Top 10 Clearinghouses in Medical Billing (2025 Guide).

Medical billing is a complex, detail-driven process—and one of the key players behind the scenes is the clearinghouse. These third-party intermediaries ensure that healthcare claims are correctly formatted and securely transmitted between providers and payers.

Whether you run a small private practice or manage a hospital system, using the right clearinghouse can speed up payments, reduce denials, and simplify compliance.

In this article, we break down the top 10 clearinghouses in medical billing for 2025, what they offer, and how to choose the best one for your practice.

What Is a Medical Billing Clearinghouse?

A clearinghouse in medical billing is a third-party service that:

• Scrubs claims for errors
• Converts them into payer-accepted formats (EDI 837)
• Sends them securely to insurance companies
• Receives and relays responses like EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advice)

Using a clearinghouse reduces rejected claims, ensures HIPAA compliance, and improves revenue cycle management.

Benefits of Using a Medical Billing Clearinghouse

• Claims Scrubbing: Reduces denials due to coding or formatting errors
• Faster Claim Submission: Real-time or batch transmissions
• HIPAA-Compliant Data Transfer
• ERA & EOB Processing
• Dashboard Analytics & Reporting
• Eligibility & Benefits Verification

Top 10 Clearinghouses in Medical Billing (2025)

Availity

Best For: Practices looking for a robust, user-friendly clearinghouse with payer integration.

• Key Features: Real-time claim edits, eligibility checks, remittance tracking
• Integrations: Compatible with most EHRs/EMRs
• Payer Network: Extensive (including Blue Cross, Aetna, Humana)
• Pros:Free version availableStrong support networkReal-time dashboard

Change Healthcare

Best For: Large practices and enterprise-level billing operations.

• Key Features: Advanced claims scrubbing, analytics, EDI management
• Payer Network: 2,200+ connections
• Strength: Industry-leading data analytics
• Pros:Excellent scalabilityReal-time claim trackingDeep reporting tools

Office Ally

Best For: Small practices and independent providers.

• Key Features: Free claim submission, batch file support, real-time eligibility
• Payer Network: 5,000+ payers
• Strength: No-cost option with affordable add-ons
• Pros:Budget-friendlyEasy to useSupports solo practices

Kareo Billing (now Tebra)

Best For: Medical practices using Kareo’s EHR and PM software.

• Key Features: Integrated clearinghouse with claims scrubbing
• Payer Network: Nationwide
• Strength: Seamless EHR + billing experience
• Pros:All-in-one platformSmart automation toolsBuilt for outpatient care

Waystar

Best For: Organizations prioritizing payment acceleration and transparency.

• Key Features: Claim management, predictive analytics, denial prevention
• Payer Network: 1,000+ payers
• Strength: Revenue cycle intelligence
• Pros:Fast claim approvalsActionable insightsGood for mid-size to large practices

Trizetto Provider Solutions (Cognizant)

Best For: Practices needing customized clearinghouse solutions.

• Key Features: Claims editing, EDI processing, patient eligibility
• Payer Network: Extensive across all states
• Strength: Deep customization for large providers
• Pros:Secure data exchangeDedicated account supportEnterprise-level scalability

Claim.MD

Best For: Simple, clean interface and fast claim submission.

• Key Features: HIPAA-compliant claims, ERA, EOB, eligibility checking
• Payer Network: 5,000+
• Strength: Usability and speed
• Pros:Easy setupTransparent pricingGood support for small billing firms

PracticeSuite

Best For: Medical billing companies needing end-to-end workflow tools.

• Key Features: Integrated PM, clearinghouse, ERA, and eligibility tools
• Payer Network: 2,000+
• Strength: Modular platform
• Pros:Cloud-basedMulti-specialty supportBuilt-in revenue cycle features

Zirmed (Acquired by Waystar)

Best For: Healthcare systems needing integrated analytics and billing tools.

• Key Features: Claims lifecycle tracking, automated edits, payer insights
• Strength: Merged with Waystar for more robust capabilities
• Pros:Strong analyticsFast processingPayer trend tracking

Medclaims

Best For: Medical billing companies and specialty practices.

• Key Features: Batch claims, payer remittances, EDI integration
• Payer Network: Over 3,000
• Strength: High customization and hands-on support
• Pros:Tailored servicesReal-time claim statusStrong customer service

How to Choose the Right Medical Billing Clearinghouse

When comparing options, consider:

CriteriaWhat to Look ForPayer NetworkEnsure your payers are supportedIntegrationCompatible with your EHR/PM systemPricing StructureFlat rate vs. per-claim pricingSupport & TrainingAccess to live support, training, and onboardingFeaturesEligibility checks, real-time edits, dashboard reportingScalabilityCan it grow with your practice or business?

Pro Tip: Ask for a demo or free trial to test usability and support responsiveness before committing.

Compliance and Security Standards to Expect

All top medical billing clearinghouses should adhere to:

• HIPAA (Health Insurance Portability and Accountability Act)
• EDI X12 837 Format
• Secure file transfer protocols (SFTP/HTTPS)
• Data encryption and audit logging

Always verify their security certifications before submitting PHI (Protected Health Information).

How Clearinghouses Impact Your Revenue Cycle

FunctionRevenue ImpactClaim ScrubbingFewer denials, faster paymentsEligibility ChecksFewer rejected claimsERA IntegrationEasier reconciliationAnalytics & ReportingInformed decisions, faster correction loops

A strong clearinghouse reduces A/R days and boosts overall collections.

Conclusion

Choosing the right clearinghouse is crucial for smooth medical billing operations, faster reimbursements, and stronger revenue cycle management. Whether you’re a solo provider or a multi-specialty group, the top medical billing clearinghouses listed above offer tools to reduce denials, improve compliance, and simplify your claims workflow.

Take time to compare features, test platforms, and find the best fit for your unique needs—your bottom line will thank you.

FAQs

1. What’s the difference between a clearinghouse and a billing company?

A clearinghouse transmits and processes claims, while a billing company manages the full revenue cycle, including coding, billing, and follow-up.

2. Can I use more than one clearinghouse?

Yes, but it may complicate data flow. Most practices stick with one to maintain efficiency.

3. How much does a clearinghouse cost?

Prices vary: some are free (like Office Ally), while others charge per claim (e.g., $0.25–$0.50/claim) or offer monthly plans.

4. Do clearinghouses help with denied claims?

Yes. Many offer denial management tools and help resubmit claims faster with corrected information.

5. Is using a clearinghouse required?

No, but using one streamlines claims, reduces rejections, and keeps your practice compliant and profitable.