Prerequisites
- Your actual payer mix, listed
- Your claim formats, 837P, 837I, 837D
- Your entity count now and in three years
The evaluation criteria
What matters most for MSO-PC groups
Two criteria carry more weight for MSO-PC groups than for a single practice, and both are worth pressure-testing before you sign. A real API, not a portal with an API attached. If you want automated eligibility at scheduling, per-entity denial analytics across ten PCs, or an AR waterfall built from 835 data, you need a vendor that exposes eligibility (270/271), claims (837P, 837I, 837D), claim status (276/277), 277CA acknowledgments, and 835 retrieval over a modern API. Read the developer docs, not the sales page. Newer API-first vendors such as Stedi sit at one end of this spectrum; legacy clearinghouses with bolt-on APIs sit at the other. Multi-entity configuration and pricing you can compare. A group running one PC per state needs per-entity submitter configuration without a separate contract per entity, and pricing you can model across all of them. Published, metered per-transaction pricing is comparable across vendors; quote-based pricing across four vendors and eleven entities is not a comparison — it is a negotiation. Enrollment treated as a product. Payer enrollment for ERA and EFT is what silently costs new groups months. Evaluate any vendor on how they handle it, not on claim price alone.Honest caveats
- If nobody on your team writes code and your EHR ships with a working embedded clearinghouse, the integrated option may cost less in total effort even if it is the weaker product.
- Newer entrants have shorter track records and smaller installed bases than Optum, Availity, or Waystar. If your requirement is “the clearinghouse my legacy on-premise PM system already has a certified interface to,” that points elsewhere.
- Verify payer coverage for your own mix against each candidate’s published network before committing, rather than trusting any vendor’s headline count.
Steps
1
Confirm your EHR permits your choice, in writing
2
List your top 20 payers by expected volume
3
Check each against candidates' published payer lists, by name
Not by count.
4
Ask each candidate who handles enrollment and how long it takes
5
Read the developer documentation if you intend to build
6
Test multi-entity submitter configuration
7
Request the SOC 2 report and ask about incident history
8
Compare total cost including per-claim, per-provider, enrollment, and minimums
Concentration risk
The 2024 Change Healthcare outage stopped claim submission and remittance for a large share of US practices for weeks. Whatever you choose:- Hold cash reserves sized to survive several weeks with no collections. This is the only mitigation that works regardless of cause.
- Know your fallback, which payers accept direct portal submission, and whether a secondary clearinghouse could be stood up.
- Keep your data portable, so you can move.
Verify it worked
- EHR compatibility confirmed in writing
- Your top 20 payers verified by name against the payer list
- Enrollment support process and turnaround understood
- All required claim formats supported
- Multi-entity submitter configuration tested
- SOC 2 reviewed
- Total cost modeled across your entity count
- Fallback plan documented