior claim information is available
* whether the payment type is supported for that client and session
For example, Thrizer Pay has additional eligibility requirements and may not appear for every client.
## Related articles
Compare Self-Pay, OON Pay, and Thrizer Pay before choosing a payment type.
Learn how OON Pay handles upfront payment, claim submission, and reimbursement to the client.
Understand how Thrizer Pay estimates client responsibility and where reimbursement is sent.
Learn when Self-Pay applies and how superbills fit into client-submitted claims.
Review the insurance terms that affect reimbursement and out-of-pocket cost.
# Reimbursement basics
Source: https://docs.thrizer.com/help/payments/reimbursement-basics
How out-of-network reimbursement works through Thrizer, why estimates can change, and how deductibles, allowed amounts, and coinsurance affect payouts.
## Overview
Out-of-network reimbursement is money an insurance carrier may pay back after it processes a claim.
Thrizer helps submit and track supported claims, estimate reimbursement from available benefit information, and route reimbursements based on the payment type being used.
The insurance carrier makes the final decision on whether the claim is approved, whether money is reimbursed, how much is paid, and when the claim is processed.
Any reimbursement amount shown before insurance finishes processing the claim is an estimate, not a guarantee.
## How reimbursement usually works
Reimbursement usually depends on four things:
* what the clinician charges
* what insurance recognizes for the service
* whether the client has met their deductible
* what share of the cost the client owes after the deductible is met
The most important thing to know is this:
Insurance usually calculates reimbursement from the amount it recognizes for the service, not necessarily the clinician's full session fee.
## Why the clinician's fee and insurance amount can be different
The clinician's fee is the full session rate.
Insurance may recognize a different amount for the same service. That recognized amount is often called the allowed amount.
For example:
* the clinician charges \$200
* insurance recognizes \$140 for that service
* reimbursement is usually calculated from \$140, not \$200
The difference between the clinician's fee and the amount insurance recognizes may remain the client's responsibility.
## How the deductible affects reimbursement
A deductible is the amount a client must pay before insurance starts reimbursing eligible services.
If the deductible has not been met, a claim can be approved and still result in \$0 reimbursement.
That does not always mean the claim failed. It may mean insurance accepted the claim and counted the recognized amount toward the client's deductible instead of paying money back.
In plain English:
* approved can mean paid
* approved can also mean applied to deductible
* denied means insurance did not approve the claim for reimbursement or deductible credit
## How coinsurance affects reimbursement
Coinsurance is the client's share after the deductible has been met.
For example, if the deductible has been met, insurance recognizes \$140 for a session, and the client has 20% coinsurance:
* the client's share of the recognized amount is \$28
* insurance may reimburse the remaining \$112
* the client may still be responsible for any difference between the clinician's fee and the amount insurance recognizes
This example assumes the claim is approved and no other plan rules apply.
## Common claim outcomes
A processed claim usually falls into one of these categories.
| Outcome | What it means |
| --------------------- | ------------------------------------------------------------------------------------ |
| Reimbursed | Insurance accepted the claim and paid some amount |
| Applied to deductible | Insurance accepted the claim, but paid \$0 because the amount went toward deductible |
| Denied | Insurance did not approve the claim for reimbursement or deductible credit |
The "applied to deductible" outcome is one of the most common sources of confusion. The claim may be valid and accepted, but it does not produce a payment yet.
## Why an estimate can change
Before insurance processes a claim, Thrizer may estimate reimbursement using the information available at that time.
That information may include deductible status, coinsurance, plan details, and an estimated amount insurance may recognize for the service.
The final result can change because insurance makes the final decision after reviewing the claim.
Common reasons estimates change include:
* insurance recognizes a different amount for the session
* the claim goes toward deductible instead of reimbursement
* deductible information changes before the claim is processed
* the benefit check returned incomplete information
* insurance denies the claim
* the first processed claim gives new information about how the plan actually reimburses
## What benefit checks can tell you
A benefit check helps Thrizer estimate out-of-network benefits using information available from the insurance plan.
Benefit checks may help estimate:
* deductible status
* deductible remaining
* coinsurance
* whether out-of-network benefit information is available
* whether manual verification may be needed
Benefit checks are useful, but they are not final claim decisions. The insurance carrier still determines the final result after the claim is processed.
## What Thrizer does
Thrizer helps with:
* estimating reimbursement from available benefit information
* submitting supported out-of-network claims
* tracking claim status
* sending reimbursement based on the payment type
* updating future estimates when actual claim information becomes available
Thrizer does not decide whether insurance approves the claim or how much insurance pays.
## What insurance determines
The insurance carrier determines:
* whether the claim is approved or denied
* what amount it recognizes for the service
* whether the claim is reimbursed or applied to deductible
* how much reimbursement is paid
* when the claim is processed
This is why reimbursement estimates can be helpful but cannot be guaranteed.
## What this means for clients
Use reimbursement estimates as a planning tool.
