Top 10 Clearinghouses in Medical Billing in 2025

In medical billing, accuracy and speed make all the difference between getting paid on time and struggling with constant delays. That’s where a clearinghouse comes in. A clearinghouse acts like the middle step between providers and insurance companies, checking claims for errors and making sure they meet payer rules before they are submitted.

In this blog, we will cover the following topics:

• What is a Medical Billing Clearinghouse?
• How to Choose the Right Clearinghouse for Your Practice
• Top 10 Medical Billing Clearinghouses (With Pros & Cons)
• Benefits of Using a Clearinghouse in Medical Billing
• Conclusion
• Frequently Asked Questions

What is a Medical Billing Clearinghouse?

A medical billing clearinghouse is a service that acts as a bridge between healthcare providers and insurance companies. When a provider submits a claim, it doesn’t go straight to the payer. Instead, the claim first passes through the clearinghouse.

The clearinghouse checks the claim for errors, makes sure it follows payer rules, and then forwards it to the right insurance company. This process is called claim scrubbing, and it helps reduce denials and delays.
How to Choose the Right Clearinghouse for Your Practice

Not all clearinghouses are the same, and the best choice often depends on the unique needs of your practice. Here are some key factors to consider before deciding:

1. Practice size and specialties

A small clinic may not need the same features as a large multi-specialty group. Some clearinghouses are designed for high-volume billing, while others cater to niche specialties like behavioral health or hospital-based care.

2. Payer mix and network coverage

Make sure the clearinghouse connects with the payers you work with most often. Wider payer connections mean fewer delays and a smoother billing process.

3. Budget and pricing model

Clearinghouses can be priced per claim, per provider, or on a monthly subscription. Understanding your claim volume will help you choose a model that makes financial sense.

4. Integration with EHR and practice management systems

A clearinghouse that integrates smoothly with your existing software reduces double entry, saves time, and lowers the chance of errors.

5. Support and training

Billing can get complex, and having reliable customer support is critical. Look for clearinghouses that provide onboarding help, staff training, and ongoing support when issues arise.

Top 10 Medical Billing Clearinghouses (With Pros & Cons)

Choosing the right clearinghouse can make a huge difference in how quickly and accurately your practice gets paid. With so many options available, it’s not always easy to know which one will work best for your size, specialty, and budget. To help you decide, we’ve rounded up the 10 most popular medical billing clearinghouses in the U.S., with a breakdown of their pros, cons, and who they are best suited for.

1. Change Healthcare

Change Healthcare is one of the most established clearinghouses in the industry, recently merging with Optum. It provides end-to-end revenue cycle solutions, with strong claim scrubbing, payer connectivity, and advanced analytics that help practices handle high claim volumes with fewer errors.

Pros

• Connects to one of the largest payer networks in the U.S.
• Advanced claim editing tools reduce denials and rework
• Strong reporting and analytics dashboards to track performance
• Scalable for practices ranging from mid-sized clinics to large hospitals

Cons

• Pricing tends to be higher compared to smaller clearinghouses
• Onboarding and setup can take more time for new users
• A complex interface may require staff training
• Customer support feedback is mixed, with some users reporting delays

Best For

Change Healthcare is best for large practices, hospitals, and health systems that need robust payer connectivity, advanced analytics, and scalable solutions for complex billing environments.

2. Availity

Availity is one of the most widely used medical billing clearinghouses in the United States. It connects providers with thousands of payers and offers tools for eligibility checks, claim submission, prior authorizations, and real-time reporting. Its focus is on simplifying the revenue cycle while improving accuracy.

Pros

• Extensive payer network that covers most major insurers in the U.S.
• Real-time eligibility verification and benefits checks
• Strong reporting tools with detailed claim status updates
• Offers extra services such as prior authorization management and remittance advice

Cons

• It can feel complex for smaller practices with fewer billing needs
• Some features require additional training to use effectively
• Pricing can be higher than low-cost options like Office Ally
• Customer support response times can vary depending on the issue

Best For

Availity is best for medium to large practices, multi-specialty groups, and organizations that need a broad payer network and advanced revenue cycle tools.

