> ## 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.

# The clearinghouses, compared

> Stedi, Optum (Change Healthcare), Availity, and Waystar compared across connectivity, pricing, enrollment support, API modernity, and risk, with a which-one-for-whom conclusion.

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.

## At a glance

|                         | **Stedi**                                                       | **Optum (Change Healthcare)**  | **Availity**                                          | **Waystar**                 |
| ----------------------- | --------------------------------------------------------------- | ------------------------------ | ----------------------------------------------------- | --------------------------- |
| **Ownership**           | Independent                                                     | UnitedHealth Group             | Payer-founded lineage; PE-backed                      | Public (NASDAQ: WAY)        |
| **Generation**          | **API-first**                                                   | Legacy, at very large scale    | Portal-first, payer-connected                         | Platform, RCM-oriented      |
| **Payer network**       | 3,500+ medical and dental, published and searchable<sup>1</sup> | Very large                     | Very large, strongest where payer-connected           | Very large                  |
| **Pricing**             | **Published, metered, no minimums**<sup>2</sup>                 | Quote-based                    | Free tier for some payer-direct functions; paid tiers | Quote-based                 |
| **API**                 | **Modern JSON, plus X12**                                       | Available, legacy-shaped       | Available                                             | Available                   |
| **Portal**              | Yes, alongside the API                                          | Yes                            | **Strong, it is the portal for many payers**          | Yes                         |
| **Multi-entity**        | Per-entity submitter config                                     | Supported                      | Supported                                             | Supported                   |
| **Bundled RCM tooling** | No, clearinghouse focused                                       | Extensive                      | Some                                                  | **Extensive**               |
| **Notable risk**        | Shorter track record                                            | **Feb 2024 ransomware outage** | Payer-adjacent ownership history                      | Bundling and contract terms |

## 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.<sup>1</sup>

**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.<sup>1</sup>
* **Published, searchable payer coverage.** A network of 3,500+ medical and dental payers, including Medicare, state Medicaid programs, and the major commercial carriers.<sup>1</sup> 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](https://www.stedi.com/pricing), metered per transaction, without monthly minimums or setup fees.<sup>2</sup> 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.<sup>1</sup>

**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.

## 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.<sup>3</sup>

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.<sup>4</sup> 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.<sup>5</sup>

**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.

## 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.

## 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](/concepts/banking/bundled-payroll-and-processing) deliberately.

**Fits:** Mid-size to large groups wanting an integrated RCM platform rather than a clearinghouse plus separately chosen tooling.

## Which one for whom

| If you are…                                                         | Consider                                               |
| ------------------------------------------------------------------- | ------------------------------------------------------ |
| A multi-entity MSO-PC group with engineering capacity               | An API-first vendor such as Stedi                      |
| Building your own eligibility, denial, or AR analytics              | An API-first vendor such as Stedi                      |
| Price-sensitive and pricing across many PCs                         | A vendor with published, metered pricing such as Stedi |
| Wanting one platform for clearinghouse plus RCM tooling             | Waystar                                                |
| Concentrated in payers where Availity is the portal                 | Availity                                               |
| Already deeply integrated with Optum, and it works                  | Optum                                                  |
| Using an EHR with an embedded clearinghouse and no engineering team | Whatever is embedded, if it performs                   |

## 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](/guides/billing/choose-an-ehr).

## 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

## Sources

1. Stedi, [Healthcare clearinghouse APIs](https://www.stedi.com/healthcare), [Developer Docs](https://www.stedi.com/docs/healthcare), [Payer network](https://www.stedi.com/healthcare/network) (checked August 2026).
2. Stedi, [Pricing](https://www.stedi.com/pricing) (checked August 2026).
3. HIPAA Journal, [Change Healthcare Responding to Cyberattack](https://www.hipaajournal.com/change-healthcare-responding-to-cyberattack/); Congressional Research Service, [The Change Healthcare Cyberattack](https://www.congress.gov/crs_external_products/IN/HTML/IN12330.web.html).
4. American Hospital Association, [Change Healthcare Cyberattack Underscores Urgent Need to Strengthen Cyber Preparedness](https://www.aha.org/change-healthcare-cyberattack-underscores-urgent-need-strengthen-cyber-preparedness-individual-health-care-organizations-and).
5. IBM, [Change Healthcare discloses USD 22M ransomware payment](https://www.ibm.com/think/news/change-healthcare-22-million-ransomware-payment); Holland & Knight, [Change Healthcare Cybersecurity Incident: Financial Impact and Resulting Litigation](https://www.hklaw.com/en/insights/publications/2024/06/change-healthcare-cybersecurity-incident-financial-impact).


## Related topics

- [Step 9: Pick your billing stack](/start/zero-to-paid/pick-billing-stack.md)
- [Choose a clearinghouse](/guides/billing/choose-a-clearinghouse.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)
- [Clearinghouse directory](/reference/vendors/clearinghouse-directory.md)