The final amount may be higher, lower, or \$0. A \$0 reimbursement does not always mean something went wrong. It may mean the claim was applied to the deductible.
For OON Pay, you pay the full session fee upfront. If insurance reimburses the claim, reimbursement is sent back to you through Thrizer.
Some insurers send reimbursement directly to you instead of through Thrizer, for example by mailing a paper check to the address on file. The insurer chooses the delivery method, and Thrizer cannot control it. This does not change your upfront payment, your clinician's payout, or how Thrizer submits the claim. When reimbursement is sent directly to you this way, the 1% OON Pay fee is not charged.
For Thrizer Pay, you pay an estimated responsibility upfront. Thrizer advances part of the session fee to your clinician, so reimbursement for that claim goes to Thrizer. If the insurer's final result differs from the estimate, your final responsibility may change.
## What this means for clinicians
Do not present reimbursement estimates as guaranteed client savings.
A client's final reimbursement can differ from the estimate even when you submit the claim correctly.
Thrizer helps create a clearer claims and reimbursement process, but insurance remains responsible for final claim decisions.
## Related articles
Learn the insurance terms that most directly affect reimbursement.
Understand why Thrizer estimates may change after insurance processes a claim.
Learn why an approved claim can still result in \$0 reimbursement.
See how benefit checks help estimate out-of-network reimbursement before a claim is processed.
Learn how reimbursement is sent when a client pays the full session fee upfront.
Learn how Thrizer Pay uses estimates and how reimbursement is sent after claim processing.
# What is a benefit check?
Source: https://docs.thrizer.com/help/payments/what-is-a-benefit-check
Learn how a Thrizer benefit check helps estimate insurance reimbursement, what it can and cannot confirm, and why the final claim result may differ.
## Overview
A benefit check is an estimate based on insurance information available before a claim is processed.
It can help estimate whether an out-of-network session may be reimbursed, what deductible or coinsurance may apply, and what the client's out-of-pocket responsibility could be. It is not a final decision from the insurance company.
The processed claim is the final result for that claim.
## How this works
Thrizer uses benefit checks to understand whether there is enough insurance information to support claim submission and reimbursement estimates.
A benefit check may help answer questions like:
* Does the insurance plan appear usable with Thrizer?
* Does the plan have out-of-network benefit information available?
* Has the deductible been met?
* What coinsurance may apply?
* What reimbursement may be estimated?
These answers help clients and clinicians understand what may happen before a session is charged or a claim is submitted.
## What does "out-of-network" mean?
Out-of-network usually means the clinician does not have a direct contract with the insurance plan.
Many clients still have insurance benefits that may reimburse part of the cost for out-of-network care. The amount depends on the insurance plan, deductible, allowed amount, coinsurance, and how the insurance carrier processes the claim.
A benefit check helps estimate these pieces before the claim is processed.
## What a benefit check can tell you
A benefit check may show information such as:
* whether benefit information was successfully returned
* deductible status
* coinsurance
* out-of-network benefit details, when available
* estimated reimbursement
* estimated out-of-pocket responsibility
The exact information depends on what the insurance carrier makes available.
## When is a benefit check considered usable?
A benefit check is considered usable when Thrizer can return enough benefit information for the plan, either through an automated check or through manual verification.
A usable benefit check lets Thrizer:
* support claim submission for that client and plan
* generate reimbursement estimates
If a benefit check is not usable through either an automated or manual check, Thrizer cannot support claim submission or insurance-based payment for that client and plan. Self-Pay remains available.
## What benefit checks are more and less reliable for
Benefit checks are estimates, but not every piece of information is equally certain.
* **More reliable:** deductible status, coinsurance percentage, and whether coverage appears active. These can usually be treated as confirmed, though the insurance carrier may still adjust them when a claim is processed.
* **Less reliable:** the allowed amount used to calculate reimbursement. The insurance carrier sets the final allowed amount when it processes the claim.
This is why estimated reimbursement can change once the claim is actually processed.
## Is a benefit check a guarantee?
No. A benefit check is not a guarantee.
It does not guarantee:
* coverage
* claim approval
* reimbursement
* final cost
* claim timing
A benefit check uses information available before the insurance carrier processes the claim. The insurance carrier makes the final decision after the claim is submitted and reviewed.
## Why can the final claim result be different?
The final result can differ because insurance companies make the final decision when they process the actual claim.
For example, the insurance carrier determines:
* the final allowed amount
* whether the claim is approved or denied
* whether money is reimbursed or applied to the deductible
* how much deductible remains
* how coinsurance applies
Thrizer may estimate these values in advance, but the insurer's processed claim determines the final result for that claim.
## What is a deductible?
A deductible is the amount a client may need to pay before insurance starts reimbursing eligible services.
If the deductible has not been met, an approved claim may still pay \$0 because the amount is applied to the deductible instead of being reimbursed.
