EDI & files

What is Clearinghouse?

An intermediary that validates, formats, and routes claims to payers and returns acknowledgements and remittances.

Also known as
EDI clearinghouse · claims clearinghouse

Definition

A clearinghouse sits between provider and payer: it takes 837 claim files, validates them against payer-specific requirements, routes them to the right payer, and returns acknowledgements, rejections, and 835 remittances. It saves a practice from maintaining a separate connection to every payer it bills.

The critical artefact it produces is the acknowledgement report. A claim rejected at the clearinghouse never reached the payer — it will not appear in any payer status inquiry, will never deny, and will never show up in payer-side reporting. It simply does not exist anywhere except that report, while its timely-filing clock keeps running.

Why it matters

Unworked clearinghouse rejections are the purest form of silent revenue loss: the claim was never received, so nothing will ever alert you.

Denial codes to know

Related terms

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