Questions to ask any Claims & Clearinghouses vendor
Every vendor in this category demos well. These are the questions that separate a product that will work on your volume, payer mix, and staff from one that works in the sales deck. Take them into the demo.
- 1
What is your first-pass acceptance rate for our payer mix and claim types?
- 2
What was your longest outage in the last 24 months, and what is the redundancy plan?
- 3
Which of our top ten payers are direct connections versus routed through intermediaries?
- 4
What do enrollments look like: how long until all our payers are live?
- 5
What are the real per-claim economics including eligibility, remits, and attachments?
- 6
How do we export our data and re-enroll if we leave?
- 7
Is there an API, and is it a first-class product or a bolt-on?
- 8
How did your customers fare during the 2024 Change Healthcare outage?
The 7 Claims & Clearinghouses vendors we cover
Waystar
Public RCM platform spanning claims to patient payments
Availity
Payer-owned network for claims and eligibility
Stedi
API-first clearinghouse for developers
Candid Health
Automated billing infrastructure for digital health
Change Healthcare (Optum)
The largest US medical claims clearinghouse, now part of Optum
Experian Health
Patient access, coverage discovery, and claims tools from Experian
Office Ally
Low-cost all-payer clearinghouse with practice software attached
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First Pass covers Claims & Clearinghouses and the rest of the getting-paid stack every Thursday.