> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Choose and set up your clearinghouse

> The pipe between your EHR and every payer: how to choose one, and the enrollment work that makes claims and ERAs flow.

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](/concepts/clearinghouses-explained)).

## 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.

## 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](/guides/switch-banks).

Test before opening: send test claims to your top payers and confirm
acceptance reports come back
([the rehearsal](/start-here/launch-in-4-months)).

## Related

* [Clearinghouses explained](/concepts/clearinghouses-explained)
* [Choose your EHR and practice management system](/guides/choose-your-ehr)
* [Set up your payers](/guides/set-up-payers)
* [Front desk stack](/guides/front-desk-stack)