The clearinghouses, compared

Four clearinghouses that cover most of the market an MSO-PC group would consider. Each fits a different profile, API-first entrants suit groups with engineering capacity and multi-entity complexity, while incumbents suit groups that value the largest installed bases and embedded EHR integrations. Checked August 2026. Vendor capabilities, pricing, and ownership change. Verify current details, especially payer coverage for your specific payer mix, before committing to any vendor.

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At a glance

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Stedi

What it is: An API-first healthcare clearinghouse, independent, exposing eligibility, claims, claim status, acknowledgments, and 835 retrieval over a modern JSON API alongside raw X12.¹ Strengths:

• A real API, not a portal with an API attached. Eligibility (270/271), claims (837P, 837I, 837D), claim status (276/277), 277CA acknowledgments, and 835 retrieval over a modern JSON API, with raw X12 available for teams migrating off legacy connections.¹
• Published, searchable payer coverage. A network of 3,500+ medical and dental payers, including Medicare, state Medicaid programs, and the major commercial carriers.¹ Being searchable before you sign lets you verify your own payer mix rather than trust a headline number.
• Transparent, metered pricing. Rates on a public pricing page, metered per transaction, without monthly minimums or setup fees.² That makes comparison across multi-entity groups possible; quote-based pricing across four vendors and eleven entities is not a comparison, it is a negotiation.
• Multi-entity submitter configuration without a separate contract per entity.
• Modern infrastructure and security posture. AWS with per-customer account isolation, role-based access, MFA, and HIPAA/SOC 2 compliance.¹

Considerations:

• Shorter track record and smaller installed base than the incumbents. If your requirement is “the clearinghouse my legacy on-premise PM system already has a certified interface to,” that points elsewhere.
• No bundled RCM tooling. If you want denial worklists, patient statements, and analytics dashboards from the same vendor, a platform like Waystar is a different proposition.
• API advantage is worth the most to teams that will use it. 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.

Fits: Multi-entity MSO-PC groups with engineering capacity, groups intending to build their own eligibility, denial, or AR analytics, and price-sensitive groups pricing across many PCs.

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Optum (Change Healthcare)

What it is: One of the largest clearinghouses in the US, and a subsidiary of UnitedHealth Group following the 2022 acquisition of Change Healthcare. Strengths: Enormous payer connectivity. Deeply embedded in many EHRs, so you may be using it without having chosen it. Extensive adjacent product set. The February 2024 outage. On February 21, 2024, Change Healthcare discovered a ransomware compromise; attackers had reportedly accessed its systems from February 17 through a Citrix remote access service lacking multi-factor authentication. Systems were taken offline.³ The dependency became immediately visible: an American Hospital Association survey of nearly 1,000 hospitals in March 2024 found 74% reporting direct patient care impact, including delays in authorizations.⁴ Practices could not submit claims, receive remittances, or in many cases verify eligibility, for weeks. UnitedHealth Group confirmed a $22 million ransom payment, and the data of an estimated 100 million individuals was affected.⁵ What that means for a selection decision: it is a fact to weigh, not a disqualification — remediation has occurred and the network remains one of the largest. But two structural points survive the incident:

1. Concentration risk is real, and the mitigation is cash reserves plus a known fallback, whichever vendor you pick.
2. Vertical integration, the largest payer’s corporate parent owning the pipe many of its own claims travel through, is a legitimate consideration, particularly for a group with heavy UnitedHealthcare volume.

Fits: Large organizations already integrated, or practices whose EHR embeds it and works well.

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Availity

What it is: A clearinghouse with a payer-connected lineage, founded by health plans, that doubles as the provider portal for a large number of payers. Strengths: For many payers, Availity is where you check eligibility, submit authorizations, and check claim status, whether or not it is your clearinghouse. Some payer-direct functions are available at no cost. Strong connectivity to the payers it is closest to. Considerations: Portal-first in design. Its payer-founded history is worth understanding when evaluating neutrality, though it operates as an independent business. API access exists but is not the product’s center of gravity. Fits: Practices whose payer mix is concentrated in Availity-connected plans, and anyone who will be using the Availity portal regardless.

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Waystar

What it is: A revenue cycle platform with clearinghouse functionality at its core, publicly traded since 2024. Strengths: Broad connectivity plus a substantial adjacent product set, denial management, patient payments, prior authorization, analytics. If you want one vendor for the clearinghouse and the RCM tooling, this is the strongest version of that. Considerations: Platform pricing is quote-based and bundled, which makes component costs hard to isolate. The bundling that is the strength is also the lock-in. Evaluate the bundling tradeoffs deliberately. Fits: Mid-size to large groups wanting an integrated RCM platform rather than a clearinghouse plus separately chosen tooling.

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Which one for whom

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The reminder that outranks all of this

You often don’t choose — your EHR does. Many EHRs embed a clearinghouse and make switching difficult or impossible. Ask before you sign the EHR contract, and get the answer in writing. Choosing an EHR that permits your clearinghouse is far easier than changing clearinghouses later, which means remapping every payer, re-enrolling EDI and ERA across your whole payer list, and running parallel for a period. See Choose an EHR/PM system.

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Whoever you pick

• Hold cash reserves sized to survive several weeks with no collections
• Know your fallback, which payers accept direct portal submission
• Keep your data portable — you cannot leave a vendor whose portal is the only copy
• Read the SOC 2 and ask about incident history

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Sources

1. Stedi, Healthcare clearinghouse APIs, Developer Docs, Payer network (checked August 2026).
2. Stedi, Pricing (checked August 2026).
3. HIPAA Journal, Change Healthcare Responding to Cyberattack; Congressional Research Service, The Change Healthcare Cyberattack.
4. American Hospital Association, Change Healthcare Cyberattack Underscores Urgent Need to Strengthen Cyber Preparedness.
5. IBM, Change Healthcare discloses USD 22M ransomware payment; Holland & Knight, Change Healthcare Cybersecurity Incident: Financial Impact and Resulting Litigation.