3. Waystar

Waystar is a modern, cloud-based clearinghouse known for its automation and AI-driven tools. It helps practices streamline the revenue cycle by reducing claim errors, simplifying payment processes, and providing real-time financial insights. Its clean interface and strong integration options make it a popular choice among practices of all sizes.

Pros

• AI-powered claim scrubbing that reduces denials and rework
• User-friendly dashboard with real-time claim tracking and analytics
• Seamless integration with many EHR and practice management systems
• Scalable for both small practices and large healthcare organizations

Cons

• Premium features can increase the overall cost
• May feel feature-heavy for very small practices
• Some advanced tools require additional training to use effectively
• Pricing is not transparent and usually requires a sales quote

Best For

Waystar is best for practices that want modern automation, strong analytics, and a scalable clearinghouse that integrates easily with their existing systems.

4. Office Ally

Office Ally is one of the most affordable clearinghouses available, popular among small and mid-sized practices. It provides electronic claims submission, patient statements, and basic practice management tools. Known for its low cost and wide payer network, it offers a budget-friendly entry point for providers.

Pros

• Very affordable, with many clearinghouse services offered for free or at low cost
• Wide payer network that supports thousands of insurance connections
• Simple and easy-to-use platform for small practices
• Additional tools available, including EHR and patient statements

Cons

• Interface feels outdated compared to newer platforms like Waystar
• Reporting and analytics are limited
• Customer support can be slow at times
• May not scale well for large, multi-specialty groups

Best For

Office Ally is best for solo providers and small practices looking for a cost-effective clearinghouse with basic tools and wide payer connectivity.

5. Trizetto Provider Solutions (Optum)

Trizetto Provider Solutions, now part of Optum, is a well-known clearinghouse used by thousands of providers across the U.S. It offers advanced claim scrubbing, payer connectivity, and compliance tools that support both small practices and large healthcare organizations. Its strong infrastructure makes it a trusted option for high-volume billing.

Pros

• Extensive payer network with nationwide coverage
• Advanced claim editing that reduces errors and rejections
• Scalable solution that supports both small clinics and large hospital systems
• Reliable performance with high-volume claim processing

Cons

• Higher pricing compared to budget-friendly clearinghouses like Office Ally
• It can feel complex for smaller practices with limited staff
• Onboarding and setup may take longer than expected
• Some users report mixed experiences with customer support responsiveness

Best For

Trizetto Provider Solutions is best for hospitals, multi-specialty groups, and large practices that need a scalable clearinghouse with advanced compliance tools and strong payer connectivity.

6. Kareo Clearinghouse (Tebra)

Kareo, now rebranded as Tebra, combines practice management, billing, and patient engagement tools with its built-in clearinghouse. It is designed primarily for small to mid-sized practices that need an affordable, user-friendly solution to manage claims and reduce denials.

Pros

• Integrated clearinghouse with Kareo/Tebra’s billing and practice management software
• Easy-to-use interface tailored for smaller practices
• Includes claims tracking, ERA posting, and denial management
• More budget-friendly compared to enterprise-level solutions like Change Healthcare

Cons

• Payer connectivity is not as extensive as Availity or Waystar
• Works best only if you are using Kareo/Tebra’s full suite (not as strong as a standalone)
• Limited advanced analytics compared to larger clearinghouses
• Some users report occasional delays in customer support response

Best For

Kareo Clearinghouse (Tebra) is best for small to mid-sized practices, startups, and specialty clinics that want an affordable all-in-one platform combining billing, clearinghouse services, and patient engagement tools.7. 

7. NextGen

NextGen Healthcare provides a fully integrated clearinghouse within its practice management and EHR platform. It is designed for practices that want to streamline billing, compliance, and reporting while keeping everything under one system.

