> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Choose a clearinghouse

> Evaluate dental clearinghouses for 837D claims, attachments, real-time eligibility, X12 275 readiness, payer coverage, and concentration risk.

A **clearinghouse** translates, validates, and routes claims, then returns claim responses and remittances. Dental workflows often combine an **837D** with radiographs, periodontal charts, or narratives and a preceding real-time eligibility check. Evaluate how well each vendor connects those parts of the workflow.

## Prerequisites

* Your actual payer mix, including any Medicaid dental benefit administrators
* Your entity count now and in three years
* Confirmation from your PMS vendor that you may choose your own clearinghouse; see [Choose a PMS](/guides/billing/choose-a-pms)

## The dental buying criteria

Three transactions have to work together, and the test is whether they are one workflow or three products:

| Criterion                                     | Why it matters                                                                                                             | How to test                                                                                                             |
| --------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------- |
| **837D support with dental-aware validation** | Tooth, surface, and quadrant edits catch errors a generic 837 scrubber passes                                              | Ask to see the validation rules for dental content                                                                      |
| **Integrated attachments**                    | Crowns, SRP, and implants adjudicate on documentation; a claim without its attachment buys a request-for-information cycle | Submit a test claim with a radiograph attached; count the systems involved                                              |
| **Real-time 270/271 eligibility**             | The check at scheduling is where downgrades and exhausted maximums get caught                                              | Run your top payers live; see what benefit detail comes back                                                            |
| **Payer coverage for *your* mix**             | Headline counts are marketing                                                                                              | Check your top 20 payers by name against the published payer list, including your state's Medicaid dental administrator |
| **Enrollment support**                        | EDI/ERA/EFT paperwork is what silently costs new groups months                                                             | Ask who does it and what the turnaround is                                                                              |
| **Multi-entity configuration**                | Each billing entity and payer relationship may need distinct submitter, receiver, identifier, and bank configuration       | Test the exact planned entities without assuming a separate clearinghouse contract for each                             |
| **API access**                                | Determines whether you can build eligibility automation or denial analytics                                                | Read the developer docs, not the sales page                                                                             |
| **X12 275 roadmap**                           | The attachments mandate lands in 2028                                                                                      | Ask directly; see below                                                                                                 |

## The vendor landscape

**Dental-focused networks.** **DentalXChange**, legally EDI Health Group, Inc., runs ClaimConnect. It combines 837D submission with validation, an integrated attachment service, real-time eligibility, claim status, and ERA.<sup>1</sup> **Vyne Dental** brings together NEA, the FastAttach attachment repository; Renaissance/Tesia, a clearinghouse; and Onederful, an eligibility API. It offers claims, attachments, and real-time 270/271 through one connection and reports serving more than 100,000 dental providers. That figure is vendor-reported.<sup>2</sup>

**Broader networks that also carry dental.** Legacy **Change Healthcare** dental products now sit inside **Optum**, whose network supports the 837D alongside medical transactions.<sup>3</sup> **Availity** also carries the 837D, and some Blues plans require dental submission through it. Its attachment workflow is separate from claim submission.<sup>4</sup>

The practical split: dental-native vendors sell the bundle; medical-first networks sell reach. A dental group usually wants the bundle, and adds a medical-capable path only for [medical billing of dental work](/guides/billing/bill-medical-for-dental-work). The full comparison is in [the clearinghouse comparison](/reference/vendors/clearinghouse-comparison).

## Ask every vendor about their 275 roadmap

Today's attachment workflow is proprietary. You upload files to NEA FastAttach or the clearinghouse's service, then place the reference number on the claim. In March 2026, CMS finalized **X12 275** as the HIPAA claims-attachment transaction, with a **compliance date of May 26, 2028**.<sup>5</sup> Before signing a multi-year contract, ask how the vendor will support 275, whether that support will cost extra, and what happens to stored attachments. See [CDT and the 837D](/reference/edi/cdt-and-837d) and [dental attachments](/reference/edi/dental-attachments) for background.