This does not necessarily mean the claim failed. It may mean the insurance carrier accepted the claim and counted it toward the deductible.
## What is coinsurance?
Coinsurance is the percentage of the allowed amount the client is responsible for after the deductible has been met.
For example, if a plan says the client is responsible for 30% coinsurance, insurance may reimburse the remaining portion of the allowed amount, depending on the final claim result.
Coinsurance is based on the allowed amount, not always the full session fee.
## What is an allowed amount?
The allowed amount is the amount an insurance plan uses to calculate reimbursement for a service.
This may be different from the clinician's full session fee. For example, if the clinician charges \$200 and the insurance plan's allowed amount is \$150, reimbursement is usually calculated from \$150.
Thrizer may estimate the allowed amount before the claim is processed, but the insurance carrier determines the final allowed amount.
## What if the benefit check fails?
A failed or incomplete benefit check does not automatically mean there is no coverage.
It may happen because:
* the insurance details do not exactly match the insurer's records
* the insurer did not return complete benefit details
* required benefit fields (such as deductible status, coinsurance, allowed amount details, or out-of-network reimbursement rules) are missing
* behavioral health benefits are handled by a separate administrator and were not included in the response
* the insurer does not share detailed out-of-network benefits through automated tools
* the insurer system timed out or returned only limited information
* the plan recently changed and insurer systems have not finished updating
* the plan requires manual phone verification
When information is missing, Thrizer does not fill in missing values by assumption. Manual verification may be needed before benefits can be safely interpreted.
## What is manual verification?
Manual verification means additional insurance information needs to be checked outside the automated benefit check.
The client may be asked to provide:
* the front of the insurance card
* the back of the insurance card
* date of birth
Manual verification can help confirm benefit details when the automated check does not return enough information.
## What Thrizer does
Thrizer helps check benefits, estimate costs, submit claims when the payment type supports claim submission, and track claim outcomes.
Thrizer uses available benefit information to estimate what may happen before the claim is processed.
## What insurance determines
The insurance carrier determines final coverage, reimbursement, deductible application, claim approval, and timing.
A benefit check can help set expectations, but it does not replace the insurer's processed claim result.
## What to rely on
Use the benefit check as an estimate to understand what may happen.
Use the processed claim as the final result for that claim.
## Related articles
Learn how Thrizer evaluates whether an insurance plan can be used.
Understand the insurance terms that affect reimbursement estimates.
See why the final claim result may be different from the benefit check estimate.
Learn why an approved claim can still result in \$0 reimbursement.
Learn what happens when automated benefit information is incomplete or unavailable.
# Why an approved claim may not pay reimbursement
Source: https://docs.thrizer.com/help/payments/why-an-approved-claim-may-not-pay-reimbursement
Why an approved insurance claim can still result in $0 reimbursement, deductible credit, or partial payment, and how to read the explanation of benefits.
## Overview
An approved claim does not always mean money will be reimbursed.
It means the insurance carrier accepted and processed the claim. Depending on your plan, the claim may result in reimbursement, may be applied to your deductible, or may pay only part of the expected amount.
This is most common when your deductible has not been met.
## What does "approved" mean?
When a claim is approved, the insurance carrier has accepted and processed the claim under the plan's rules.
Approved does not automatically mean:
* you will receive reimbursement
* the full session cost will be covered
* the estimate will match the final result
* your deductible has already been met
The claim still has a financial result. That result may be reimbursement, deductible application, partial reimbursement, or another plan-determined outcome.
## Why would an approved claim pay \$0?
An approved claim may pay \$0 when the allowed amount is applied to your deductible.
A deductible is the amount you may need to pay out of pocket before insurance begins reimbursing eligible claims. If your deductible has not been met, your insurance may accept the claim but apply the allowed amount toward your deductible instead of paying money back.
In that case, the claim was still processed. It just did not result in cash reimbursement.
## Can an approved claim pay partial reimbursement?
Yes. If part of your deductible remains, the insurance carrier may apply part of the allowed amount to your deductible and reimburse part of the remaining amount.
For example, the claim result may include:
* an amount applied to deductible
* an amount reimbursed based on your plan's coinsurance
The exact result depends on how much deductible remains and how your insurance carrier processes the claim.
## What happens after the deductible is met?
After your deductible is met, reimbursement generally depends on your coinsurance and the allowed amount.
Coinsurance is the portion of the allowed amount you are responsible for after your deductible has been met. Insurance reimbursement is usually calculated from the allowed amount, not necessarily from the clinician's full session fee.
That means your reimbursement may still be less than the full session cost.
## How is this different from a denied claim?
A denied claim is different from an approved claim with \$0 reimbursement.
If a claim is denied:
* there is no reimbursement
* no amount is applied to your deductible
* the claim does not result in payment or deductible credit
If a claim is approved and applied to deductible:
* reimbursement may be \$0
* the allowed amount may still count toward your deductible
* the claim may still be considered successfully processed
## Why can this differ from the estimate?
Before a claim is processed, Thrizer may show an estimate based on available benefit information. That estimate is not the final insurance outcome.
