> ## 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.

# Clearinghouse directory

> The longer tail of clearinghouses with one-paragraph profiles, categorized by best-fit segment.

Beyond the four compared in [The clearinghouses, compared](/reference/vendors/clearinghouse-comparison), a substantial market exists. This directory categorizes it by best-fit segment.

**Checked August 2026.** Vendors merge, rebrand, and change ownership frequently in this market. Verify current status, ownership, and payer coverage before selecting.

## API-first / developer-oriented

Built around programmatic access rather than a portal.

[**Stedi**](https://www.stedi.com/healthcare), API-first healthcare clearinghouse exposing eligibility, claims, claim status, acknowledgments, and remittance retrieval over a modern JSON API while also supporting raw X12. Publishes a searchable payer network and public metered pricing. Fits groups with engineering capacity, multi-entity complexity, or a plan to build their own analytics. See the [comparison](/reference/vendors/clearinghouse-comparison) for the tradeoffs.

**Change Healthcare / Optum APIs**, the incumbent's API surface, available but legacy-shaped.

Note also that several **healthcare API infrastructure companies** sit adjacent to this category, offering eligibility, claims, or payments primitives that route through underlying clearinghouses. Understand what is being resold versus what is a direct connection before selecting one.

## Large national

**Optum (Change Healthcare)**, one of the largest by volume; UnitedHealth Group subsidiary. See the [comparison](/reference/vendors/clearinghouse-comparison) including the February 2024 outage.

**Availity**, payer-founded lineage; doubles as the provider portal for many payers. Free tier for some payer-direct functions.

**Waystar**, publicly traded revenue cycle platform with clearinghouse at its core; extensive adjacent RCM tooling.

**TriZetto Provider Solutions**, part of Cognizant. Broad connectivity, commonly embedded in practice management systems, with RCM services alongside.

**Inovalon**, clearinghouse and data analytics, incorporating the former Ability Network. Strong in post-acute and analytics-oriented segments.

## Small practice and value-oriented

**Office Ally**, long-established, widely used by small practices, with a free tier for claim submission to participating payers. Portal-first; the economics are the draw.

**Claim.MD**, small-to-mid practice focus, generally well regarded for support responsiveness and straightforward pricing.

**Apex EDI**, small practice focus across medical, dental, and vision.

**eProvider Solutions**, clearinghouse services with a small-practice orientation.

## Dental-specific

Dental requires 837D and CDT support, and dental payer connectivity is a partly separate network.

**DentalXChange**, dental-focused clearinghouse with broad dental payer connectivity and integrations into major dental practice management systems.

**Vyne Dental (Tesia)**, dental claims and attachments; strong in the attachment workflow that dental claims frequently require.

**Skygen / Dental clearinghouse arms of larger platforms**, several dental payers and administrators operate or partner with dedicated dental clearing services.

<Note>
  🦷 **Dental attachments are a distinct workflow.** Dental claims frequently require radiographs, periodontal charting, or narratives, and the attachment mechanism is not uniform across payers. Evaluate dental clearinghouses on attachment handling specifically, not just claim transmission. See [Dental: the DSO model](/concepts/industries/dental-dsos).
</Note>

## Vision

Vision plans (VSP, EyeMed, and others) frequently operate their own submission channels separate from medical clearinghouses. An optometry practice typically needs medical clearinghouse connectivity **plus** direct vision plan channels. See [Optometry and vision](/concepts/industries/optometry).

## Institutional and facility

Groups operating an ambulatory surgery center or facility component need **837I** support in addition to 837P. Most large national clearinghouses handle it; verify with smaller and specialty vendors.

## Embedded in EHRs

Many practices use a clearinghouse they never selected, because it ships with the EHR. Common patterns:

| EHR segment                                                       | Frequently embedded                                    |
| ----------------------------------------------------------------- | ------------------------------------------------------ |
| Independent medical (athenahealth, Tebra, AdvancedMD, and others) | Proprietary or partnered clearinghouse                 |
| Dental (Open Dental, Dentrix, Eaglesoft)                          | Dental clearinghouse partnerships, often with a choice |
| Behavioral (SimplePractice, TherapyNotes)                         | Integrated partner                                     |
| PT (WebPT, Prompt)                                                | Integrated partner                                     |

**Ask before you sign the EHR contract**: does this system permit me to use my own clearinghouse, and can I change later? Get it in writing. See [Choose an EHR/PM system](/guides/billing/choose-an-ehr).

## How to evaluate any of them

Regardless of category:

| Criterion                       | Test                                                                                          |
| ------------------------------- | --------------------------------------------------------------------------------------------- |
| **Payer coverage for your mix** | Check your top 20 payers **by name** against their published list                             |
| **Enrollment support**          | Who does the EDI/ERA/EFT paperwork, and what is the turnaround?                               |
| **Rejection reporting**         | Ask to see an actual 277CA rejection as the product presents it                               |
| **835 handling**                | Delivery method, retention period, and whether PLB is surfaced clearly                        |
| **API access**                  | Read the developer docs, not the sales page                                                   |
| **Format support**              | 837P, 837I, 837D as applicable                                                                |
| **Multi-entity**                | Separate submitter configuration per PC                                                       |
| **Pricing**                     | Per claim, per provider, enrollment fees, minimums, model total cost across your entity count |
| **Security**                    | SOC 2 report; incident history                                                                |
| **Portability**                 | What can you export, and how, if you leave?                                                   |


## Related topics

- [Choose a clearinghouse](/guides/billing/choose-a-clearinghouse.md)
- [Choose an EHR/PM system](/guides/billing/choose-an-ehr.md)
- [What is a clearinghouse?](/concepts/payments/what-is-a-clearinghouse.md)
- [The clearinghouses, compared](/reference/vendors/clearinghouse-comparison.md)
- [EHR/PM directory by segment](/reference/vendors/ehr-directory.md)