Clearinghouse & payer-API comparison (2026-06-22)
All vendors side by side. The "most-public price" column shows the most trustworthy public datapoint we have — and how often it's simply "no public pricing." That blank space is the market problem.
| Vendor | API style | Self-serve | Functions | Most-public price |
|---|---|---|---|---|
| Availity | sales-gated | yes | 270/271, 837, 835, 276/277, 278 | Free Essentials portal for transactions to sponsored payers (plans pay Availity) |
| Optum (Change Healthcare) | sales-gated | no | 270/271, 837, 835, 276/277, 278 | Free sandbox (no contract, no financial obligation), but provisioned via a rep — not instant |
| Waystar | sales-gated | no | 270/271, 837, 835, 276/277, 278 | Per claim ~$0.11, per remit ~$0.04, per eligibility ~$0.14, paper claim ~$0.91 (third-party reported estimate) |
| TriZetto Provider Solutions | sales-gated | no | 270/271, 837, 835, 276/277, 278 | Per claim ~$0.15–$0.40 (third-party reported estimate) |
| pVerify | API-first | no | 270/271, 276/277 | Claim Status from ~$40/mo (≤150 txns); Enterprise from ~$70/mo (≤250 txns) (third-party reported estimate) |
| Office Ally | sales-gated | yes | 270/271, 837, 835, 276/277, 278 | Free: no set-up, monthly, or per-claim fees for electronic claims to Participating (Par) payers |
| Claim.MD | API-first | yes | 270/271, 837, 835, 276/277, 278 | Basic $25/mo, 0 included, $100 setup; add'l claim $0.30, add'l eligibility $0.30 |
| Stedi | API-first | yes | 270/271, 837, 835, 276/277 | Usage-based pay-as-you-go (prepaid credits); per-unit rate auto-drops with volume; no setup, no per-provider, no per-payer fees |
The transparency split:
- Publishes pricing / self-serve: Office Ally, Claim.MD, Stedi — you can scope cost before talking to anyone.
- Sales-gated (no public price): Optum (Change Healthcare), Waystar, TriZetto Provider Solutions — quote-only.
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Independent transparency directory. Pricing and access details are compiled from public vendor pages and practitioner reports and are dated and confidence-tagged — published = vendor's own public page, reported = third-party/forum estimate, no public price = none found. We do not invent numbers. Last verified 2026-06-22. Not affiliated with any vendor; verify current terms directly before contracting. Some outbound links may be referral links.