The final result can differ because the insurance carrier determines:
* the final allowed amount
* whether the claim is approved or denied
* how much deductible remains
* whether the claim pays reimbursement or applies to deductible
* how coinsurance is applied
Thrizer may help submit and track claims when the payment type supports claim submission, but the insurance carrier determines the final claim result.
## What should you do if you expected reimbursement?
First, check whether the claim result shows that the amount was applied to your deductible. If it was, the claim may have been processed correctly even though no reimbursement was paid.
If the result is unclear, contact Thrizer support for help reviewing the claim status and result. Some claim outcomes depend on insurer-specific processing, and Thrizer may need to review the claim details before explaining what happened.
## Related articles
Learn how reimbursement generally works for out-of-network claims.
Understand the insurance terms that determine whether a claim pays reimbursement or applies to deductible.
Learn why final reimbursement can be different from the estimate shown before a claim is processed.
See what happens after a claim is submitted and why timing depends on the insurance carrier.
Learn how OON Pay submits claims and returns reimbursement when insurance pays.
# Why reimbursement can differ from the estimate
Source: https://docs.thrizer.com/help/payments/why-reimbursement-can-differ-from-estimate
Why an out-of-network reimbursement estimate may not match the final insurance payment, and what approved, applied to deductible, and denied claims mean.
## Overview
A reimbursement estimate is Thrizer's best prediction before insurance finishes processing the claim. The final amount can differ because the insurance carrier makes the final decision after reviewing the claim.
That decision can affect:
* whether the claim is approved
* how much the plan recognizes for the session
* whether the amount goes toward the deductible
* whether any money is reimbursed
* whether the claim is denied
A difference between the estimate and the final result does not always mean something went wrong. In many cases, the claim was submitted correctly, but insurance processed it differently than the estimate predicted.
## How this works
Before insurance processes a claim, Thrizer may estimate reimbursement using the information available at that time.
That information can include the client's deductible, coinsurance, plan details, and the estimated amount the insurance carrier may recognize for the service. That recognized amount is often called the allowed amount.
These details are useful for planning, but they are not final. The final result comes only after the insurance carrier processes the claim.
## Why the estimate can change
### Insurance recognizes a different amount for the session
Insurance does not always calculate reimbursement from the clinician's full session fee.
Instead, insurance usually uses the amount it recognizes for that type of service. This is often called the allowed amount.
For example, if a clinician charges \$200, insurance may recognize a lower amount for the session. Reimbursement is usually based on the amount insurance recognizes, not necessarily the full \$200 session fee.
If the amount insurance recognizes is different from the estimate, the final reimbursement can change.
### The claim goes toward deductible
A claim can be approved and still result in \$0 reimbursement.
This often happens when the client has not met their deductible. In that case, insurance may accept the claim and count the recognized amount toward the deductible instead of sending reimbursement.
That means the claim still matters. It may help the client move closer to meeting their deductible, even though no money is paid back for that claim.
### Deductible information changes
Deductible information can change between the estimate and the final claim result.
This can happen if another healthcare claim is processed first, if the insurance carrier updates its records, or if the original benefit information was incomplete.
When deductible information changes, the estimated reimbursement may no longer match the final outcome.
### Benefit information was incomplete
Sometimes insurance systems do not return complete benefit information before a claim is processed.
For example, the insurance carrier may confirm general eligibility but not return complete out-of-network details. In other cases, the plan may not return enough information about deductible, coinsurance, or the amount it recognizes for the service.
When that happens, the estimate may be based on limited information. [Manual benefit verification](/help/widget/manual-benefit-checks) may help gather missing benefit details. The final outcome is still determined by insurance after the claim is processed.
### The claim is denied
If insurance denies the claim, there is no reimbursement for that claim.
A denial can happen for reasons determined by the insurance carrier. Thrizer can help submit and track claims, but it does not control whether insurance approves or denies them.
### The first claim is less predictable
The first claim for a client, plan, or service can be harder to estimate.
Before insurance processes the first claim, some information may still be based on available benefits or historical expectations. After the first claim is processed, Thrizer can use the actual insurance result to improve future estimates for similar claims.
Future estimates may become more useful after that, but they are still not guarantees. Insurance can still change how it processes future claims.
## Approved does not always mean paid
One of the most confusing parts of insurance is that "approved" does not always mean "reimbursed."
A claim can have different outcomes:
| Outcome | What it means |
| ---------------------------------- | ------------------------------------------------------------------------------------ |
| Approved and reimbursed | Insurance accepted the claim and paid some amount |
| Approved and applied to deductible | Insurance accepted the claim, but paid \$0 because the amount went toward deductible |
| Denied | Insurance did not approve the claim for reimbursement or deductible credit |
The middle case is common and can be frustrating. The claim was not necessarily rejected. It may simply have been applied to the deductible.
