Top 10 Clearinghouses in Medical Billing (2027): Pricing, Picks, and How to Choose

The top 10 clearinghouses in medical billing for 2027 are Optum, Waystar, Availity, Cognizant TriZetto, Experian Health, Office Ally, The SSI Group, Quadax, Claim.MD, and Tebra. Picking a medical billing clearinghouse comes down to your claim volume, your payer mix, and your practice management (PM) system.

Looking for the best clearinghouse for medical billing? You'll get a short list sorted by situation. We checked published pricing in October 2026. You'll also see each network's payer reach, its KLAS results, its security record since 2024, the rule changes that take effect in 2027, and our picks by practice size and specialty.

MedSole RCM is a medical billing company, not a healthcare clearinghouse. No vendor paid to appear on this list. Our team works inside whichever clearinghouse a client already uses as part of our claims submission services. That means we read these networks' rejection reports every week.

Key takeaways

• A clearinghouse checks, formats, and routes your claims. It doesn't code, appeal, or chase payments.
• Free routes exist: Office Ally charges nothing for claims to participating payers, and Availity Essentials is free for transactions with health plans that sponsor it.
• Few vendors publish prices. Claim.MD lists $30, $60, and $120 monthly plans (checked October 25, 2026).
• Security comes first now. The February 2024 Change Healthcare attack affected about 192.7 million people (HHS, July 31, 2025).
• Quadax won the 2026 Best in KLAS award for Claims Management & Clearinghouse.
• Prior authorization APIs go live January 1, 2027, for Medicare Advantage, Medicaid, CHIP, and federal exchange plans, and the first HIPAA claims attachments standard is due May 26, 2028.
• Denials are still high: 40% of providers say 10% or more of their claims are denied (Experian Health, October 28, 2026).

What Are the Top 10 Clearinghouses in Medical Billing in 2027?

1. Optum (Change Healthcare): best for enterprise scale
2. Waystar: best for AI-powered automation
3. Availity: best for multi-payer connectivity
4. Cognizant TriZetto Provider Solutions: best for high-volume processing
5. Experian Health (ClaimSource): best for data-driven accuracy
6. Office Ally: best free option for small practices
7. The SSI Group: best for health system claims
8. Quadax: best for mid-sized hospitals and labs
9. Claim.MD: best value for transparent pricing
10. Tebra (formerly Kareo): best all-in-one option for independent practices

We numbered these top 10 medical clearinghouses to help you scan. Each one wins a different situation, so read the order as a map rather than a ranking. The reviews below give every vendor's network size, pricing model, and security record since 2024. Each figure carries its source and date.

What Is a Medical Billing Clearinghouse?

A medical billing clearinghouse is a company that receives your electronic claims, checks them against payer rules, converts them into the HIPAA standard format (ANSI X12 5010), and routes each one to the right insurance payer. It then sends back the payer's responses: acceptance reports, claim status updates, and electronic remittance advice (835 files).

Whether you call it a medical claims clearinghouse or a clearing house in medical billing, the job stays the same. One connection replaces hundreds of separate payer connections. The scrubber also catches errors before a payer sees the claim. The 2025 CAQH Index estimates that electronic transactions helped the industry avoid about $258 billion in administrative costs in 2024. Our guide to how clearinghouses work goes deeper on the workflow.

HIPAA's legal definition, at 45 CFR 160.103, covers this role. It describes a "health care clearinghouse" as an entity that converts health data between nonstandard and standard formats. That makes a healthcare clearinghouse a covered entity under HIPAA. The Privacy and Security Rules apply to it, as they apply to your practice.

Examples of Healthcare Clearinghouses (and the Old Names You'll Still See)

Common healthcare clearinghouse companies include Availity, Optum (Change Healthcare), Waystar, Cognizant TriZetto Provider Solutions, Experian Health, Office Ally, The SSI Group, Quadax, and Claim.MD. Many practice management systems, including Tebra and athenahealth, also have a clearinghouse built in.

Older brand names still turn up on payer enrollment forms and in software menus. This table maps each one to its current owner.

Types of Clearinghouses in Medical Billing

You'll run into four setups when you shop:

1. All-payer EDI clearinghouse: a standalone network your PM system connects to, such as Availity, Waystar, Office Ally, or Claim.MD
2. Built-in clearinghouse: part of a PM or EHR subscription, such as Tebra or athenahealth
3. Enterprise claims management platform: editing and routing for hospitals and large groups, including UB-04 claims, from The SSI Group, Quadax, or Experian Health
4. Direct payer connection: claims sent straight to one payer, such as a Medicare Administrative Contractor (MAC)

Clearinghouses also pass claims to one another to reach payers they have no direct connection with. That handoff is the source of the interconnect fees some vendors add to your bill.

Clearinghouse vs Payer Portal vs Billing Software

The difference between a clearinghouse and medical billing software comes down to one job each. Your billing software builds the claim. The clearinghouse checks that claim and delivers it to every payer you bill.

A billing company is the fourth option, because it runs all three tools for you. We compare that route with a clearinghouse later in this guide.

How a Claim Moves Through a Medical Billing Clearinghouse

A claim moves through a clearinghouse in five steps. Your PM system sends an 837 claim file. The clearinghouse scrubs it and confirms receipt with a 999. Next, the payer returns a 277CA showing whether it accepted or rejected the claim. Payment comes back as an 835 remittance, and the money arrives by EFT.

The HIPAA Transactions Every Clearinghouse Handles

Every healthcare EDI clearinghouse works with the same set of HIPAA standard transactions. That means these codes carry the same meaning whichever vendor you pick.

Hospitals and facilities send UB-04 claims through an EDI clearinghouse as 837I files. If your group bills both professional and facility claims, confirm that the clearinghouse supports 837P and 837I before you sign.

