A clearinghouse sits between your practice management system and every payer you bill. It checks claims for errors, converts them to the format each payer accepts, and returns rejections, claim status and remittance files. Choosing the right one affects how fast you get paid, how many claims bounce, and how exposed you are when a vendor goes down. This guide compares the main medical billing clearinghouses in use in 2026 and explains what to check before you sign.
Quick answer: The clearinghouses most US practices use are Availity, Waystar, Optum (Change Healthcare), Office Ally, TriZetto Provider Solutions, Claim.MD and Experian Health. Pick based on payer connections, rejection reporting, ERA enrollment support and how well it integrates with your PM system. Keep a backup connection for your top payers.
Key takeaways
- Payer list first: Confirm the clearinghouse connects directly to your top ten payers.
- Rejections matter more than price: Clear, fast front-end rejection reports protect timely filing.
- Plan for outages: The 2024 Change Healthcare cyberattack showed why a second route to key payers matters.
- Names have changed: Navicure and ZirMed are now Waystar, and Kareo is now Tebra.
What Is a Medical Billing Clearinghouse?
A clearinghouse is a HIPAA covered entity that processes electronic health care transactions on behalf of providers. Under HIPAA, it must protect patient data the same way a practice does. In daily billing, it handles these standard transactions:
| Transaction | What it does |
|---|---|
| 837P / 837I | Sends professional and institutional claims to payers |
| 999 / 277CA | Confirms receipt and reports front-end acceptance or rejection |
| 270 / 271 | Checks patient eligibility and benefits |
| 276 / 277 | Requests and returns claim status |
| 835 | Delivers the electronic remittance advice (ERA) |
Medicare claims can also go straight to a MAC, but most practices route them through a clearinghouse along with commercial claims. CMS lists the rules and enrollment steps on its Electronic Billing and EDI Transactions page.
Top Medical Billing Clearinghouses in 2026
1. Availity
Availity is a multi-payer portal and clearinghouse owned in part by several large health plans. Many payers, including major Blue Cross Blue Shield plans, use it as their preferred provider portal for eligibility, authorizations and claim status. Basic portal features are free to providers.
Best fit: Practices that bill a lot of BCBS, Humana or other Availity-aligned plans.
2. Waystar
Waystar was formed from Navicure and ZirMed and later added eSolutions. It offers claims, eligibility, denial and analytics tools in one platform and integrates with many PM and EHR systems.
Best fit: Mid-size and large groups that want analytics and denial tools along with claims.
3. Optum (Change Healthcare)
Change Healthcare, now part of Optum, runs one of the largest claims networks in the US. Its February 2024 cyberattack disrupted claims and payments nationwide for weeks, and many practices added a second clearinghouse afterward.
Best fit: Organizations already on Optum systems, ideally with a backup connection.
4. Office Ally
Office Ally is a low-cost clearinghouse popular with small practices. Many claims can be sent at no charge through its online service, and it also offers a basic PM and EHR.
Best fit: Solo and small practices with simple payer mixes.
5. TriZetto Provider Solutions
TriZetto Provider Solutions, a Cognizant company, provides claims, eligibility and remittance services and connects to many PM systems.
Best fit: Practices whose PM vendor integrates with TriZetto.
6. Claim.MD
Claim.MD is a web-based clearinghouse known for simple pricing, a clean interface and fast rejection reporting.
Best fit: Independent billers and small to mid-size practices.
7. Experian Health
Experian Health combines claims processing with patient access tools such as eligibility, identity checks and cost estimates.
Best fit: Hospitals and larger groups focused on front-end accuracy.
8. Inovalon (ABILITY Network)
Inovalon, which acquired ABILITY Network, offers direct Medicare connectivity and eligibility tools used widely by home health, hospice and facility billers.
Best fit: Facility and post-acute providers with heavy Medicare volume.
9. Tebra (formerly Kareo)
Tebra is a PM and EHR platform for independent practices with a built-in clearinghouse, so claims, eligibility and ERAs run inside the same system.
Best fit: Independent practices that want PM and clearinghouse in one product.
10. DrChrono
DrChrono is an EHR and PM system with integrated claims submission through its clearinghouse partners.
Best fit: Practices already using DrChrono that want billing in the same app.
How Do the Top Clearinghouses Compare?
| Clearinghouse | Type | Strongest for |
|---|---|---|
| Availity | Multi-payer portal and clearinghouse | Eligibility and payer portal access |
| Waystar | Standalone platform | Analytics and denial management |
| Optum (Change Healthcare) | Large national network | Payer reach |
| Office Ally | Low-cost clearinghouse | Small practices |
| TriZetto Provider Solutions | Standalone clearinghouse | PM integrations |
| Claim.MD | Web-based clearinghouse | Simple setup and rejection reports |
| Experian Health | Revenue cycle suite | Patient access accuracy |
| Inovalon (ABILITY) | Medicare-focused connectivity | Facility and post-acute billing |
| Tebra | PM/EHR with built-in clearinghouse | All-in-one for independents |
| DrChrono | EHR/PM with integrated claims | DrChrono users |
How to Choose a Clearinghouse
- List your top payers. Confirm direct connections, not routing through another clearinghouse, for the payers that drive most revenue.
- Test rejection reporting. Ask for a sample 277CA report. Rejections should be specific enough to fix without calling support.
- Check ERA and EFT enrollment support. Some clearinghouses handle payer enrollment for you; others leave it to the practice.
- Confirm PM integration. Claims, eligibility and ERAs should post back into your system automatically.
- Plan a backup route. Keep a second connection, or at least a portal option, for your top payers in case of an outage.
Clearinghouse edits are not enough on their own. They catch format errors, not coding or payer-policy errors. Pair them with a claim scrubbing process like the one in our guide to the eClinicalWorks claim scrubbing process, and see how eligibility setup affects rejections in eCW eligibility verification failures.
Rejections that never reach the payer do not count as filed, so a slow rejection queue can turn into timely filing denials. Tracking your first-pass claim acceptance rate shows whether the clearinghouse and your front-end checks are working. Persistent coding errors or payer denials need denial management, not a new clearinghouse.
Conclusion
The best clearinghouse is the one that connects cleanly to your payers, reports rejections clearly and fits your PM system. Availity, Waystar, Optum, Office Ally, TriZetto, Claim.MD and Experian Health cover most US practices, and all-in-one platforms like Tebra suit smaller offices. Whatever you choose, keep a backup route for key payers and work rejections daily.
Need help with claims and clearinghouse setup?
Dr Biller RCM manages claim submission, rejections and ERA posting for small to medium practices on all major clearinghouses.
Clearinghouses FAQs
It checks claims for format errors, converts them to the standard 837 format, sends them to payers, and returns rejections, claim status and electronic remittance advice.
No, but most practices use one because it lets them send claims to many payers from one system instead of connecting to each payer separately.
They merged to form Waystar, which later acquired eSolutions.
Kareo is now part of Tebra, a PM and EHR platform with a built-in clearinghouse.
Office Ally is often the lowest-cost option because many claims can be sent through its online service at no charge, though pricing depends on payer mix and features.
Many do. The 2024 Change Healthcare outage showed that a backup route to key payers protects cash flow during a vendor outage.