## What Thrizer does
Thrizer helps estimate, submit, and track out-of-network claims when the selected payment type supports claim submission.
After insurance processes a claim, Thrizer may update the claim information and future expectations based on the actual result.
That may include:
* whether the claim was reimbursed, applied to deductible, or denied
* the amount insurance recognized for the service
* whether the deductible changed
* whether future estimates should be adjusted
The exact impact depends on the payment type being used.
## What insurance determines
Insurance determines the final claim result.
That includes:
* whether the claim is approved or denied
* the allowed amount for the service
* whether the claim applies to deductible
* whether reimbursement is paid
* how much reimbursement is paid
* when the claim is processed
Thrizer does not guarantee reimbursement amount, claim approval, deductible application, or claim timing.
## What this means for clients
Use the estimate as a planning tool, not a final promise.
The final reimbursement may be higher, lower, or \$0. A \$0 reimbursement does not always mean the claim failed. It may mean insurance applied the claim to the deductible.
For OON Pay, you pay the full session fee upfront. If insurance reimburses the claim, the reimbursement is sent back to you through Thrizer.
For Thrizer Pay, you pay an estimated responsibility upfront. Thrizer advances part of the session fee to your clinician, so any insurance reimbursement for that claim is sent to Thrizer.
## What this means for clinicians
Avoid presenting reimbursement estimates as guarantees.
A client's final reimbursement can differ from the estimate even when you submit the claim correctly.
Thrizer is designed so the insurance claim result does not later reduce your payout. That protection applies if insurance denies the claim, reimburses less than expected, reimburses \$0, or applies the claim to the client's deductible.
## How to explain this simply
A simple explanation is:
> The estimate is based on the insurance information available before the claim is processed. The final amount can change because insurance makes the final decision after reviewing the claim. Sometimes an approved claim pays reimbursement, and sometimes it goes toward the deductible instead.
## Related articles
Learn how out-of-network reimbursement generally works through Thrizer.
Understand the insurance terms that most often affect reimbursement estimates.
Learn why an approved claim can still result in \$0 paid back to the client.
See how benefit checks help estimate costs before insurance processes a claim.
Walk through simple examples of deductibles, coinsurance, allowed amounts, and reimbursement.
Learn what happens after a claim is submitted and why timing can vary.
# How to set up the Thrizer Widget
Source: https://docs.thrizer.com/help/widget/how-to-set-up-the-thrizer-widget
Learn how clinicians can configure the Thrizer Widget, share it with prospective clients, and help clients estimate out-of-network benefits.
## Before you start
The Thrizer Widget lets prospective clients check estimated out-of-network benefits using the services and rates configured by your practice. You can customize the widget, embed it on your website, or share a Thrizer-hosted link. The results are estimates only, and insurance determines final coverage, reimbursement, and claim outcomes.
## Where do I find the Thrizer Widget?
You can find the widget in the Clinician Portal under the **Benefits** area.
From there, you can preview the widget, configure it, and select how to share it with prospective clients.
## What's required to show the widget
Before the public widget can be used, your account needs:
* At least one clinician set up
* At least one service for that clinician
* A rate for that service
* The clinician's **Display** setting set to **Shown**
Business information and bank information are **not** required to show the widget. The Thrizer Widget is free for clinician accounts.
## Who can manage widget settings?
Widget settings are managed by practice administrators and practice staff. Clinicians see a preview only. If you do not see edit options for your practice's widget, contact a practice administrator.
## What can I customize?
Open **Widget settings** from the Benefits Widget page to configure the widget. Settings are organized into three tabs:
* **Team** — Add team members and configure which services and rates appear in the widget.
* **Appearance** — Set branding details such as the practice name and colors.
* **Advanced** — Select how to share the widget, including the website embed type and the Thrizer-hosted shareable link.
The Benefits Widget page also shows a live preview of the public widget and analytics for traffic over time.
Use these settings to make the widget feel connected to your practice while still letting clients check their estimated out-of-network benefits through Thrizer.
## What needs to be set up before the widget works?
At least one team member must be active with a service and rate, and be set to **Shown** in Widget settings, before the widget can be used.
The services and rates connected to your team members determine what prospective clients can select in the public benefits calculator. If clients do not see the right service options, check that the relevant team member has an active service and rate configured.
## When you see a setup checklist instead of the live preview
When your widget is not ready to publish, the Benefits page hides the live preview. It shows a **Finish setting up your benefits widget** card with an **Action required** badge instead. The card replaces the preview so the remaining setup steps are what you see first.
The card shows three states, and each one comes with a clear next step:
* **No services added.** No team member has a publishable service yet. Select **Add services** to open Widget settings on the Team tab. Then add a service to a team member. If your practice has only one team member, that member's drawer opens automatically. A secondary **Customize** action opens the Appearance tab, which is optional but recommended.