Attachments come next. HHS adopted the X12 275 and 277 transactions (version 6020) as the first HIPAA standard for electronic claims attachments, with compliance due May 26, 2028, while claims and remittances stay on version 5010. Only 24% of medical claim attachments were fully electronic in the 2025 CAQH Index, so many payers and vendors still have work to do.

A Real Claim, Start to Finish

This illustrative example follows one office visit through a medical billing clearinghouse. We made up the practice and the patient, and each step matches how real claims behave:

1. On Monday, a family practice's PM system sends an 837P for a 99214 visit to a commercial payer.
2. The scrubber flags a missing rendering provider NPI. The biller adds it the same day, before anything reaches the payer.
3. The 999 confirms the batch arrived. Then the payer's 277CA rejects the claim because the member ID doesn't match the subscriber's date of birth. Careful patient demographics entry at check-in would have stopped it.
4. The front desk corrects the patient record, and the biller resends the claim as a new original claim (frequency code 1). A rejected claim never entered adjudication, so it isn't a corrected claim (frequency code 7).
5. The next 277CA shows the claim accepted. Later, the 835 arrives with the allowed amount, a CARC 45 contractual adjustment, and the patient's share, and the team moves on to ERA payment posting.

Steps 2 and 3 show why the first-pass acceptance rate is the number to watch on any clearinghouse dashboard.

Clearinghouse Rejections vs Payer Denials

Clearinghouse rejections in medical billing happen before adjudication. The clearinghouse or the payer's front end bounces the claim for a data or format error, and you fix it and send it again as a new claim. A denial happens after the payer processes the claim and refuses payment, and it needs a corrected claim or an appeal.

You'll see rejections on 999 and 277CA reports, while denials show up on the 835 with CARC and RARC codes. An electronic claims clearinghouse only helps if someone on your team reads those rejection reports every day, before they pile up.

Speed matters for one more reason. Most payers don't treat a rejected claim as received for timely filing until you resend it and they accept it. A rejection left sitting for three weeks costs you three weeks of your filing window.

If your team reworks the same rejections every week, the cause in most practices sits in front-end data, not in the clearinghouse. Get a free RCM review, and we'll trace a month of your rejection reports back to where they start.

How to Choose a Medical Billing Clearinghouse: 7 Criteria We Used

The best medical claims clearinghouse for your practice reaches all your payers, fits your PM system, and shows its price up front. We judged all ten networks on the seven criteria below, and you can bring the same list to any vendor demo.

1. Payer coverage. Count direct connections to your top ten payers. Many all-payer medical billing clearinghouses for small practices reach some payers only through another clearinghouse.
2. Real-time eligibility. Among top clearinghouse options, real-time eligibility checks vary. The good ones return deductible and copay detail, and a bare "active" 271 response falls short of full insurance benefit verification.
3. Prior authorization and attachment readiness. Ask about 278 support, connections to payers' new FHIR-based prior authorization APIs, and X12 275 attachments for the May 2028 deadline. Under the CMS prior authorization rule, impacted payers (Medicare Advantage plans, Medicaid and CHIP programs and their managed care plans, and ACA plans on the federal exchange) have had to give specific denial reasons and post prior authorization metrics since 2026, and most must decide expedited requests within 72 hours and standard requests within seven calendar days. Starting January 1, 2027, they must also run a Prior Authorization API that certified EHRs can connect to. If your staff still chases approvals by phone, our prior authorization services take that work off their desks.
4. PM and EHR integration. A native connection or API keeps your staff from uploading batch files by hand.
5. Pricing you can see. Look for a published price and written terms on setup, ERA, enrollment, and interconnect fees.
6. Rejection reporting. You want claim-level 999 and 277CA detail and a first-pass acceptance rate on the dashboard.
7. Security and continuity. Ask for a current SOC 2 Type II report, a signed business associate agreement (BAA), the vendor's breach history, and a backup route for your claims.

How We Built This List (and What Changed in This Update)

We used vendor websites, SEC filings, KLAS Research's Best in KLAS results for 2024 to 2026, HHS breach data, CMS and HHS rule texts, and published price pages, checked October 25 to 30, 2026. Anonymous medical clearinghouse reviews stayed out, because no one can verify who wrote them or whether they still apply.

MedSole RCM is a medical billing and credentialing company, not a clearinghouse. We charge a flat 2.99% of monthly collections for full-service billing and $99 per payer application for credentialing. Our team works inside whichever clearinghouse a practice uses, and no vendor paid for a spot on this list.

Changes in this update:

• We added the 2027 rule changes: payer prior authorization APIs from January 1, 2027, and the HIPAA claims attachments standard due May 26, 2028.
• We added 2026 denial data from Experian Health and Kodiak Solutions, plus automation figures from the 2025 CAQH Index.
• We removed Optum's "15 billion transactions" figure, which dates from Change Healthcare's fiscal year ending March 31, 2020.
• We added Availity's 13 billion+ annual transaction count, TriZetto's notification timeline, Optum's September 1, 2026 connection change for Medisoft and Lytec users, and the Medicare telehealth extension through 2027.

Medical Claims Clearinghouse Comparison: All 10 Side by Side

"Published scale" in this table means what each vendor reports about itself, with the date. The most common mistake we see is choosing on network size, when your payer mix and PM integration decide how your claims run day to day.

Medical billing clearinghouse comparison, United States, checked October 25, 2026

This list of medical billing clearinghouses covers the ten networks most US practices choose between. If you bill a payer none of them reaches, the directory further down adds seven more names.

Detailed Reviews of the Top 10 Medical Billing Clearinghouses

Each review opens with a one-line verdict, then key facts, one honest caution, and the practice it fits. Every medical billing clearinghouse here handles the core HIPAA transactions, so the differences come down to payer reach, tools, price, and security record. Figures are what each vendor reports about itself, with the date, unless we name another source.

