> ## Documentation Index > Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt > Use this file to discover all available pages before exploring further. # Choose a clearinghouse > When you get a choice, the evaluation criteria that matter for MSO-PC groups, and how to test candidates against your own payer mix. A **clearinghouse** translates, validates, routes, and returns your claims and remittances. Choosing well matters most for multi-entity groups and for anyone who wants programmatic access to their own claim data. ## Prerequisites * Your actual payer mix, listed * Your claim formats, 837P, 837I, 837D * Your entity count now and in three years Consider asking your EHR. Many EHRs embed a clearinghouse and make switching difficult or impossible. It is far easier to choose an EHR that permits your clearinghouse than to change clearinghouses later, which means remapping every payer, re-enrolling EDI and ERA across your whole payer list, and running parallel for a period. ## The evaluation criteria | Criterion | Why it matters | How to test | | --------------------------------- | ---------------------------------------------------------------------- | -------------------------------------------------------------------- | | **Payer coverage for *your* mix** | Headline counts are marketing; what matters is your specific payers | Check your top 20 payers against their published payer list, by name | | **Enrollment support** | The highest-value service they provide, and the biggest differentiator | Ask who does the EDI/ERA/EFT paperwork and what the turnaround is | | **Rejection reporting clarity** | Determines how fast your biller resolves rejections | Ask to see an actual 277CA rejection as the product presents it | | **835 retrieval and handling** | Where remittances come from | Confirm delivery method and retention period | | **API access** | Determines whether you can build anything | Read the developer docs, not the sales page | | **Pricing transparency** | Multi-entity groups price across many PCs | Is there a published price, or a quote process? | | **Multi-entity configuration** | Separate submitter config per PC | Test it | | **Format support** | 837P, 837I, 837D as applicable | Confirm explicitly | | **Security posture** | Post-2024, non-negotiable | Ask for the SOC 2 report | ## 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](https://www.stedi.com/healthcare) 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. The full four-way comparison of Optum (Change Healthcare), Availity, Waystar, and Stedi, including the 2024 Change Healthcare outage, is in [The clearinghouses, compared](/reference/vendors/clearinghouse-comparison). ## Steps Not by count. ## 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. See [What is a clearinghouse?](/concepts/payments/what-is-a-clearinghouse). ## 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 ## Related topics - [Step 9: Pick your billing stack](/start/zero-to-paid/pick-billing-stack.md) - [Choose an EHR/PM system](/guides/billing/choose-an-ehr.md) - [Set up EDI, ERA, and EFT with each payer](/guides/enrollment/set-up-edi-era-eft.md) - [What is a clearinghouse?](/concepts/payments/what-is-a-clearinghouse.md) - [Clearinghouse vs RCM vs EHR (vs biller)](/concepts/payments/clearinghouse-vs-rcm-vs-ehr.md) - [The clearinghouses, compared](/reference/vendors/clearinghouse-comparison.md) - [Clearinghouse directory](/reference/vendors/clearinghouse-directory.md)