Depending on the vendor you choose and the number of claims you send, a medical claims clearinghouse can be free a month or cost over $500. That gap confuses most buyers, who think clearinghouses generally charge about the same.
The price of a medical claims clearinghouse in 2026 varies from $0 for small practices that use free tiers to $200 to $800 a month for mid-size groups selecting subscription plans. Per-claim fees are between $0.10 and $0.50 depending on the vendor. Costs vary from Free (Office Ally basic) to $0.50 per claim for premium services. Subscription models range from $200 to $800 a month.
Here’s a look at what five popular clearinghouses actually charge: Waystar, Availity, Office Ally, Optum (formerly Change Healthcare) and Claim.MD. The numbers are from vendor pricing pages and third-party pricing audits published in 2026.
How Much Does a Medical Claims Clearinghouse Cost by Pricing Model
Clearinghouses usually charge a flat monthly subscription, a per-claim fee, or offer a free base tier with paid add-ons. Most clearinghouses charge in one of three ways: You pay a per-claim fee, a flat monthly subscription per billing provider or nothing up front with paid transactions on top. Which model is cheaper depends entirely on your volume of claims, not the sticker price.
Free or almost free tier
Both Office Ally and Availity have a free entry-level tier for claims sent to payers who sponsor the connection. These work well for solo practices with consistent, low volume billing to common commercial payers.
Monthly flat subscription
claimMD has three flat-rate plans, while Waystar and Optum offer customized monthly subscriptions once a practice gets larger than a handful of providers.
Per claim or transaction pricing
Bigger platforms like Optum and some Waystar contracts are per transaction billed which is only cheaper than a flat plan at low volume.
Office Ally Clearinghouse Pricing: Free Claims, $44.95 Payment Non Par Fee
Office Ally is the budget benchmark most buyers compare everything else to. Office Ally is one of the lowest-cost clearinghouses on the market and does not charge set-up fees, general monthly fees, or per-claim fees for electronic claims submission to participating payers.
The catch comes when you bill payers that Office Ally does not sponsor. The Non-Par processing fee is $44.95 and is calculated and charged by unique Tax ID + Rendering NPI combination if any Non-Par claims are submitted in the month. Paper claims add still more. Any claims that cannot be electronically sent by Office Ally may be printed and mailed automatically for a fee of $0.75 per claim.
Add-on services appear as separate line items. Eligibility and benefits verification is $10 each month for the first 100 transactions and $0.10 for each additional transaction. Claim attachments are $0.55 each.
Claim.MD Pricing:
Flat $30, $60 or $120 a Month Claim.MD is the most transparent vendor in this category and prices accordingly. Claim.MD offers three plans: Basic for $30 a month, Small Volume for $60 and Unlimited for $120.
Every level works differently. Basic is the pay as you go tier where you get nothing included in the monthly fee and every claim, eligibility check and electronic remittance advice is billed at $0.30. Small Volume has 100 claims, 100 ERAs and 100 eligibility checks each month as three separate allowances and, after that, each additional transaction is $0.50.
The plan with the bigger volume wins. A practice with 300 claims a month pays $120 on Unlimited, versus $385 on Small Volume.
| Plan | Monthly Price | What’s Included | Overage Rate |
|---|---|---|---|
| Basic | $30 | Pay per use | $0.30 per claim/eligibility check |
| Small Volume | $60 | 100 claims, 100 ERAs, 100 eligibility checks | $0.50 per extra transaction |
| Unlimited | $120 | Unlimited claims and ERAs, 1,000 eligibility checks | $0.02 to $0.10 per extra eligibility check |
Source: Claim.MD, 2026.
Pricing Availity Essentials Free Essentials Plus $25/month
Availity has split its clearinghouse into separate products and priced each separately. Essentials Plus offers non-sponsored payers for a published rate of $25 a month. The multi-payer provider portal, Availity Essentials, is free for providers because sponsoring health plans pay for it.
The free tier has real limitations. Availity offered Essentials Plus for 25 USD per month, described as early adopter pricing, which included unlimited transactions with sponsored payers and 250 transactions a month with non-sponsored payers, with a small overage fee per transaction beyond that.
Availity’s Essentials Pro tier, Fusion product and API access move to custom quotes for a full clearinghouse replacement. Essentials Pro, the complete clearinghouse and revenue cycle suite, Availity Fusion and API access are quoted, priced per provider per month, per transaction or as a flat fee and are typically on an annual contract.
Waystar Pricing: Starting at $11,000 a Year
Waystar doesn’t have a rate card, which makes it harder for buyers to comparison shop. Pricing: Waystar doesn’t publish pricing (checked September 2026).
