Clearinghouse Vendor Guide

A clearinghouse sits between your practice management system and the insurance payers. Every electronic claim you submit passes through one. It scrubs claims for errors, translates them into the format each payer requires, routes them to the right destination, and returns the response.

Most practices have their clearinghouse chosen for them by their EMR. Kareo routes through TriZetto. Athenahealth bundles its own. Elation and Jane App use Claim.MD. If you're on one of these systems, your clearinghouse decision was made when you signed up for your EMR.

This guide covers the clearinghouses that matter when building out a practice — the ones you'll work with directly or inherit through your EMR.

What You Want In A Clearinghouse

Your clearinghouse is your first line of defense against rejections. A good clearinghouse screens every claim the moment you submit it, spotlighting coding errors, missing fields, and payer-specific formatting problems before the claim ever reaches the insurance company. A payer takes 2-3 weeks to tell you something was wrong. A clearinghouse takes 20 minutes.

Beyond scrubbing, your clearinghouse is your go-to source for claim information. A good clearinghouse tells you where every claim is at all times — submitted, accepted, pending, paid, denied. That visibility is what keeps your revenue cycle moving and your A/R days low.

We favor clearinghouses with clean APIs. If a clearinghouse has an API, you can hook it into any system you want — your PM, your reporting tools, your automation workflows. You're not locked into one vendor's portal. That flexibility matters as your practice grows and your tech stack evolves.

The best clearinghouses also offer additional services that save time across your front and back office: real-time eligibility portals so you can verify coverage before a patient walks in, insurance discovery tools, and patient responsibility estimators.

Our Recommendations

There are dozens of clearinghouses. If you have a choice, we recommend three: Claim.MD, TriZetto, and Stedi. Each offers a straightforward, high-quality portal and robust customer service.

Claim.MD is your go-to option for smaller practices. Quality EMRs like Elation and Jane have full native integrations. It has well-documented APIs, which is very rare for a smaller clearinghouse. Support is on top of their game and very knowledgeable. Pricing at the unlimited tier is around $100 a month, which is easily worth it.

TriZetto is our favorite among the more established options. You'll work with it already if you have Tebra/Kareo or ECW, but for many major EMRs it's one of a few choices you have. It has the broadest payer connection network in the U.S. (nearly 10,000) and does everything you need at a high level. We've never experienced any uptime issues and support can figure out problems quickly.

Stedi is the best option for practices using custom EMRs or building their own workflows. It's the clearinghouse Atlas uses for its own software. Every transaction is available through modern REST APIs, so it can be configured to work with any system. Stedi connects to 3,500+ payers with built-in redundancy — if one route to a payer goes down, claims automatically reroute through an alternate connection. Popular among digital health companies and billing platforms that need programmable infrastructure.

On the right hand side, you can read our reviews of the other main clearinghouse options too. We find Waystar, Availity, and Change Healthcare all to be reliable, although support can be tricky — especially Availity. Contracts can be a bit more punishing as well, but that is determined on a practice-by-practice basis.

We've also spared a couple words for two clearinghouses we often see in smaller practices. Candidly, we've moved quite a few clients off of Office Ally and Infinedi (usually to Claim.MD) because of the interface challenges. They do not integrate well with other technologies. Infinedi in particular is an example of the challenges of a smaller clearinghouse with less money to invest in modernizing the technology.

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