1. Optum (Change Healthcare): Best for Enterprise Scale

Figure 1. Optum (Change Healthcare) offers enterprise-scale EDI connectivity for medical, dental, and attachment claims.

Optum is best for enterprise-scale connectivity, and it says its EDI network reaches 2,400 payers (checked October 2026). Is Optum a clearing house? Yes. Optum runs the former Change Healthcare clearinghouse, which it took over when the two companies combined on October 3, 2022.

Health systems, large groups, and billing companies use Optum when they need medical, dental, and attachment transactions in one network. Optum lists support for 837P, 837I, 837D, 835, 270/271, 276/277, 278, 275 attachments, 277CA, and 999 files. Teams that want a clearinghouse API for EHR and billing integration get API, SFTP, and portal options.

Key facts

• Owner: UnitedHealth Group runs the Optum clearinghouse (formerly Emdeon, then Change Healthcare)
• Connections: API, SFTP, and portal access
• Pricing: quote-based
• 2024 event: a February 2024 ransomware attack that HHS says affected about 192.7 million people

Watch out for: concentration risk. After the network went down in 2024, practices across the country lost claim flow for weeks, so keep a backup route ready. Also confirm your PM software is on Optum's current connection. Optum required connected software vendors to move to a new format called ECG2 by September 1, 2026, which ended its connection to Medisoft and Lytec, and practices that hadn't moved lost claim submission and eligibility checks.

Best fit: you send very high volume across medical and dental claims and want one enterprise vendor.

2. Waystar: Best for AI-Powered Automation

Figure 2. Waystar offers claim scrubbing, denial prediction, and appeals automation for larger healthcare organizations.

Waystar is best for automation at scale. The Waystar clearinghouse platform processes over 7.5 billion healthcare payment transactions a year (Waystar FY2025 results, February 17, 2026). Is Waystar a clearing house? Yes. It won the 2025 Best in KLAS award for Claims Management & Clearinghouse.

Health systems and large groups pick Waystar when they want claim scrubbing, denial prediction, and appeals in one platform. Waystar markets AI tools for denial prevention and appeals. Ask the sales team to run a demo on your own rejected claims before you put weight on those tools.

Key facts

• History: if you used the ZirMed clearinghouse or the Navicure clearinghouse, you're on Waystar now. The two merged in 2017 and took the Waystar name in 2018.
• Scale: over 30,000 clients and more than 1 million distinct providers (2025 Form 10-K)
• Pricing: quote-based
• Company: a public company that files annual reports with the SEC; it bought Iodine Software, an AI company focused on clinical documentation, in 2025

Watch out for: no published pricing, and enterprise-style contracts that a small practice may not need.

Best fit: you have the volume to justify automation and want analytics on every claim.

3. Availity: Best for Multi-Payer Connectivity

Figure 3. Availity connects providers and payers through eligibility, claims, status, and remittance transactions.

Availity is best for multi-payer connectivity, reporting direct connections to more than 4,000 payers and more than 3.5 million providers (April 28, 2026). Is Availity a clearinghouse? Yes. It runs a full EDI clearinghouse alongside Availity Essentials, the provider portal that's free for transactions with sponsoring health plans.

Practices of any size with a mixed commercial, Blue plan, and Medicaid payer mix lean on Availity. The company calls itself the nation's largest real-time health information network, a description that comes from Availity itself. It's a strong pick among top clearinghouse options for real-time eligibility checks.

Key facts

• Reach: over 95% of payers and 17,000+ trading partners (April 28, 2026)
• Transactions: eligibility, claim status, claims, and remittance
• Pricing: free Essentials access for sponsoring plans' transactions, with paid premium options
• 2026 update: launched Availity Extend, an AI and automation layer on its network, and partnered with Abridge on real-time prior authorization (January 2026)

Watch out for: portal work runs one payer at a time. High-volume practices still need batch submission from their PM system, and the free routes vary by payer.

Best fit: you bill many commercial and Blue plans and want real-time eligibility across all of them.

4. Cognizant TriZetto Provider Solutions: Best for High-Volume Processing

Figure 4. Cognizant TriZetto Provider Solutions supports high-volume claims and HIPAA transaction processing.

Cognizant TriZetto Provider Solutions is best for high-volume claim processing, and Cognizant says its TriZetto platforms handle 4.4 billion transactions a year across all products. Is TriZetto a clearinghouse? Yes. TriZetto Provider Solutions, the former Gateway EDI, runs the provider-side clearinghouse, and Cognizant has owned TriZetto since November 20, 2014.

Physician groups and billing companies that send large batch volumes use it for eligibility, claims, and remittance in one portal. If you're shopping for the best EDI clearinghouse for high-volume healthcare claims, put TriZetto on your list, then read its 2025 breach notice before you sign.

Key facts

• Owner: Cognizant
• Transactions: core HIPAA claims, eligibility, status, and remittance
• Pricing: quote-based
• Breach: TriZetto detected suspicious activity in a provider web portal on October 2, 2025. The access went back to November 2024, and more than 3.4 million patients received notices covering names, dates of birth, Social Security numbers, and insurance member numbers, with no financial data involved.

Watch out for: ask what changed after the breach, and ask for a current SOC 2 Type II report. Ask how fast it notifies clients, too: TriZetto told providers on December 9, 2025, and patient letters didn't start until early February 2026.

Best fit: you need batch volume and you've reviewed the security record.

5. Experian Health (ClaimSource): Best for Data-Driven Accuracy

Figure 5. Experian Health ClaimSource offers payer-specific claim edits and denial prediction before submission.