Third party pricing audits fill this gap with contract-based estimates. The most detailed published estimate states that small practices pay around 100 to 300 USD per provider per month . Mid-sized organizations often report 2,000 to 5,000 USD or more a month . Transaction-based agreements are around 0.11 USD per claim and 0.14 USD per eligibility check .
Implementation is added to first year bill. The same guide lists onboarding costs of 2,000 to 10,000 USD, EHR integration costs of 1,000 to 7,500 USD, and advanced training costs of 500 to 5,000 USD, and mentions annual contracts starting at around 11,000 USD. Waystar pricing also begins at around $11,000 a year, according to Software Finder’s own vendor profile, with Starter, Core, Performance, and Premium plans available at custom pricing.
Optum (Change Healthcare) Price: $0.25 – $0.50 per Claim
Optum took the change Healthcare’s clearinghouse technology after their 2022 merger, and pricing now is done through Optum’s enterprise contracting process. Pricing Custom enterprise Buyers want to pay $0.25 to $0.50 per claim or negotiate volume based pricing. Setup fees and implementation support are typically included for large clients.
One carve-out is important for practices with high volumes of UnitedHealth claims. UnitedHealthcare claims submitted through iEDI do not have an additional clearinghouse fee. Per claim fees are $0.25 to $0.50 for mid-volume practices.
Medical Claims Clearinghouse Cost Comparison Table
| Vendor | Entry Price | Typical Cost Range | Best For |
|---|---|---|---|
| Office Ally | $0 | $0 to $44.95/mo non-par fee | Solo and small practices, low volume |
| Claim.MD | $30/mo | $30 to $120/mo flat | Small to mid practices wanting predictable pricing |
| Availity | $0 | $0 to $25/mo, custom for Pro | Mid-size practices needing broad payer access |
| Waystar | Custom quote | $11,000+/year, $100 to $300/provider/mo | Growing practices wanting AI claim scrubbing |
| Optum (Change Healthcare) | Custom quote | $0.25 to $0.50 per claim | Hospitals and large health systems |
Source: vendor pricing pages and third-party pricing audits, 2026.
The question that all buyers considering options on forums ask (over and over again, but in different ways) is: what is this really going to cost me, once I factor in add-ons and overage fees and not just the number on the pricing page? A fair question. You have several vendors here like Office Ally and Claim.MD, if the base product is priced low, you can recover margin through non-par fees, attachment fees or overage rates as volume exceeds the included allowance.
FAQ’s
What does the clearinghouse charge for each claim?
Typically, vendors charge between $0.10 and $0.50 per claim depending on volume. Claim.MD’s pay-as-you-go plans charge $0.10 to $0.25 per claim, while Optum (Change Healthcare) charges $0.25 to $0.50 per claim for mid-volume practices. Office Ally does not charge anything per claim for participating payers.
Monthly fees for clearinghouses?
Some do, and some don’t. Claim.MD has flat monthly plans at $30, or $60 or $120. Office Ally and Availity Essentials don’t charge monthly for claims you send to participating payers, but they do charge once you submit claims to non-participating payers or need other services like ERAs.
Office Ally free for small practices?
Yes, for claims submitted to Participating Payers. Office Ally does not charge setup fees, monthly fees or per-claim fees to participating payers for electronic claims, however, it charges a monthly non-par fee of $44.95 per Tax ID and rendering NPI when you start submitting claims to non-participating payers.
Cost of Waystar vs Claim.MD?
Waystar costs much more. Waystar does not publish a price list, but third-party pricing guides show annual contracts starting around $11,000, with per-provider prices from $100 to $300 a month for small practices, plus implementation fees of $2,000 to $10,000 or more. By contrast, Claim.MD offers flat plans at $30, $60 or $120 a month with no setup fee.
Why doesn’t Availity or Waystar have transparent pricing?
Both vendors have tiered products, not one flat service. The final price depends on provider count, claim volume and which module you need. Availity provides the free Essentials tier and Essentials Plus for $25 monthly, but for the full clearinghouse product, Essentials Pro, you’ll get a separate quote, similar to Waystar’s Starter through Premium plans.
How to Select the Best Clearinghouse for Your Claim Volume
The cheapest paper clearinghouse may not be the cheapest clearinghouse for your practice. If you’re a solo provider sending less than 100 claims a month you’ll generally pay less on Office Ally or Claim.than any subscription model. A group of 10 providers processing thousands of claims a month will typically find that they are better off on a flat enterprise contract with Waystar or Optum when the per-claim fees are taken into account.
Before you sign anything, ask each vendor for a written breakdown of the non-par fee, attachment fee and overage rate based on your actual claim volume. Visit full profiles for Waystar, Availity, Office Ally, Optum (Change Healthcare), and Claim.MD or visit the full Insurance Claims software directory to compare other Insurance Claims software.