* **All team members hidden.** At least one team member has services, but no one is set to **Shown** in the widget. Select **Manage Team** to open Widget settings, then turn on **Show in widget** for a team member. For a solo team, the relevant member's drawer opens automatically.
* **No active clinician on the team.** Your practice does not have an active clinician who can be published to the widget. Contact Thrizer support at [help@thrizer.com](mailto:help@thrizer.com) if you believe this is an error.
Once at least one team member is visible on the widget with a publishable service, the setup card disappears and the live preview returns automatically.
Clinicians who do not manage widget settings see an inactive-widget notice on the Benefits page instead of the setup hero. When available, the notice shows the name of a practice administrator to contact.
## How do I add team member services and rates?
You can add team member services and rates from **Benefits Widget → Widget settings → Team → Add team member**.
This is also available from **Clinician Portal → Team**.
Team member services and rates are what power the options clients see when they use the public benefits calculator.
## Widget rates vs. what you charge clients
The rate set for a service on the widget is used to generate the public benefit estimate that prospective clients see. It does not have to match the exact amount you charge a specific client.
The amount actually charged is determined by the client-specific rate or charge details you use when you create a Charge in the Clinician Portal.
Thrizer does not currently support sliding scale as an automated rate schedule, global pricing rule, or default charging profile applied across all clients. If you use sliding scale or client-specific rates, adjust the rate manually on each client's charge profile or on the Charge itself before charging. If you change your rate later, update the affected client charging profiles before their next charge.
Because widget results are estimates, a client's final charged amount and reimbursement can differ from the widget estimate.
## How do I control which team members appear in the widget?
Each team member has a **Show in widget** toggle in their drawer on the **Team** tab.
* New team members start hidden from the widget.
* The toggle stays disabled until the team member has at least one service. Add a service first, then turn on **Show in widget** to make the team member selectable in the public benefits calculator.
* If you remove every service from a team member, they are automatically hidden from the widget.
## How can I share the widget?
You can share the widget in two main ways:
1. Use the **Website Embed** option to place it on your practice website.
2. Use the **Shareable Link** option to send clients to a Thrizer-hosted version.
Both options live on the **Advanced** tab in Widget settings.
To copy your shareable link:
1. Go to **Clinician Portal → Benefits**.
2. Open **Widget settings** and select the **Advanced** tab.
3. Under **Shareable Link**, copy the Thrizer-hosted URL and paste it wherever you want to share it, such as your directory profile or an email.
The shareable link is useful if you do not want to edit your website right away or want to send the benefit check directly to a prospective client.
If the **Shareable Link** field does not appear on the Advanced tab, the widget is not ready to publish yet. Check that at least one team member has a service and rate configured and that **Show in widget** is turned on for that team member. See [What's required to show the widget](#whats-required-to-show-the-widget).
## What does the widget collect from clients?
The widget uses the client's service selection, session rate, and insurance details to generate an estimated reimbursement amount and estimated out-of-pocket responsibility.
The widget is designed for prospective benefit checks. Thrizer does not save the client information entered into the public widget.
## Are widget results guaranteed?
No. Widget results are estimates based on available insurance information. Final outcomes are determined by the insurance carrier after claim processing.
For the full list of what a benefit check can and cannot confirm, see [What is a benefit check?](/help/payments/what-is-a-benefit-check).
## Related articles
Learn what the Thrizer Widget does and how it helps prospective clients estimate out-of-network benefits.
Use the clinician-side benefit checker to estimate a client's out-of-network benefits from inside the portal.
Learn what happens when an automated benefit check does not return enough information.
Understand what benefit checks can estimate and why results are not guaranteed.
See how insurance compatibility depends on the client's plan, benefits, and verification results.
# How to use the Instant Benefit Checker
Source: https://docs.thrizer.com/help/widget/how-to-use-the-instant-benefit-checker
Learn how clinicians can use Thrizer's Instant Benefit Checker to estimate a client's out-of-network benefits before care or billing.
## Before you start
The Instant Benefit Checker helps clinicians estimate a client's out-of-network benefits before intake, consultation, or session billing. It can be useful when you are out-of-network with a client's insurance and want to understand what their plan may cover. Results are estimates and do not guarantee coverage, reimbursement, or final cost.
## Where do I find the Instant Benefit Checker?
You can find the Benefits Checker in the Clinician Portal under the **Benefits** area.
## What information do I need?
The Instant Benefit Checker asks for:
* Rate
* Service
* Client first name
* Client last name
* Date of birth
* Insurance company
* Member ID
Enter the information as accurately as possible. If the client's insurance details do not match the insurer's records, the benefit check may fail or return incomplete information.
## When should I use it?
Use the Instant Benefit Checker when you want to estimate a client's out-of-network benefits before starting care or billing for a session.
It is commonly used before:
* Intake
* Consultation
* Session billing
* Discussing possible out-of-network costs with a client
The benefit check is not required to create a charge or submit a claim, but it can help set expectations before services begin.
