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The clearinghouse is the middleman that takes claims out of your EHR, reformats them for each payer, and routes remittances (835s) back. It decides how fast you learn about rejections, so it’s worth choosing deliberately (what it is).

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Choosing

Start from your EHR: most PM systems have one or two integrated clearinghouses (Change Healthcare/Optum, Availity, Waystar, Trizetto, DentalXChange in dental), and the integrated option beats a technically better standalone. Then compare on payer coverage for your panel (ask for their payer list and check your top payers support electronic claims, ERA, and eligibility), rejection reporting quality, per-claim vs. flat pricing, and whether eligibility (270/271) and claim status (276/277) are included or upsold.

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The setup work

The clearinghouse account itself is fast. The real work is payer enrollments through the clearinghouse: many payers require signed EDI agreements per transaction type (claims, ERA, eligibility) before they’ll talk to your clearinghouse on your behalf. Expect a stack of enrollment forms in the first weeks, prioritized by claim volume. ERA enrollment here determines where your 835s land, which is why changing clearinghouses later means re-pointing ERA payer by payer, plan that like a bank switch. Test before opening: send test claims to your top payers and confirm acceptance reports come back (the rehearsal).