Clearinghouse
An entity that translates electronic transactions between providers and payers and applies front-end edits to reduce rejected claims.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Primary sources
- 1
- Workspace handoff
- revenue audit →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
HIPAA defines a clearinghouse as one of the three covered-entity types. Major commercial clearinghouses also offer denial-management dashboards and payer connectivity.
How it shows up in your practice
Front-end edits are your first line of defense. Track first-pass clean-claim rate; under 95% suggests EHR/clearinghouse misconfiguration.
Sources
- CMS — HIPAA Administrative Simplificationhttps://www.cms.gov/regulations-and-guidance/administrative-simplification
Audit clearinghouse rejections in Revenue Audit
Open revenue audit →Related terms
- Billing837 Electronic ClaimThe HIPAA-mandated electronic transaction for submitting professional (837P), institutional (837I), or dental (837D) claims.
- Denials & Appeals835 Electronic Remittance Advice (ERA)The HIPAA-mandated electronic transaction by which payers communicate payment and adjustment information to providers.
- Denials & AppealsDenial ManagementThe end-to-end workflow of identifying, categorizing, appealing, and preventing claim denials.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- Glossary837 Electronic ClaimThe HIPAA-mandated electronic transaction for submitting professional (837P), institutional (837I), or dental (837D) claims.
- Glossary835 Electronic Remittance Advice (ERA)The HIPAA-mandated electronic transaction by which payers communicate payment and adjustment information to providers.
- GlossaryDenial ManagementThe end-to-end workflow of identifying, categorizing, appealing, and preventing claim denials.
- GlossaryEFT (Electronic Funds Transfer)The HIPAA-mandated electronic payment transaction that moves funds from payer to provider, paired with the 835 remittance.
- Glossary270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- GlossaryBusiness AssociateA person or entity that performs functions or activities on behalf of, or provides services to, a covered entity that involve the use or disclosure of PHI.
- GlossaryCoordination of Benefits (COB)The rules and processes that determine which of two or more insurance plans pays first when a patient is covered by multiple plans.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.