Cleaner claims. Fewer denials.

A healthcare claims clearinghouse is a third-party agent that receives electronic claims from providers, scrubs them for errors, reformats them to meet payer-specific requirements, and submits them to insurance companies for processing. Healthcare claims clearinghouse software validates claims against payer rules and checks for coding errors, missing information, and formatting issues before submission — significantly reducing rejection rates. Waystar Claim Manager, for example, uses advanced automation and Waystar AltitudeAI™ to provide revenue cycle teams with a powerful, reliable clearinghouse. Capabilities include electronic claim submission, automated claim scrubbing, error detection, and predictive analytics that help healthcare organizations achieve an average 98.5% first-pass clean claim rate.

First-pass claim acceptance rate measures the percentage of claims accepted and paid by payers on initial submission without rework, resubmission, or appeal. A higher first-pass rate improves cash flow, reduces days in accounts receivable, and lowers administrative cost per claim. Industry benchmarks target 95% or higher, and many organizations fall short because of coding errors, missing data, and shifting payer rules. Healthcare organizations using Waystar Claim Manager achieve 98.5% average first-pass clean claim rate and first-pass acceptance rates, supported by extensive payer connectivity and Waystar AltitudeAI™ claim validation.

Automated claim scrubbing audits every claim against a rules engine before payer submission, checking for incorrect or missing patient demographics, invalid or outdated procedure codes, modifier errors, duplicate claims, timely filing risks, and payer-specific billing requirements. Claims flagged with potential issues are routed for correction before submission, preventing denials at the source. Waystar’s claim scrubbing software, powered by Waystar AltitudeAI™, automates 90% of claims follow-up activities. It continuously learns from denial patterns and automatically updates rules as payer requirements change. Revenue cycle teams gain fewer denials, faster payments, and less rework across the claim lifecycle.

Waystar Claim Manager integrates with all major EHR and practice management (PM) systems through standard healthcare data interfaces including HL7, FHIR, and EDI 837/835 transactions. This allows claims to flow directly from the clinical system into Waystar for scrubbing, validation, and submission without manual re-entry. The platform supports bidirectional data exchange, feeding claim status, rejection alerts, and remittance information back into the provider’s source system. Waystar has been ranked Best in KLAS for Claims and Clearinghouse every year since 2010.

Claim monitoring tracks claim status after submission, giving billing teams real-time visibility into where each claim stands in the payer adjudication process. Automated monitoring surfaces status updates so teams can identify and resolve issues before they become denials, without waiting on payer portals or phone calls. Waystar Claim Monitoring, part of the Claim Management suite, has over 600 claim status payer connections, which reduces days in AR, accelerates cash flow, and frees up staff from hours of follow-up work — allowing revenue cycle teams to focus on higher-value tasks.