Do you want faster claim processing for your practice? Are you looking for the best medical billing clearinghouses? Studies show clearinghouses cut claim denials by 40%. Practices save 15-20 hours per week on claim work. Electronic claims get paid 50% faster than paper claims. About 95% of medical practices use clearinghouses now. The right clearinghouse can increase collections by 25%.
Healthcare clearinghouses for medical billing act as middlemen between providers and payers. They check claims for errors before sending them to insurance. Most clearinghouses catch 95% of claim errors early. They submit claims to thousands of insurance payers. Research shows clearinghouses improve first-pass claim rates to 98%. This means fewer denials and faster payment always. Choosing the right clearinghouse is very important for practice success.
This guide covers the top 10 clearinghouses in medical billing today. We review features, pricing, and benefits of each one. Learn which clearinghouse fits your practice needs best. Compare options to make the right choice quickly. These clearinghouses serve practices of all sizes well. Find the perfect billing partner for your practice now.
What is a Medical Billing Clearinghouse
A clearinghouse is an electronic claims processor. They check claims before sending them to insurance. This saves time and cuts errors a lot.
Clearinghouses act as middlemen between medical providers and insurance companies. They scrub claims for errors before submission to payers. Most clearinghouses connect to thousands of insurance companies nationwide.
Key Functions:
- Check claims for common coding errors
- Submit claims electronically to insurance payers
- Track claim status in real-time
- Provide eligibility verification for patients
- Deliver electronic remittance advice fast
1. Change Healthcare
Change Healthcare is the largest clearinghouse in the USA. They process over 12 billion transactions yearly. Most practices trust them for claim processing.
Key Features:
- Connect to 2,000+ health plans nationwide
- Real-time eligibility verification included
- Advanced claim scrubbing technology
- Same-day claim submission available
- Integration with 600+ practice systems
- 24/7 customer support available
Pricing: Starts at $0.25 per claim with volume discounts
Best For: Large multi-specialty practices with high claim volume
2. Availity
Availity is a free clearinghouse for providers. Over 2 million healthcare pros use it. They focus on ease of use and accessibility.
Key Features:
- Free basic clearinghouse services
- Connect to 2,000+ health plans
- Real-time eligibility verification is free
- Claims status tracking at no cost
- Mobile app for on-the-go access
- Secure provider portal included
Pricing: Free basic services, premium add-ons available
Best For: Small to medium practices on a tight budget
3. Trizetto Provider Solutions
Trizetto offers complete revenue cycle solutions. They serve over 300,000 providers nationwide. Known for reliability and good support always.
Key Features:
- Connect to 1,500+ health plans
- Advanced claim scrubbing included
- Electronic remittance advice delivered
- Denial management tools provided
- Comprehensive reporting and analytics
- Integration with major PM systems
Pricing: Around $0.30 per claim with volume discounts
Best For: Mid-sized practices with moderate claim volumes
4. Office Ally
Office Ally provides free clearinghouse services, too. They serve over 1 million providers nationwide. Simple interface makes them a popular choice.
Key Features:
- Completely free clearinghouse services
- Connect to major insurance payers
- Real-time eligibility checking included
- Practice management software is free
- Patient scheduling tools available
- Electronic health records option
Pricing: Free clearinghouse, optional premium features
Best For: Very small practices and solo practitioners
5. Waystar
Waystar focuses on revenue cycle management solutions. They process billions of claims yearly. Known for cutting-edge technology and innovation.
Key Features:
- AI-powered claim scrubbing technology
- Predictive analytics for denial risks
- Automated patient payment solutions
- Real-time claim tracking included
- Integration with 600+ PM systems
- Advanced denial management tools
Pricing: Custom pricing based on practice size
Best For: Large practices wanting advanced technology features
6. Kareo
Kareo offers integrated practice management and a clearinghouse. Over 50,000 providers use their platform. Popular with small independent practices always.
