What is Clearinghouse?
Also called: medical billing clearinghouse · EDI clearinghouse
Without a clearinghouse a practice would need a direct electronic connection, and a separate format, for every payer it bills. The clearinghouse collapses that into one submission pipeline and one set of status reports.
The critical operational habit is reading clearinghouse acknowledgement reports daily. A claim rejected at the clearinghouse never reaches the payer, never appears in the payer's system, and will not show up in any aging report that is built from payer data. Practices routinely discover months of silently rejected claims this way.
Where Vizora handles this
Primary sources
Where "Clearinghouse" is defined by the bodies that set the rules, rather than by us.
- CMS-1500 claim form standards (opens in a new tab)
National Uniform Claim Committee — Maintainer of the CMS-1500 professional claim form and its data element definitions, plus the provider taxonomy code set.
- Medicare Claims Processing Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — The operative manual for how Medicare claims must be coded, submitted, adjusted and appealed. When a payer policy and a vendor's advice disagree, this settles it.
- CAQH Index: cost of administrative transactions (opens in a new tab)
CAQH — Per-transaction cost of eligibility checks, claim status inquiries and prior authorization, manual versus electronic. The best public evidence for automating front-end work.
Last reviewed August 20, 2026
Related terms
EDI 837
The EDI 837 is the HIPAA-mandated electronic format for submitting healthcare claims. The 837P variant carries professional claims, 837I carries institutional claims, and 837D carries dental. It is the electronic equivalent of a CMS-1500 or UB-04 paper form.
ERA
An electronic remittance advice, transmitted as an X12 835 file, is the payer's electronic explanation of how a claim was adjudicated. It reports what was allowed, what was paid, what was adjusted and why — using CARC and RARC codes — and it drives automated payment posting.
Rejection
A rejection is a claim stopped before adjudication — by the clearinghouse or the payer's intake system — for a format, data or eligibility error. Because it never entered adjudication, it carries no appeal rights and does not appear in payer claim status. It must be corrected and resubmitted.
Clean Claim
A clean claim is a claim that passes payer adjudication and is paid on first submission, without rejection, denial or a request for additional information. Clean claim rate — the percentage of claims meeting that standard — is the most direct measure of whether a billing operation is working.
More in Claims and submission
Find out what your denials are costing you
A free billing audit reviews your denial rate, AR aging and clean claim rate against industry benchmarks. Takes about two minutes to request. No sales pitch.
No setup fees · You pay when we collect · Pricing from 3% of net collections