What is a healthcare clearinghouse?
A clearinghouse is the middle layer between providers and payers. It checks claims, routes them to the right payer, and passes back acknowledgments, status responses and remittances.
Clearinghouse batch report
- Batch
- 1201
- Sent
- 03/15/2026 09:30
- Claims
- 5
| Claim | Payer | 999 | 277CA | Result |
|---|---|---|---|---|
| CLM00417 | Example Health Plan | Accepted | A2 accepted | With the payer |
| CLM00418 | Example Health Plan | Accepted | A7 rejected: billing NPI | Fix and resend |
| CLM00419 | Example Health Plan | Accepted | A2 accepted | With the payer |
| CLM00420 | Sample Medicaid | Accepted | A6 rejected: member ID missing | Fix and resend |
| CLM00421 | Sample Medicare | Accepted | A2 accepted | With the payer |
- Both rejections are invisible unless someone reads the report. The payer never received those claims.
Few providers connect to hundreds of payers one by one. A clearinghouse does it for them: one connection out, every payer on the other side.
What a clearinghouse does
- Checks claims against format rules and its own edits before they reach a payer, and rejects what would fail.
- Routes each 837 to the right payer, translating payer IDs and formats where needed.
- Returns responses: 999s, 277CAs, 276/277 status answers and 835 remittances.
- Runs eligibility through 270/271 transactions.
What it doesn’t do
A clearinghouse reports problems; it doesn’t fix them. Rejections land in a report or a portal, and someone has to read them, correct the claim and send it again before the timely filing limit passes. Payers that aren’t connected to the clearinghouse still need paper claims or their own portal.
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