## What does the result mean?
The result gives estimated out-of-network benefit information based on available insurer data.
A benefit check can help estimate whether Thrizer has enough benefit information to support claim submission and reimbursement estimates. It does not guarantee that the insurer will approve a claim or reimburse a specific amount.
Insurance determines final coverage, deductible application, reimbursement, and claim outcomes.
## What if the benefit check fails or looks incomplete?
A failed or incomplete benefit check does not automatically mean the client lacks coverage. Common quick checks:
* Confirm the client's name, date of birth, insurance company, and Member ID match the insurer's records.
* Check whether behavioral health benefits are managed separately from general medical benefits.
* Consider whether the plan recently changed or requires manual phone verification.
If the automated check still does not provide enough information, manual verification may be required. See [Manual benefit checks](/help/widget/manual-benefit-checks) for the full list of reasons and what information may be needed.
## How do I request help with a benefit check?
If an automated benefit check is unavailable or fails, email [help@thrizer.com](mailto:help@thrizer.com) to request a manual benefit check. Thrizer may need additional insurance details to manually verify out-of-network benefits.
## Are Instant Benefit Checker results guaranteed?
No. Instant Benefit Checker results are estimates. The insurance carrier determines final outcomes.
For the full list of what a benefit check can and cannot confirm, see [What is a benefit check?](/help/payments/what-is-a-benefit-check).
## Related articles
Learn what a benefit check can and cannot tell you about a client's insurance.
Understand what happens when an automated benefit check fails or needs review.
Learn how the Thrizer Widget helps prospective clients estimate out-of-network benefits.
Set up the public benefit-checking widget for your practice.
Learn why benefit estimates may differ from the final insurer-determined outcome.
# Manual benefit checks
Source: https://docs.thrizer.com/help/widget/manual-benefit-checks
Learn why Thrizer may need to manually verify insurance benefits, what information may be needed, and what a manual check can and cannot confirm.
## When to request help
Thrizer may need to manually check insurance benefits when automated insurance systems do not return enough information.
This does not automatically mean the client does not have coverage. It usually means the available benefit information is incomplete, unclear, or not reliable enough to use for claim submission or reimbursement estimates.
A manual benefit check helps Thrizer determine whether enough benefit information is available to support claim submission and reimbursement estimates. Benefit checks are still estimates. The insurance carrier makes the final decision on coverage, claim approval, reimbursement, deductible application, and timing.
## Why manual benefit checks may be needed
A manual benefit check may be needed when automated insurance verification fails, returns only limited information, or leaves out important benefit details.
This can happen when:
* the insurance information does not exactly match the insurer's records
* the insurer did not return complete benefit details
* required benefit fields (such as deductible status, coinsurance, allowed amount details, or out-of-network reimbursement rules) are missing
* behavioral health benefits are handled by a separate administrator and were not included in the response
* the insurer does not share detailed out-of-network benefits through automated tools
* the insurer's system timed out or returned only limited information
* the plan recently changed and insurer systems have not finished updating
* the plan requires manual phone verification
An automated failure is not the same as a coverage denial. It only means the automated check did not return enough usable information.
## How to request a manual benefit check
**Clinicians:** email [help@thrizer.com](mailto:help@thrizer.com) to request a manual benefit check for a client.
**Clients:** email [help@thrizer.com](mailto:help@thrizer.com) and ask for a manual benefit check. It usually helps to include your clinician's name so support can connect the request to the right account.
## What information may be needed
Thrizer may ask for additional insurance details so the plan can be verified manually.
This may include:
* the front of the insurance card
* the back of the insurance card
* the client's date of birth
* corrected insurance information, if the submitted details do not match insurer records
These details help Thrizer identify the plan and request the missing benefit information.
## What a manual benefit check tries to confirm
A manual benefit check tries to confirm whether the client's insurance information can be used with Thrizer.
That may include confirming:
* whether benefit information can be obtained
* whether out-of-network benefit details are available
* deductible information
* coinsurance information
* whether reimbursement estimates can be generated
* whether claim submission can be supported for that client and insurance plan
## Does a failed automated check mean there is no coverage?
No. A failed or incomplete automated benefit check does not, by itself, mean there is no coverage.
Some insurance systems do not return complete out-of-network or behavioral health benefit details through automated tools. Sometimes an insurer may confirm general medical eligibility while leaving out behavioral health benefit information.
In those cases, manual verification may be needed before Thrizer can interpret the benefits safely.
## What happens after manual verification
If benefit information can be obtained and is complete enough, Thrizer may be able to support claim processes and generate reimbursement estimates.
If benefit information cannot be obtained through either automated or manual verification, Thrizer cannot support insurance-based payment types (OON Pay, Thrizer Pay, or claim submission) for that client. Self-Pay remains available.
