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Healthcare clearinghouse vs. gateway. What’s the difference?

“Do I need a healthcare clearinghouse or a gateway?” We hear that question a lot, which is understandable since Availity offers both.   

The answer depends. Are you a provider submitting transactions to a payer, or are you a payer receiving transactions from a provider? If you’re a provider (or a vendor who submits on behalf of a provider), you purchase clearinghouse services. For payers, it’s a gateway. 
If you read our first blog in this series, you know clearinghouses serve as an intermediary between payers and providers. They aggregate transactions and scrub them for errors before sending them on to the payer. What we didn’t mention is that clearinghouses don’t send transactions directly to the payer. Instead, they first go to the payer’s gateway, which functions like a clearinghouse. It reviews transactions, checks for HIPAA compliance and other payer-specific edits, and ensures the transactions are as clean as possible before sending them to the payer for payment processing.  

Pretty simple, right? So, if you’re a provider (or a vendor submitting on behalf of a provider) and want to learn more about Availity’s clearinghouse service, visit Availity EDI Clearinghouse. Payers can get details on our gateway services at Availity Intelligent Gateway.  

One last thing… 

Payers sometimes ask if moving to Availity’s Intelligent Gateway means their provider network must also move to Availity’s EDI Clearinghouse. They’re concerned about workflow disruptions for providers. The answer is “no.” When payers migrate to our Intelligent Gateway, providers can remain with their existing clearinghouse.  

But even though it’s not required, there are some really good reasons for payers to recommend Availity’s provider solutions to a provider network. In addition to our EDI Clearinghouse, Availity Essentials Pro offers a sophisticated, end-to-end revenue cycle solution that helps providers not just manage denials but prevent them in the first place. For payers, receiving cleaner claims from providers helps reduce administrative back and forth.