## Steps

<Steps>
  <Step title="Confirm your PMS permits your choice, in writing" />

  <Step title="List your top 20 payers by expected volume">
    Include your state's Medicaid dental benefit administrator, such as DentaQuest, MCNA, Liberty, or another contractor. Verify whether claims route through the clearinghouse or the administrator's portal.
  </Step>

  <Step title="Check each payer against candidates' published lists, by name">
    Evaluate coverage by transaction rather than total payer count. A payer may accept claims while offering no 271 or ERA connection through that clearinghouse.
  </Step>

  <Step title="Test the claim-plus-attachment workflow end to end">
    One test claim, one radiograph, one narrative. If it takes three logins, it will take three logins ten thousand times a year.
  </Step>

  <Step title="Ask each candidate who handles EDI/ERA/EFT enrollment and how long it takes" />

  <Step title="Ask for the X12 275 roadmap" />

  <Step title="Test multi-entity submitter configuration" />

  <Step title="Request the SOC 2 report and ask about incident history" />

  <Step title="Compare total cost including per-claim, per-attachment, eligibility, enrollment, and minimums">
    Attachment and eligibility transactions are often priced separately from claims. Model the cost using your actual volumes.
  </Step>
</Steps>

## Concentration risk

The **February 2024 Change Healthcare cyberattack** stopped claim submission and remittance across the network for weeks, and hit dental practices hard enough that the ADA publicized emergency funding for affected dentists.<sup>6</sup> It is the standing lesson in single-clearinghouse dependency. Whatever you choose:

* **Hold cash reserves** sized to survive several weeks with no insurance collections. This is the only mitigation that works regardless of cause.
* **Document a fallback.** Identify which payers accept direct portal submission and whether you could stand up a second clearinghouse.
* **Keep your data portable**, so you can move.

See [What is a clearinghouse?](/concepts/payments/what-is-a-clearinghouse).

## Verify it worked

* [ ] PMS compatibility confirmed in writing
* [ ] Top 20 payers verified by name, including the Medicaid dental administrator
* [ ] Claim-plus-attachment workflow tested end to end
* [ ] Real-time 270/271 confirmed for the payer mix
* [ ] Enrollment support process and turnaround understood
* [ ] 275 roadmap answered
* [ ] Multi-entity submitter configuration tested
* [ ] SOC 2 reviewed
* [ ] Total cost modeled at real claim, attachment, and eligibility volumes
* [ ] Fallback plan documented

## Sources

1. DentalXChange, [ClaimConnect services](https://payconnect.dentalxchange.com/provider/claimconnect/ClaimServices) and [attachment service](https://payconnect.dentalxchange.com/provider/claimconnect/AttachmentPage).
2. Vyne Dental, [payer connectivity](https://vynedental.com/payers/); Dental Products Report, [Vyne acquires Renaissance Electronic Services](https://www.dentalproductsreport.com/view/vyne-acquires-renaissance-electronic-services); Vyne, [Onederful acquisition](https://vynedental.com/blog/vyne-dental-acquires-dental-plan-eligibility-software-maker-onederful/). Provider counts are vendor-reported.
3. Optum, [EDI network transactions](https://business.optum.com/en/operations-technology/network-connectivity/medical/edi.html); Change Healthcare, [dental network](https://www.changehealthcare.com/dental-network/dental-converge).
4. BCBSM, [HIPAA transaction companion guide: 837D via Availity](https://www.bcbsm.com/amslibs/content/dam/public/providers/documents/hipaa-transaction-standard-companion-transactions.pdf); Healthy Blue Louisiana, [EDI submission](https://provider.healthybluela.com/louisiana-provider/claims/electronic-data-interchange).
5. Administrative Simplification: Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures, 91 Fed. Reg. 14350 (Mar. 24, 2026), compliance May 26, 2028. [Federal Register](https://www.federalregister.gov/documents/2026/03/24/2026-05676/administrative-simplification-adoption-of-standards-for-health-care-claims-attachments-transactions).
6. ADA News, [Funding assistance available to dentists impacted by Change Healthcare cyberattack](https://adanews.ada.org/ada-news/2024/april/funding-assistance-available-to-dentists-impacted-by-change-healthcare-cyberattack/) (April 2024).