Experian Health's ClaimSource is best for data-driven accuracy, and Experian says its clients average a 4% denial rate against a 10%+ industry average (vendor-reported, February 2024). It won the 2024 Best in KLAS award for Claims Management & Clearinghouse and added two AI modules: AI Advantage Predictive Denials and AI Advantage Denial Triage.

Health systems and medical groups that want payer-specific edits and denial prediction before submission pick ClaimSource. If you're looking for the best claims clearinghouse for clean claim rates and you have the volume to feed it, ClaimSource is the data-heavy choice.

Key facts

• Owner: Experian
• Function: claim editing, formatting, and submission
• Pricing: quote-based
• Recognition: Best in KLAS 2024

Watch out for: the 4% figure is Experian's own number from February 2024, not an independent audit, and the product shows its value at higher volume.

Best fit: you want the best clearinghouse for reducing claim denials before claims leave your office.

6. Office Ally: Best Free Option for Small Practices

Figure 6. Office Ally offers free electronic claim submission to participating payers for small practices.

The Office Ally clearinghouse is best for small practices that want free claim submission, and it reports more than 1 billion transactions a year for 80,000+ organizations (April 2, 2026). Is Office Ally a clearinghouse? Yes. Its Service Center charges nothing for claims to participating payers.

For a solo provider or small group choosing its first medical billing clearinghouse, Office Ally is the lowest-cost place to start. On April 2, 2026, the company acquired Jopari Solutions, which adds workers' compensation claims, auto claims, and attachments to the platform.

Key facts

• Pricing: one of the few free clearinghouses for medical billing when claims go to participating payers, with a $44.95 monthly fee per Tax ID and rendering NPI in any month you send non-participating claims (Office Ally data sheet)
• Other fees: $0.55 per attachment, and eligibility checks start at $10 for 1 to 100 transactions
• Products: Office Ally also sells Practice Mate practice software and EHR 24/7
• 2026 update: the Jopari acquisition; Office Ally is a portfolio company of New Mountain Capital and Francisco Partners

Watch out for: you get fewer analytics and denial-prediction tools than the enterprise platforms offer.

Best fit: you're small, cost-conscious, and most of your claims go to participating payers.

7. The SSI Group: Best for Health System Claims

Figure 7. The SSI Group supports hospitals with institutional and professional claims management.

The SSI Group is best for hospitals and health systems with heavy institutional claim volume, and its HFMA Peer Review profile lists 2,400+ customers. Inside ClickON, its claims management platform, the SSI clearinghouse edits, validates, and sends institutional and professional claims.

Facility billing teams use SSI when they need UB-04 claims, edits, and remittance in one workflow. The tools target UB-04 EDI clearinghouse work inside hospital revenue cycle management, and the company has its headquarters in Mobile, Alabama.

Key facts

• Location: Mobile, Alabama; Jennifer Strahan became President in May 2026
• Claims: 837I and 837P, plus Enhanced Claim Status (launched June 2026 with Janus Health), which shows line-level claim detail up to five days before the ERA
• Pricing: quote-based
• 2024 to 2026: no major public event on record

Watch out for: SSI builds for facilities, so a two-provider practice would pay for features it won't use.

Best fit: you're a hospital comparing clearinghouse software for ERA delivery and institutional claims.

8. Quadax: Best for Mid-Sized Hospitals and Labs

Figure 8. Quadax provides claims management solutions for hospitals, laboratories, and specialty groups.

Quadax is best for mid-sized hospitals, labs, and specialty groups, and it won the 2026 Best in KLAS award for Claims Management & Clearinghouse (announced February 4, 2026). It's a private revenue cycle technology and services company in Cleveland, Ohio, founded in 1973.

Quadax serves hospitals, health systems, ambulatory providers, and laboratories. That mix suits organizations that have outgrown small-practice tools but don't want a national enterprise contract. Ask for references from organizations your size before you commit.

Key facts

• Company: private, based in Cleveland since 1973
• Function: claims management and clearinghouse; QDXOne, its unified AI platform, launched September 28, 2026
• Pricing: quote-based
• Recognition: Best in KLAS 2026, its fifth KLAS claims management distinction after 2018, 2019, 2021, and 2022

Watch out for: confirm a native connection to your PM or hospital system before you sign.

Best fit: you need the best clearinghouse software for mid-sized hospitals or lab billing.

9. Claim.MD: Best Value for Transparent Pricing

Figure 9. Claim.MD publishes monthly plans for electronic claims, ERAs, and eligibility transactions.

Claim.MD is best for practices that want the price before they sign, with plans of $30, $60, and $120 a month and no setup fee (checked October 25, 2026). The Claim.MD clearinghouse Basic plan costs $30 a month plus $0.30 per claim, ERA, or eligibility check.

Small Volume costs $60 a month with 100 of each included, then $0.50 apiece. Unlimited costs $120 for unlimited claims and ERAs plus 1,000 eligibility checks. That makes Claim.MD the easiest medical billing clearinghouse to budget for, because anyone can do the math from its public price page.

On these list prices, Basic costs less than Unlimited until you pass 300 billable transactions a month: $30 + (300 x $0.30) = $120. Past that point, Unlimited saves you money every month.

Key facts

• Other fees: $1.00 for a paper claim of up to five pages, plus $0.20 per extra page, and $0.60 per attachment
• Transactions: claims, ERAs, and eligibility
• Pricing: published monthly plans
• Checked: October 25, 2026

Watch out for: you get fewer enterprise analytics than Waystar or Experian Health offer.

Best fit: you bill a few hundred to a few thousand claims a month and want a fixed, predictable cost.

10. Tebra (Formerly Kareo): Best All-in-One Option for Independent Practices

Figure 10. Tebra combines practice management, EHR, and built-in clearinghouse services for independent practices.

