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What are Clearinghouses?

In the healthcare industry, a clearinghouse is an institution that electronically transmits different types of medical claims data to insurance carriers. Types of claims data include pharmacy claims, dental claims, DME claims, inpatient and outpatient claims, and more.

Clearinghouses prescreen and clean medical claims data, searching for errors and inaccuracies. Once a claim passes inspection, the clearinghouse securely transmits the electronic claim data to the specified payor over a secure connection that meets strict standards outlined by HIPAA.

Why are Clearinghouses important?

Clearinghouses are a product of the healthcare industry entering the electronic age. Where medical claims data were once transmitted, organized, and distributed to health insurance carriers across the world on paper, a new infrastructure had to be created as healthcare providers shifted to digital platforms.

Clearinghouses are intended to serve as a middleman between providers and insurers, capable of handling and securely sending billions of claims electronically.