Clearinghouse
A healthcare clearinghouse is the intermediary that validates, formats, and routes electronic claims between providers and payers — the switchboard medical billing runs through.
- Validates, formats, and routes claims between providers and payers
- Claim scrubbing catches denials before submission
- Major players include Availity and Change Healthcare (Optum)
- Clearinghouses are HIPAA covered entities in their own right
What a clearinghouse does
Providers submit claims in one format; hundreds of payers each want their own. The clearinghouse scrubs claims for errors (missing NPIs, invalid code pairs), translates them into each payer’s required format, routes them, and returns acknowledgments and remittances. Good scrubbing catches denials before they happen, which is why clearinghouse choice quietly shapes RCM performance.
The 2024 Change Healthcare cyberattack — which froze a huge share of US claims traffic for weeks — made the category famous and taught the industry that clearinghouse redundancy is a real resilience concern.
Compliance handled, so you can build
Lithos runs the clinicians, pharmacies, and 50-state rules behind your care program — one API.
Frequently asked questions
Does a cash-pay program need a clearinghouse?
No — clearinghouses exist for claims. They enter the stack only when insurance billing does.
Is a clearinghouse the same as a billing company?
No — a billing company (or RCM vendor) manages the process; the clearinghouse is the pipe claims travel through.
Why did the Change Healthcare hack matter so much?
It processed a large share of all US claims; when it went down in 2024, provider cash flow froze nationwide — a lesson in single-point-of-failure risk.