Tebra is best for independent practices that want billing software and a clearinghouse in one subscription, and Tebra says it supports electronic claims to 8,000+ commercial and government payers. It's medical billing software with a clearinghouse built in, not a standalone clearinghouse.

Kareo and PatientPop merged to form Tebra in November 2021, so the old Kareo clearinghouse now runs inside Tebra. You also manage insurance enrollments through Tebra's clearinghouse, which keeps claims and enrollment in the same screens your staff already uses.

Key facts

• Company: formed in 2021, based in Newport Beach, California
• Function: claims, eligibility, and enrollment inside the PM and EHR
• Pricing: subscription priced by practice size, provider count, and claim volume, with no percentage-of-collections fee (Tebra FAQ)
• 2024 to 2026: no major public event on record

Watch out for: Tebra only makes sense if you're willing to run your practice on its PM and EHR. Ask which network sits behind its claims screen, then check that network's security record too. [Editor: confirm in Tebra's enrollment guide which clearinghouse it routes claims through. One billing-software review reports TriZetto for claims and Jopari for attachments.]

Best fit: you're picking the best medical clearinghouse for independent practices and replacing your PM system at the same time.

Still not sure which network fits your payer mix? Request a free RCM review, and we'll look at your top payers and monthly claim volume, then show you which clearinghouse setup fits them.

Who Are the Biggest Clearinghouses? Volume and KLAS Results

By published annual volume, the biggest clearinghouses in the US are Availity, Waystar, Cognizant TriZetto, and Office Ally. Optum, which runs the former Change Healthcare network, is also one of the largest, but it hasn't published a current transaction count. Payer fit still matters more than size when you choose a medical billing clearinghouse.

No healthcare claims clearinghouse publishes audited volume. Treat each figure below as self-reported. The healthcare clearinghouses in this table also count different things as a transaction.

Top clearing houses by published volume, US, checked October 25, 2026

These EDI clearinghouse companies count claims, eligibility checks, and remittances together. Read the figures as a sense of scale rather than a ranking you can compare line by line.

Best in KLAS Claims Management and Clearinghouse: 2024 to 2026

Want the highest-rated medical billing clearinghouse by independent customer research? KLAS Research's annual Best in KLAS award is the closest thing to a scorecard. The last three winners in the Claims Management & Clearinghouse segment are below. KLAS usually publishes each year's awards in early February, so the 2027 winner should be out in early 2027.

KLAS builds its scores from interviews with provider organizations that use each product. Check whether practices your size were part of the sample before you treat a KLAS result as a verdict on how health care clearinghouses serve solo and small practices.

Other Clearinghouses Worth Knowing

The top 10 cover most US practices, but the right medical billing clearinghouse for a dental office, a Medicare-heavy practice, or a software-first team can be a smaller network. Our directory below adds the names you'll meet in PM systems, dental offices, and Medicare billing.

Full List of Clearinghouses in Medical Billing

These are the medical billing clearinghouse names you'll see most often beyond the top 10. Most medical claims clearinghouse companies sell to providers, while some insurance clearinghouse companies serve payers first, so check which side a vendor works for before you book a demo.

Claims clearinghouse companies beyond the top 10, checked October 25, 2026

Medical billing clearinghouse companies change hands often. Check the current owner before you sign a multi-year contract, because a new owner can change pricing and support terms.

[Download button: the full medical billing clearinghouse list, with the top 10, this directory, and the seven-point checklist, as a free PDF. Publish the button once the PDF is live.]

Print it and keep it at the front desk as an EDI clearinghouse list your team can check when a payer or software vendor asks which network you use.

How Much Does a Medical Billing Clearinghouse Cost?

Healthcare clearinghouse cost runs from $0 to about $120 a month among vendors that publish prices. Office Ally and Availity Essentials offer free routes for certain payers, and Claim.MD charges $30, $60, or $120 a month. Enterprise vendors quote by volume. The real cost of a medical billing clearinghouse also includes setup, ERA, enrollment, and interconnect fees.

Clearinghouse Cost per Month: Published Prices

Healthcare clearinghouse pricing comes from only a few vendors, so this table shows who publishes what and where we found it.

Two examples show how the math works. A practice sending 400 claims, 400 ERAs, and 400 eligibility checks a month makes 1,200 transactions. On Claim.MD Basic, that's $30 + (1,200 x $0.30) = $390 a month. Unlimited costs $120 for the same month, because 400 eligibility checks fall within the 1,000 included.

On Office Ally, a two-provider practice under one Tax ID pays no claim fees in a month with only participating-payer claims. If each provider sends one non-participating claim that month, the bill comes to $89.90 ($44.95 x 2).

Waystar clearinghouse pricing, TriZetto clearinghouse pricing, and Optum (formerly Change Healthcare) clearinghouse pricing aren't published. Ask each vendor for a written quote at your current volume and at double that volume, so growth doesn't reprice you halfway through the contract.

Clearinghouse Fees to Ask About Before You Sign

Any clearinghouse in medical billing can add fees beyond the headline price, so get these five in writing:

1. Interconnect fee: a charge when your clearinghouse hands a claim to another clearinghouse to reach a payer it can't reach on its own. Ask which of your top payers have a direct connection and which ones the clearinghouse routes through a partner.
2. Setup or onboarding fee: a one-time charge some vendors add for configuration and testing.
3. ERA fee: a charge per 835 remittance file, separate from claim fees.
4. Payer enrollment fee: a charge per payer for EDI and ERA enrollment paperwork.
5. Paper, attachment, and extra-TIN fees: Claim.MD, for example, lists $1.00 per paper claim of up to five pages, $0.60 per attachment, and tiered fees for extra billing tax IDs.

Free Clearinghouses: What "Free" Covers

A free clearinghouse for medical claims is free only for certain payers. Office Ally's free route covers participating payers, and Availity Essentials covers sponsoring health plans. Expect fewer analytics, and expect support and batch tools to vary from vendor to vendor.