Key Features:
- All-in-one practice management solution
- Built-in clearinghouse is always included
- Easy-to-use interface requires minimal training
- Mobile app for on-the-go management
- Patient engagement tools included
- Cloud-based system accessible anywhere
Pricing: Starts at $160 per month subscription
Best For: Small independent practices under 5 providers
7. DrChrono
DrChrono combines EHR with clearinghouse services. They focus on a mobile-first design approach. Popular with tech-savvy younger physicians always.
Key Features:
- Electronic health records with a clearinghouse
- iPad and iPhone apps available
- Real-time eligibility at check-in
- Claims submission from the EHR directly
- Telehealth capabilities are built in now
- Medical billing services optional
Pricing: Starts at $199 per month per provider
Best For: Mobile practices and tech-savvy providers
8. Navicure
Navicure was a leading clearinghouse before the merger. Still operates under the Waystar brand now. Legacy clients continue using their services today.
Key Features:
- Proven technology with a track record
- Strong payer network connections
- Advanced claim scrubbing included
- Good customer support provided
- Reliable uptime and performance
- Smooth transition to Waystar offered
Pricing: Grandfathered into Waystar pricing structure
Best For: Existing Navicure clients and mid-size practices
9. Apex EDI
Apex EDI specializes in dental and medical billing. They serve over 100,000 providers nationwide. Known for excellent customer service always.
Key Features:
- Connect to 3,500+ insurance payers
- Real-time eligibility verification included
- Electronic remittance advice delivered
- Claim status tracking in real-time
- Integration with major PM systems
- Dedicated customer support team
Pricing: Starts around $0.20 per claim submitted
Best For: Dental and small medical practices
10. Zirmed
Zirmed merged with Navicure, forming the Waystar brand. Still recognized name in the clearinghouse market. Existing clients transitioned to the Waystar platform now.
Key Features:
- Advanced technology platform with AI
- Predictive analytics prevent denials
- Automated workflows speed processing
- Real-time eligibility verification included
- Comprehensive denial management tools
- Integration with popular PM systems
Pricing: Follows Waystar pricing model structure
Best For: Former Zirmed clients and large practices
Comparison Table
| Clearinghouse | Cost | Payer Network | Best For |
| Change Healthcare | $0.25/claim | 2,000+ | Large practices |
| Availity | Free | 2,000+ | Small practices |
| Trizetto | $0.30/claim | 1,500+ | Mid-size practices |
| Office Ally | Free | Major payers | Solo practitioners |
| Waystar | Custom | 2,000+ | Advanced features |
| Kareo | $160/month | Major payers | Small independent |
| DrChrono | $199/month | Major payers | Mobile practices |
| Navicure | Custom | 2,000+ | Mid-size practices |
| Apex EDI | $0.20/claim | 3,500+ | Dental practices |
| Zirmed | Custom | 2,000+ | Large practices |
Conclusion
The top 10 clearinghouses in medical billing offer various features. The best medical billing clearinghouses provide fast claim processing. Healthcare clearinghouses for medical billing cut errors and denials. Choose based on practice size and budget. Consider features needed for your specialty. Compare pricing and support options carefully. The right clearinghouse improves cash flow significantly.
FAQs
What is a medical billing clearinghouse?
A clearinghouse checks claims for errors before submission. They send claims to insurance payers electronically. This cuts denials and speeds up payments. Most practices use clearinghouses for efficiency today.
How much do clearinghouses cost?
Costs range from free to $0.30 per claim. Some charge monthly subscription fees instead. Volume discounts available for high-volume practices. Free options work well for small practices.
Which clearinghouse is best for small practices?
Availity and Office Ally offer free services. Kareo provides an all-in-one solution for small offices. Apex EDI has affordable per-claim pricing. Choose based on your specific needs.
Do I need a clearinghouse?
Yes, most insurance companies require electronic claims. Clearinghouses make electronic submission easy and fast. They catch errors before claims go out. This saves time and improves collections significantly.
Can I use multiple clearinghouses?
Yes, but it complicates billing workflow management. Most practices use one primary clearinghouse. Backup clearinghouse can help during outages. Choose one that meets all your needs.
How long does clearinghouse setup take?
Setup typically takes 1-2 weeks to complete. Training staff takes another few days, usually. Most clearinghouses provide free setup support. You can start submitting claims quickly.
