Claims Clearinghouse
Claims Clearinghouses serve as an intermediary between healthcare providers and insurance payers, ensuring that claims are error-free and in the correct format before submission. These entities streamline the claims process by converting non-standard healthcare data into a standardized format, facilitating electronic data interchange (EDI), and ensuring compliance with HIPAA regulations. By performing "claim scrubbing" to minimize errors, clearinghouses help to accelerate the reimbursement cycle, reducing denials and improving the efficiency of the healthcare billing process.
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Stedi
Claimed
Stedi
Company Info
Founded: 2017
Headcount: 11-50
Customers
Verified Customers: 7
Customers Served: Digital Health Provider
Product Overview
1 ReviewsSecurity and Compliance Certifications: SOC 2 Type 2, HIPAA
Stedi is an API-first clearinghouse that offers automated solutions for real-time eligibility checks, claims processing, and electronic data interchange (EDI) for healthcare transactions. It connects to over 7,000 payers and provides JSON-based APIs for streamlined integration. Stedi's platform is designed for healthtech companies seeking reliable data exchange, redundancy, and compliance in payer connectivity, with features like multi-region failover and role-based access controls.
Change Healthcare
Change Healthcare
Company Info
Founded: 2007
Headcount: 5001-10000
Customers
Verified Customers: 12
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan
Product Overview
1 ReviewsSecurity and Compliance Certifications: HITRUST CSF, SOC 2 Type 2, PCI DSS
Change Healthcare offers a variety of revenue cycle management, clinical and imaging, and patient engagement tools, and are well-known for their insurance clearinghouse.
Waystar
Waystar
Company Info
Founded: 2017
Headcount: 1001-5000
Customers
Verified Customers: 6
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
1 ReviewsSecurity and Compliance Certifications: HITRUST CSF, HIPAA
Waystar is an end-to-end revenue cycle management company, offering eligibility verification, claims submission, payment posting, denials management, and analytics.
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Apex EDI
Apex EDI
Company Info
Founded: 1995
Headcount: 11-50
Customers
Verified Customers: 2
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
Apex EDI provides claims processing, error-checking, and submission to payers, and is integrated with various practice management and EHR systems.
Availity
Availity Essentials
Company Info
Founded: 2001
Headcount: 1001-5000
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan
Product Overview
Security and Compliance Certifications: HITRUST CSF, HIPAA
Availity Essentials is an end-to-end RCM solution for providers. It offers a range of features aimed at improving efficiency and accuracy in tasks such as eligibility and benefits verification, claims management, and prior authorization.
Claim.MD
Claim.MD
Company Info
Headcount: 11-50
Customers
Verified Customers: 3
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System, Health Plan
Product Overview
Security and Compliance Certifications: HITRUST CSF, HIPAA
Claim.md
is a clearinghouse for electronic claims management. It offers a user-facing portal for direct entry of both batch claims and single-entry claims. It integrates directly with a number of EHRs.
Experian
Experian Claims Management
Company Info
Founded: 1980
Headcount: 5001-10000
Customers
Verified Customers: 1
Customers Served: Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA, GDPR
Experian Claims Management is a claims clearinghouse that automates the claims process for healthcare organizations, focusing on accurate claim submissions and reducing denials. It includes tools like ClaimSource for claim edits and Enhanced Claim Status for tracking. The system aims to streamline adjudication and ensure compliance with payer requirements.
Office Ally
Office Ally
Company Info
Founded: 2000
Headcount: 201-500
Customers
Customers Served: Digital Health Provider, Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HITRUST CSF, SOC 2 Type 2, HIPAA
Office Ally enables healthcare providers to submit electronic claims to payers, and has features like claim scrubbing, status tracking, and integration with various practice management systems.
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SSI Group
SSI Clearinghouse
Company Info
Founded: 1988
Headcount: 201-500
Customers
Customers Served: Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
SSI Clearinghouse offers electronic healthcare transaction processing, including claims submissions, remittance advice, and eligibility verification. It features a robust editing suite with over 1 million edit combinations for claim validation and compliance. The service supports real-time and batch transactions with a large network of payers, including Medicare and Medicaid.
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TriZetto
Trizetto
Company Info
Founded: 1994
Headcount: 5001-10000
Customers
Verified Customers: 6
Customers Served: Ambulatory Practice
Product Overview
Security and Compliance Certifications: SOC 2 Type 2, HIPAA
TriZetto RCM aims to optimize financial outcomes for healthcare providers by handling billing processes and enhancing payment accuracy.
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TruBridge
TruBridge Clearinghouse
Company Info
Founded: 1979
Headcount: 1001-5000
Customers
Verified Customers: 1
Customers Served: Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
TruBridge Clearinghouse provides electronic processing for healthcare transactions, including claims submissions, remittance advice, and eligibility verification. It validates and edits data to meet industry standards, reducing errors and ensuring compliance. The service allows providers to track claims status and offers reporting and analytics tools for insights into billing and claims processes, such as claim acceptance rates and denials.
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Veradigm
Veradigm Revenue Cycle
Company Info
Headcount: 1001-5000
Customers
Customers Served: Ambulatory Practice, Hospital / Health System
Product Overview
Security and Compliance Certifications: SOC 2 Type 2, HIPAA
Veradigm Revenue Cycle Services provides end-to-end revenue cycle management solutions, including claims management, patient billing, and payer contract management. It aims to optimize financial performance for healthcare providers by reducing claim denials, shortening accounts receivable days, and increasing payment collections.
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