## What if the plan is labeled HMO, Medicare, or Medicaid?
If a benefit check or the widget returns usable out-of-network benefit information, Thrizer can generally support claim submission for that plan. This applies even when the plan is labeled HMO, Medicare, Medicaid, or another type that clients sometimes assume is not supported.
HMO plans generally do not include out-of-network benefits, but rare plan-level exceptions exist. If you or your client believe the result looks inconsistent with the plan type, request a manual benefit check so support can review it before relying on it.
## What Thrizer does
Thrizer uses automated and, when needed, manual verification to try to obtain enough benefit information to support eligible Thrizer payment types.
Thrizer may use benefit information to help estimate reimbursement or client cost before a claim is processed.
Thrizer does not fill in missing benefit fields by assumption.
## What insurance determines
The insurance carrier determines the final claim outcome.
A manual benefit check does not guarantee:
* coverage
* reimbursement
* claim approval
* final allowed amount
* deductible application
* claim timing
The final outcome is determined by the insurance carrier after a claim is processed.
## Related articles
Learn what a benefit check is, what it estimates, and why it is not a guarantee.
See how clinicians can run an automated benefit check before manual review is needed.
Understand when insurance may be usable with Thrizer and why plan details still matter.
Learn why Thrizer Pay depends on verified benefit information and other eligibility rules.
Understand why benefit check estimates may differ from the insurer's final claim decision.
# Widget overview
Source: https://docs.thrizer.com/help/widget/widget-overview
Learn what the Thrizer Widget does, how clinicians share it with prospective clients, and how to read out-of-network benefit and reimbursement estimates.
## Overview
The Thrizer Widget lets prospective clients check estimated out-of-network benefits using the services and rates configured by a clinician or practice.
Clinicians can share a Thrizer-hosted link or embed the widget on their website. The widget can help clients understand estimated reimbursement and estimated out-of-pocket responsibility before starting care.
Widget results are estimates only. The insurance carrier determines final coverage, reimbursement, deductible application, and claim outcomes.
## Benefits Checker and widget
The Benefits Checker and the widget are part of the same benefits-checking setup in Thrizer. The Benefits Checker is the clinician-facing name inside the Clinician Portal, and the widget is the public version prospective clients use. Configuring one configures the other. You do not manage them as two separate products.
The widget is free to use for all clinician accounts. Business information and bank information are not required to display the public widget.
## How this works
The widget gives clients a way to check estimated out-of-network benefits before intake, consultation, or session billing.
It uses information such as:
* the selected service
* the session rate
* the client's insurance details
The widget uses those inputs to generate an estimated reimbursement amount and estimated out-of-pocket responsibility.
The widget uses the client information entered to generate the estimate. Thrizer does not save that information.
## Who the widget is for
The widget is mainly for clinicians or practices that want prospective clients to check out-of-network benefit estimates before they begin care.
Clients can use the widget through a link shared by the clinician or through an embedded version on the clinician's website.
## What information does the widget use?
The widget uses the clinician's configured services and rates, along with client insurance information entered during the benefit check.
Before the public widget can display a clinician, the practice must have:
* at least one active clinician set up
* at least one service for that clinician
* a rate for that service
* the clinician's Display setting set to **Shown**
Clinicians whose Display is set to Hidden do not appear on the public widget.
## What clinicians can customize or share
In the Clinician Portal, the Thrizer Widget supports:
* customization
* website embed
* a Thrizer-hosted shareable link
* analytics
The widget is managed from the Benefits area of the Clinician Portal. Editing widget settings requires a practice administrator or practice staff role. Clinicians see a preview only.
## Are widget results guaranteed?
No. Widget results are estimates based on available benefit information. Insurance carriers determine final coverage, reimbursement, claim approval, deductible application, and claim timing.
For the full list of what a benefit check can and cannot confirm, see [What is a benefit check?](/help/payments/what-is-a-benefit-check).
## What if the benefit check fails or looks incomplete?
A failed or incomplete automated benefit check does not automatically mean the client lacks coverage. In those cases, Thrizer may need manual verification before benefits can be safely interpreted.
See [Manual benefit checks](/help/widget/manual-benefit-checks) for common reasons, what information may be needed, and what manual verification can confirm.
## Is the widget required to create a charge or submit a claim?
No. The widget is intended to help clients check and understand estimated out-of-network benefits before care or billing.
Using the widget is not required to create a charge or submit a claim.
## What Thrizer does
Thrizer provides the widget so clinicians can offer prospective clients an estimated out-of-network benefit check using the clinician's configured services and rates.
Thrizer may use available benefit information to estimate reimbursement and estimated out-of-pocket responsibility.
## 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
## Related articles
Learn how clinicians configure, share, or embed the widget for prospective clients.
Compare the widget with the clinician-side benefit checker inside the Thrizer portal.
Understand what happens when automated benefit information is incomplete or unavailable.
Learn what benefit checks estimate, what they do not guarantee, and how to interpret results.
See why estimated reimbursement and final insurer-determined reimbursement may differ.