Pros

• Seamless integration with NextGen’s EHR and practice management tools
• Strong claim scrubbing and compliance checks to reduce denials
• Real-time eligibility verification and payer connectivity
• Advanced analytics and financial dashboards for revenue tracking

Cons

• Works best only for practices already using NextGen software
• Pricing is not transparent and usually requires a custom quote
• Complex interface that may require staff training
• Higher cost compared to smaller clearinghouses like Office Ally

Best For

NextGen Clearinghouse is best for mid-sized to large practices already using NextGen’s EHR and practice management system, or those looking for a tightly integrated all-in-one solution.

8. RXNT

RXNT offers a built-in clearinghouse as part of its cloud-based billing and practice management suite. It is designed for practices of all sizes and focuses on affordability, compliance, and ease of use, making it a practical option for providers who want an all-in-one system.

Pros

• Competitive pricing compared to larger clearinghouses
• Integrated with RXNT’s billing, EHR, and e-prescribing tools
• HIPAA-compliant and certified for Meaningful Use Stage 3 and ONC-ACB
• Real-time claim tracking, scrubbing, ERA posting, and payment reporting

Cons

• Interface design looks dated compared to newer solutions like Waystar
• Customization options are limited for specialty-specific workflows
• Some users report a steep learning curve at the start
• Customer support reviews are mixed, with occasional slow response times

Best For

RXNT Clearinghouse is best for small to mid-sized practices that need an affordable clearinghouse solution bundled with billing, EHR, and compliance-ready tools.

9. ClaimRemedi

ClaimRemedi is a clearinghouse that focuses heavily on claim scrubbing and error prevention. Its platform is built to help practices catch issues before submission, reducing denials and speeding up payments. It also provides detailed reporting tools that give insight into the claim cycle.

Pros

• Strong claim scrubbing tools that minimize errors
• User-friendly interface with clear claim status tracking
• Detailed reporting and analytics to identify revenue bottlenecks
• Easy integration with many practice management and EHR systems

Cons

• Smaller payer network compared to giants like Availity or Change Healthcare
• Pricing is not transparent and usually requires a custom quote
• Limited extra features outside of claims management
• May not scale as well for very large hospital systems

Best For

ClaimRemedi is best for small to mid-sized practices that want a reliable clearinghouse focused on reducing denials and providing strong visibility into claim performance.

10. PracticeSuite

PracticeSuite offers a built-in clearinghouse as part of its cloud-based billing and practice management platform. It is designed for small to mid-sized practices and is especially appealing because of its flexible pricing, including a free plan with basic features.

Pros

• Free plan available for very small practices or startups
• Integrated with PracticeSuite’s billing and practice management tools
• Customizable workflows to fit specialty-specific needs
• Real-time claim tracking and financial reporting dashboards

Cons

• The free version comes with limited features that may not suit growing practices
• Interface design feels dated compared to newer competitors
• Setup and customization can be time-consuming
• Mixed reviews about customer support response times

Best For

PracticeSuite Clearinghouse is best for small practices or startups that need a budget-friendly clearinghouse with the flexibility to scale up as they grow.

Clearinghouse	Best Feature	Pros	Cons	Best For
Availity	Wide payer network	Real-time eligibility, strong reporting, prior auth tools	Can feel complex, higher cost	Medium to large practices
Change Healthcare	Advanced analytics	Large payer connections, strong claim scrubbing, scalable	Expensive, longer onboarding, mixed support	Large practices & hospitals
Kareo (Tebra)	All-in-one integration	Easy to use, affordable, built-in clearinghouse	Limited payer network, best with Kareo suite	Small to mid-sized practices
Waystar	AI-driven automation	Advanced scrubbing, great analytics, seamless EHR integration	Premium pricing, feature-heavy	Practices wanting automation & scalability
Office Ally	Budget-friendly option	Very low cost, wide payer network, easy to use	Outdated interface, limited analytics	Solo and small practices
Trizetto (Optum)	Compliance tools	Nationwide network, advanced claim editing, scalable	Expensive, steep learning curve	Hospitals & large multi-specialty groups
ClaimRemedi	Strong claim scrubbing	User-friendly, detailed reporting, good integrations	Smaller payer network, limited extra features	Small to mid-sized practices
PracticeSuite	Free plan option	Budget-friendly, customizable workflows, real-time tracking	Limited free features, dated interface	Small practices & startups
NextGen	Full integration with NextGen EHR	Strong scrubbing, compliance checks, and advanced dashboards	Works best only with NextGen users, higher cost	Mid to large practices using NextGen
RXNT	Affordable all-in-one	Competitive pricing, HIPAA compliant, ERA posting	Outdated interface, limited customization	Small to mid-sized practices