• Claim.MD vs Office Ally: Claim.MD charges one fixed monthly price for every payer. Office Ally is free for participating payers and adds $44.95 per Tax ID and rendering NPI in months with non-participating claims.
• Office Ally vs Availity: both offer free routes, but each depends on a different payer list, so compare both lists against your top ten payers.
• TriZetto vs Office Ally: TriZetto is a quote-based enterprise portal with broader tools, and Office Ally is a free small-practice option. Read TriZetto's October 2025 breach notice before you choose.

Clearinghouse Fees vs Outsourced Billing

If you outsource billing, ask whether the billing company passes clearinghouse fees through to you. Some companies bundle medical billing clearinghouse services into their rate, and others bill them on top as a separate line item.

MedSole RCM charges a flat 2.99% of monthly collections for full-service billing, with no setup fee, software fee, clearinghouse fee, or monthly minimum. Billing company pricing guides cite 4% to 10% of collections for full service, and our medical billing cost breakdown shows where those rates come from.

Want to see your clearinghouse and billing costs side by side? Ask for a free RCM review, and we'll lay out both numbers for your practice.

Best Clearinghouse by Practice Size, EHR, and Specialty

Three facts about your practice decide which medical billing clearinghouse fits: your claim volume, your EHR or practice management system, and your specialty and payer mix. The tables below cut your choice of clearinghouse for medical billing to two or three names. Test those names against your top ten payers before you sign.

Best Clearinghouse for Small and Independent Practices (and Larger Groups)

If you're a solo provider looking for the best healthcare clearinghouse for small practices, start with the free routes and Claim.MD. For a group billing a few thousand claims a month, the best claims clearinghouse for medical practices is the one with predictable pricing and a native PM connection.

Hospitals comparing the best clearinghouse software for mid-sized hospital systems should start with Quadax and The SSI Group. Independent practices that would rather not manage a clearinghouse at all can hand the whole cycle to a billing team through private practice RCM.

Which Clearinghouse Works With Your EHR or PM System?

An EHR clearinghouse connection sends claims from your EHR or PM system to the medical billing clearinghouse without manual uploads. Most EMR clearinghouse setups fall into one of two types. Each one trades some flexibility for simplicity.

If you've wondered which clearinghouse SimplePractice uses, Stedi's customer story answers it: SimplePractice moved its claims and ERA enrollments to Stedi. SimplePractice users kept working in the same software while the network behind it changed.

Medical billing clearinghouse software built into a PM system suits small teams that want one login. A standalone network suits practices running several PM systems and billing companies that serve many clients.

Ask every vendor for its list of native PM and EHR connections. That list is the fastest test of the best medical clearinghouse software for claims submission in your setup.

Best Clearinghouse by Specialty and Payer Mix

Your specialty decides which claim edits matter, so specialty-specific billing rules belong in the clearinghouse decision from day one.

Dental clearing houses form a separate market. Most dental clearinghouse companies focus on 837D claims and dental payer lists. Small offices comparing top dental clearinghouse services for small practices should check that payer list first.

Medicare's telehealth flexibilities now run through December 31, 2027, under the Consolidated Appropriations Act, 2026, while commercial and Medicaid telehealth rules vary. Telehealth claims add place of service and modifier rules that change by payer, and our telehealth billing services team verifies those codes before claims go out.

Clearinghouse Security After the Change Healthcare Attack

Security is now the first question to ask any medical billing clearinghouse. One network attack in 2024 stopped claims and payments for practices across the country, and the facts below show what happened and what to ask before you sign.

What Happened in February 2024, and Since

On February 21, 2024, a ransomware attack hit Change Healthcare, the healthcare clearinghouse network owned by Optum, and the company disconnected its systems. Change Healthcare said the attacker presented itself as ALPHV/BlackCat. CISA's ALPHV Blackcat advisory notes that healthcare was the sector this group hit most after mid-December 2023.

UnitedHealth Group's CEO told the Senate Finance Committee on May 1, 2024 that the attackers used stolen credentials on a remote-access portal that didn't have multifactor authentication. Through that single gap, the attackers reached a network that thousands of practices depended on.

Providers felt it in their cash flow. In an AHA hospital survey of almost 1,000 hospitals (March 9 to 12, 2024), 94% reported a financial impact, and more than half called it significant or serious.

The data breach came next. Change Healthcare told HHS on July 31, 2025 that the breach affected about 192.7 million people, according to the HHS Change Healthcare FAQ. Cognizant TriZetto then detected suspicious activity on October 2, 2025, and more than 3.4 million patients received notices. Vendor breaches keep growing as a share of the total. In the first half of 2026, business associates were involved in 43% of large healthcare breaches reported to HHS, up from an average of 20% between 2009 and 2017, according to a HIPAA Journal analysis of the HHS breach portal.

Security Checklist for Any Clearinghouse

HHS has proposed a stricter HIPAA Security Rule that would make multifactor authentication mandatory, but it has pushed final action to at least July 2027, and the current rule stays in force until then. The top secure all-payer clearinghouses for EDI claims can show you all six of these items during a sales call:

1. A current SOC 2 Type II report
2. A signed business associate agreement (BAA)
3. Multifactor authentication on every portal and remote-access login
4. Breach notification timelines written into the contract
5. A disclosed incident history for the last three years
6. A documented way to reroute claims if the network goes down

How to Set Up a Secondary Clearinghouse

A secondary clearinghouse is a second, already-enrolled network you can move claims to within days. Practices that had vetted clearinghouse alternatives before February 2024 had somewhere to send claims, while others had to start enrollment from scratch in the middle of the outage.

