Your software
The medical billing clearinghouses we work in
A medical billing clearinghouse is where claims leave your system and where the answers come back: acknowledgements, rejections, eligibility responses and remittances.
A biller spends part of every day in it. These are the clearinghouses we work in, and what the work looks like. They sit alongside the rest of the billing software we work in.
Independent: Remitwright is not affiliated with or endorsed by any clearinghouse named here. Names describe the systems we work in.
Last reviewed by the Remitwright billing team. Editorial policy
Every day
What a biller does in the clearinghouse
Claim batches
Release the 837P and 837I batches your PM system creates, confirm the clearinghouse accepted the file, and keep the batch log so nothing sits unsent.1
Acknowledgements
Read the 999 and 277CA acknowledgements. A claim is not at the payer until the payer acknowledges it, so a claim with no 277CA is followed up.4
Rejections
Work front-end rejections from the clearinghouse report: subscriber IDs, provider identifiers, taxonomy, missing fields. Repeat reasons become rules in the PM system or fixes in registration.
Remittances
Retrieve 835 files, make sure they route into the PM system for posting, and chase payers whose remittances stop arriving.1
Eligibility
Run 270/271 eligibility checks ahead of visits and read the responses that need a person.1
Claim status
Send 276/277 status requests for claims past the payer's normal window and record what comes back.1
Payer enrollment
Complete the payer-specific enrollment forms for claims, ERA and eligibility. They are separate from your contract with the payer, and remittances from a new payer do not arrive until its ERA enrollment is complete.
Attachments and proof
Send attachments where the clearinghouse supports them, and pull the acceptance reports that show when a claim was received if a payer says it was filed late.
Clearinghouses
The clearinghouses
Availity
A clearinghouse and trading partner network that carries eligibility, authorization, claim and remittance transactions, alongside a multi-payer portal that health plans use with their providers.2
Waystar
A claims clearinghouse that runs payer-specific edits before a claim goes out, turns payer rejections into plain messages and monitors claim status afterwards.3
Office Ally
If your system sends claims through Office Ally, the biller works your batches and rejections there, the same way as in any other clearinghouse.
Claim.MD
A claims clearinghouse with a web portal for entering or uploading claims, real-time eligibility, and remittance data as standard 835 files or spreadsheets.6
TriZetto
TriZetto Provider Solutions, part of Cognizant, runs a clearinghouse for professional and institutional claims, with eligibility and remittance tools and links to many PM systems.7
Descriptions are written by us. Where a description draws on a company's own page, it is footnoted and listed under Sources. Each clearinghouse's site is the authority on what it offers today.
Questions
About clearinghouses
What is a clearinghouse, in one sentence?
A clearinghouse is the intermediary that takes claims from your practice management system, checks them, converts them to each payer's format, delivers them, and brings back the acknowledgements, rejections, eligibility responses and remittances.
Which clearinghouse should we use?
The one your PM system connects to well and that enrolls the payers you bill. The differences that matter are enrollment coverage, how clearly rejections are explained, and whether remittances route into your system without manual steps. We work in whichever you have and say so if it is causing problems we cannot fix.
Why do remittances from a new payer not arrive?
Check the ERA enrollment for that payer at the clearinghouse first. Contracting with the payer and enrolling for electronic remittances are separate steps, and finishing the first does not complete the second.
Can a clearinghouse report prove timely filing?
It can. The acceptance report showing the claim was received and forwarded on a date inside the payer's window is the record to send when a payer denies a claim as late. Each payer's manual says what it accepts as proof; the biller pulls the report and attaches it to the reconsideration. The timely filing limits by payer list each window.
Do we need to change clearinghouses to work with you?
No. We work in the one connected to your system. Switching is a decision with its own costs, and we would only suggest it if yours cannot enroll a payer you need or routinely loses claims.
Next step
Rejections piling up? Tell us which clearinghouse.
Three quick questions. No patient data. A written review of what is being rejected and why.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how switching works. You can also download the sample weekly report (PDF).