Benefits of Using a Clearinghouse in Medical Billing

A clearinghouse plays a critical role in the billing process by acting as the middle layer between providers and payers. Without it, practices would spend hours fixing rejected claims, logging into multiple payer portals, and chasing down delayed payments. By using a clearinghouse, practices can save time, reduce administrative headaches, and secure more consistent cash flow.

Here are the main benefits explained in detail:

1. Get Paid Faster with Quick Claim Submission

Clearinghouses allow providers to submit claims electronically within seconds. This shortens the gap between the time care is given and when payment is received. Faster processing not only helps improve cash flow but also reduces the stress of waiting weeks for reimbursements.

2. Cut Down on Denials with Claim Scrubbing

One of the most valuable features of a clearinghouse is claim scrubbing. Each claim is checked for coding errors, missing information, or formatting problems before it goes to the insurance company. Fixing these issues up front means fewer denials and less back-and-forth with payers.

3. One Connection for All Payers

Instead of logging into different portals and following separate processes for multiple insurers, a clearinghouse centralizes everything in one place. This single point of access makes it easier for billing staff to manage claims and saves time on repetitive tasks.

4. Track Claims in Real Time

Most clearinghouses provide dashboards where providers can see the progress of every claim at each stage. Whether a claim is submitted, accepted, rejected, or paid, the status is clear and updated instantly. This visibility helps staff act quickly when issues come up instead of waiting until the end of the month to discover a problem.

5. Stay Compliant Without the Stress

Healthcare billing has strict rules, and every payer has its own requirements. Clearinghouses help ensure that claims meet HIPAA guidelines and other payer-specific standards. This reduces the risk of audits, penalties, or compliance issues that could impact the practice financially.

6. Free Up Staff from Endless Paperwork

By automating tasks like claim submissions, ERA posting, and reporting, clearinghouses remove much of the manual workload. This gives staff more time to focus on patient care and the bigger picture of revenue cycle management instead of getting stuck in paperwork.

7. Save Money by Reducing Errors and Rework

Even though clearinghouses charge a fee, the long-term savings are significant. Practices save money by avoiding repeated claim resubmissions, reducing denials, and cutting down on administrative hours. Over time, this translates into higher revenue and lower operating costs.

Conclusion

Clearinghouses are a necessity for keeping claims accurate, compliant, and paid on time. From reducing denials to simplifying payer connections, the right clearinghouse can make a big difference in how smoothly your revenue cycle runs.

Each platform has its own strengths, whether it’s affordability, advanced automation, or wide payer connectivity. The key is to choose one that matches your practice’s size, specialty, and goals.

By investing the time to find the right clearinghouse, you set your practice up for fewer billing headaches, stronger cash flow, and more time to focus on patient care.

Frequently Asked Questions

1. What is a clearinghouse in medical billing?

A clearinghouse in medical billing is a service that checks claims for errors, ensures they meet payer rules, and forwards them to insurance companies for faster payment.

2. What is an example of a clearinghouse?

Examples of clearinghouses include Availity, Change Healthcare, Waystar, Office Ally, and Trizetto (Optum).

3. What is the best clearinghouse for medical billing?

The best clearinghouse depends on practice size. Change Healthcare, Availity, and Waystar are best for large practices, while Office Ally and Kareo (Tebra) work well for small clinics.

4. Who is required to do a clearinghouse?

Any healthcare provider who bills insurance electronically is required to use a clearinghouse or direct payer connection to submit HIPAA-compliant claims.

5. How much does a medical billing clearinghouse cost?

Clearinghouse costs vary. Some charge per claim, others per provider, or via monthly subscriptions. Prices range from low-cost options like Office Ally to $300+ per provider per month for advanced platforms.