Four steps get you there:

1. Choose a second network with direct connections to your top payers.
2. Complete EDI enrollment with that network ahead of time.
3. Decide in advance where ERAs go, because many payers send 835 files to only one destination per tax ID.
4. Send a few test claims through the backup each year.

If a billing partner runs your revenue cycle management services, ask how fast that partner can reroute your claims. For practices researching Change Healthcare alternatives in 2027, this checklist matters more than any vendor's size.

Clearinghouse vs Direct Payer Submission

You can send claims straight to some payers instead of using a medical billing clearinghouse. Each of those payers then needs its own connection, enrollment, and software. Medicare is the common case: instead of going through a Medicare clearing house, a provider can send claims straight to its Medicare Administrative Contractor (MAC).

CMS sets one rule for both routes. Under its Medicare EDI enrollment process, every provider that sends electronic claims to Medicare signs the CMS EDI enrollment form and files it with its MAC. That applies whether you submit on your own or through a billing service or clearinghouse.

Clearinghouse medical billing vs direct payer submission

A practice that sends almost all its claims to Medicare, or to one dominant plan, can go direct and skip a fee. Most other practices get more from an insurance clearinghouse. Managing several direct connections costs more staff time than the clearinghouse costs in dollars.

Whichever route you use, keep the payer's acceptance report as proof of filing, and track your timely filing limits by payer. A health insurance clearinghouse doesn't extend your filing deadline. It gives you dated proof that you met it.

Clearinghouse vs Medical Billing Company: Which Do You Need?

A medical billing clearinghouse checks and delivers claims. Medical billing companies run the whole revenue cycle: coding, sending claims through a clearinghouse, posting payments, and working denials and AR. Teams that already bill well need a clearinghouse. If claims, denials, or AR are slipping, you need a billing company.

A billing clearinghouse stops at the payer's front door. Healthcare clearinghouse services don't include appealing a denial or calling a payer about an unpaid claim, so that work stays with your staff.

Some vendors sell billing clearinghouse services bundled with software. Ask whether a person works your denials, or whether a dashboard only reports them and leaves the follow-up to your front desk.

Looking for the Top Medical Billing Companies Instead?

This guide ranks clearinghouses, not billing companies. If you're comparing billing companies, judge each one on five points:

1. The rate, and what it includes (is the clearinghouse fee extra?)
2. Contract length and exit terms
3. Who works denials, and how fast
4. The credentialing price per payer
5. Reporting you can see every month

MedSole RCM at a glance

MedSole RCM's billing services cover the full revenue cycle for US practices. We charge a flat 2.99% of monthly collections for outsourced medical billing services, with no setup fee, software fee, clearinghouse fee, or monthly minimum, on a month-to-month agreement.

The 2.99% covers eligibility checks, coding, claim submission, payment posting, appeals, AR follow-up, and reporting. Prior authorization comes with full-service billing at no separate charge, and our team sends claims within 24 hours of the visit.

Payer enrollment and credentialing costs $99 per payer application. We file within 48 hours of receiving complete documents and follow up with each payer weekly until approval.

Billing company pricing guides cite 4% to 10% of collections for full-service billing.

Weighing a new clearinghouse against handing off all your billing? Get a free RCM review, and we'll show you what 2.99% would have cost on last month's collections.

How to Switch Clearinghouses Without Losing Cash Flow

Switching a medical billing clearinghouse often takes several weeks, and most of that time goes to waiting for payers to approve new EDI and ERA enrollments. Your speed in moving off any network, Optum included, depends on those approvals. Plan for a short overlap rather than a hard cutover date.

This step-by-step plan keeps claims and payments moving while you switch:

1. List your top payers and volumes. Check which ones the new clearinghouse reaches on direct connections.
2. Sign the BAA and connect your PM system. Confirm the integration works before any enrollment starts.
3. File EDI and ERA enrollments for each payer. Payer enrollment and ERA enrollment take the longest, so start with your highest-volume payers. For Medicare, file the CMS EDI enrollment form with your MAC.
4. Plan ERA delivery. The most common ERA problem during a switch is a gap where remittances still flow to the old clearinghouse. Keep the old account open until every payer's 835 files arrive at the new one.
5. Send test claims. Check the 999 and 277CA results before you move full volume.
6. Run both networks for one billing cycle, then cancel. Cancel only when every payer shows accepted claims and ERAs on the new network.

Switching clearinghouses doesn't change where Medicare deposits your payments. If you also change bank accounts, Medicare needs a new EFT authorization on Form CMS-588 before the first payment can land in the new account.

Rejections and Denials After Go-Live

Any claims clearinghouse will show you rejections within a day. Denials arrive later on the 835, and someone has to find the root cause and file the appeal. That work takes root-cause denial management, because a resubmission that repeats the same error earns the same denial.

The 2026 numbers show why. In Experian Health's State of Claims survey (October 28, 2026), 40% of providers said 10% or more of their claims are denied, up from 31% in 2022, and services not covered was the top reason for the first time. Kodiak Solutions puts the overall initial denial rate at 10.63% for the first half of 2026, down from 12.00% a year earlier, but payer takebacks after payment rose to 1.57% of net revenue.

Medical claims clearinghouses also don't chase claims that get no response at all. A claim with no 277 status after the payer's normal processing time belongs in an accounts receivable follow-up queue, where someone calls the payer or checks the portal.

Track four numbers every week:

• First-pass acceptance rate
• Top rejection reasons by payer
• Top denial reason codes (CARCs) by payer
• Claims with no status after 30 days

Even the best clearinghouse for reducing claim denials catches errors only before submission. Your team, or your billing partner, owns every step after the payer decides.

Frequently Asked Questions About Medical Billing Clearinghouses

What Is the Best Clearinghouse for Medical Billing?

The best clearinghouse for medical billing depends on your size, payer mix, and PM system. Small practices often start with Office Ally or Availity Essentials for their free routes. Claim.MD suits teams that want a fixed monthly price, and Waystar fits automation at scale. Hospitals tend to look at Quadax, the 2026 Best in KLAS winner, or The SSI Group.

Before you pick, run your top ten payers against each network's payer list and get the fees in writing. A free option that can't reach two of your biggest payers ends up costing you more in workarounds than a paid network would.

Is There a Free Clearinghouse for Medical Billing?

Yes, for certain payers. Office Ally sends claims free to participating payers, and Availity Essentials is free for transactions with health plans that sponsor it. Claims to other payers and premium features cost extra at most vendors.

Office Ally, for example, charges $44.95 a month per Tax ID and rendering NPI in any month you send non-participating claims. Check each free payer list against your top ten payers before you rely on a free route, and expect fewer reporting tools than the paid platforms offer.

How Much Does a Clearinghouse Cost per Month?

Published clearinghouse prices run from $0 to about $120 a month. Claim.MD lists $30 a month plus $0.30 per transaction, $60 with 100 transactions included, or $120 for unlimited claims and ERAs (checked October 25, 2026). Waystar, Optum, and TriZetto quote by volume.

Add the fees that don't show up in the headline price: interconnect charges for routed payers, setup fees, ERA fees, payer enrollment fees, and paper claim or attachment charges. Ask for a quote at your current volume and at double it, so you know your cost as you grow.

Do I Need a Clearinghouse If I Outsource My Billing?

Not as a separate purchase. A billing company sends your claims through a medical billing clearinghouse it already uses, or it works inside yours. Ask whether the clearinghouse fee sits inside the rate or reaches you as a pass-through charge.

MedSole RCM charges a flat 2.99% of monthly collections for full-service billing, with no clearinghouse fee on top, and works inside the clearinghouse a practice already uses. You keep your payer enrollments and ERA routing, and our team takes over submission, posting, denials, and AR follow-up.

Is a Healthcare Clearinghouse a Covered Entity Under HIPAA?

Yes. HIPAA names three types of covered entity: health plans, health care clearinghouses, and providers who send standard transactions in electronic form (45 CFR 160.103). A clearinghouse has to protect patient data under the Privacy and Security Rules, as your practice does.

Most practices also sign a business associate agreement with their clearinghouse, because the clearinghouse handles protected health information on the practice's behalf. Ask for a signed BAA before you send the first claim, and file it with your other HIPAA records.

How Long Does It Take to Switch Clearinghouses?

Plan on several weeks. The setup itself goes fast, but each payer has to approve new EDI and ERA enrollments, and those approvals set the timeline. Run the old and new clearinghouse side by side for one billing cycle so you don't lose remittances.

Start enrollments with your highest-volume payers, and send test claims before you move full volume. Keep the old account open until every payer's ERAs reach the new network, and cancel the old contract only after that.

Is the Optum Clearinghouse Safe to Use After the Change Healthcare Attack?

Optum's network is running and reports 2,400 connected payers. The February 2024 ransomware attack affected about 192.7 million people (HHS, July 31, 2025), so judge Optum the way you'd judge any vendor: a current SOC 2 Type II report, multifactor authentication on every login, and a written incident history.

Whichever network you choose, keep an enrolled secondary clearinghouse. Practices with a backup in place had somewhere to send claims in 2024 while others waited for systems to come back.

Do Clearinghouses Handle Prior Authorization?

Many support the HIPAA 278 transaction for prior authorization requests, but most prior authorization work still happens in payer portals and on the phone. A CMS rule has required impacted payers to decide expedited requests within 72 hours and standard requests within seven days since January 1, 2026. Starting January 1, 2027, those payers must also run Prior Authorization APIs, yet only 40% of medical prior authorizations were fully electronic in the 2025 CAQH Index.

Physicians remain skeptical about faster approvals. In an AMA physician survey of 1,000 physicians, only 33% expected insurers' latest prior authorization pledges to make a meaningful difference (AMA, May 13, 2026). Those insurers have committed that by 2027, at least 80% of electronic prior authorization approvals sent with complete documentation will come back in real time.

More changes are on the way. CMS has proposed extending its prior authorization rules to drugs, with most provisions targeted for October 1, 2027. For clinicians, CMS has also proposed making the MIPS electronic prior authorization measure an optional bonus in 2027 and required in 2028, with the final rule due in early November 2026. In Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, the WISeR model has added prior authorization or pre-payment review for selected Traditional Medicare services since January 15, 2026.

Choosing a Medical Billing Clearinghouse in 2027: The Verdict

The best clearing house for you is the one that reaches your top payers on direct connections and fits your PM system. Among the top clearinghouses, start free if you're small (Office Ally or Availity Essentials), choose Claim.MD for a fixed monthly price, and shortlist Waystar, Experian Health, Quadax, or The SSI Group at enterprise scale. For 2027, add two questions to every demo: can the vendor connect to payers' new Prior Authorization APIs, and when will it support X12 275 attachments?

The best medical billing clearinghouse is also the one someone on your team checks every day. Clearinghouses for medical billing report problems, and people fix them, so decide who owns the rejection queue before you sign anything.

If you'd rather spend that time on patients, MedSole RCM handles the whole billing cycle, clearinghouse included, for a flat 2.99% of monthly collections, and credentialing for $99 per payer application. Talk to a MedSole specialist about what that would look like for your practice.

Updated October 30, 2026: We added the 2027 prior authorization API and claims attachments deadlines, 2026 denial data from Experian Health and Kodiak Solutions, the Medicare telehealth extension through 2027, and updated security and vendor facts. In the October 25, 2026 update, Quadax replaced athenahealth in the top 10, and Claim.MD and Office Ally pricing came from their published price pages.