Revenue cycle · Claims clearinghouse
Claim.MD
Claim.MD is an electronic claims clearinghouse with a web portal and API for claims, remittances, and real-time eligibility, sold on published monthly plans.
Strong fit
- Small and mid-sized practices and billing companies that want a low-cost clearinghouse with published prices
- Practices that want a second clearinghouse as a backup to their main one
- Billers who send workers' compensation and auto accident claims with attachments
Weak fit
- Large health systems that want denial analytics, patient payments, and prior authorization from one vendor
- Organizations looking for AI that handles claims without staff
- Teams that want an account manager visiting on site
Bottom line
Claim.MD is a Pecos, New Mexico company that runs an electronic claims clearinghouse. Practices, billing companies, and software vendors send claims through its web portal or upload files, get payment files and rejections back, and check patient eligibility. It suits practices that want published pricing, U.S.-based support, and a backup to a larger clearinghouse.
Score breakdown
Weights: Outcomes 35% · Product 30% · Implementation 20% · Pricing clarity 15%.
Rob Stuart founded Claim.MD and is its president and chief executive. In the early 1980s a physician called his university looking for someone to make a computer talk to Medicare over the phone, and the head of its information systems department sent Stuart. The company says some of its first providers are still customers more than four decades later.
Practices can type claims into its web portal or upload files from their billing software. They receive electronic payment files and can check eligibility in real time through the portal or an API. Its support team is based in the United States.
Claim.MD says it processes tens of millions of transactions a month. It also runs claim-entry portals for insurance companies, attaches documents to workers' compensation claims, and handles claims for foreign health ministries that send patients to the United States.
It was first certified by HITRUST in 2023 and kept its HITRUST r2 certification as of June 2026.
Stuart makes a case for backup clearinghouses. In April 2026, two years after the Change Healthcare cyberattack, he wrote that many payers had routed everything through one clearinghouse, which left providers with no working way to send claims. In his view, providers and payers need more than one tested way to send claims.
Other tools fit different needs. Waystar suits a health system that wants claims, denials, and patient payments in one platform, and Availity suits buyers whose main need is payer connections and prior authorization.
Experian Health suits buyers who put patient access and estimates first. AKASA suits buyers who want AI to automate billing work.
Competitor landscape
| Vendor | Overall | Ease of implementation |
|---|---|---|
| Stedi | 8.3 | 8.0 |
| Waystar | 8.0 | 7.7 |
| AKASA | 7.5 | 7.0 |
| Availity | 7.5 | 7.3 |
| Claim.MD | 7.3 | 8.5 |
| Office Ally | 7.1 | 7.9 |
| Experian Health | 7.0 | 6.7 |
Pricing
| Item | Detail |
|---|---|
| Model | Published monthly plans: Unlimited at $120 a month, Small Volume at $60 a month, and Basic at $30 a month with pay-per-use transactions. Enterprise pricing is available. |
| What usually drives cost | Claim, remittance, and eligibility volume per tax ID, plus extra transactions above each plan's limits. |
| What to ask before you buy | Which plan fits your claim volume per tax ID, the per-claim price above the plan limit, and any fees for payer enrollment. |
| Published pricing | Unlimited $120/month; Small Volume $60/month; Basic $30/month. |
Unlimited covers unlimited claims and remittances and 1,000 eligibility checks a month. Small Volume covers 100 claims, remittances, and eligibility checks a month.
Prerequisites for purchase
| Need | Why it matters |
|---|---|
| What you need to get Claim.MD to function | |
| Payer enrollment list | You must enroll with each payer for claims and payment files. |
| Billing software export format | Claims upload as 837 files or other supported formats. |
| Owner for rejected claims | Someone has to fix and resend them. |
| Eligibility workflow at check-in | Real-time checks only help if front desk staff use them. |
| A decision on whether it is your main or backup clearinghouse | Backup clearinghouses still need tested connections. |
| What will maximize your value | |
| Test claims to your largest payers first | This finds enrollment gaps early. |
| Use the claim history to prove you filed on time | It saves time in disputes with payers. |
| Keep it connected even as a backup | A second clearinghouse helps only if it is ready. |
| Deal-breakers | |
| No one to fix rejected claims | |
| You need patient payments in the same tool | |
| You want AI to automate the work | |
Value creation time frame
| # | Stage | Typical range |
|---|---|---|
| 1 | Account setup and payer enrollment | 1-3 weeks |
| 2 | First claims and payment files | 2-4 weeks |
| 3 | All payers live | 1-2 months |
Leadership
Methodology
| Weight | Factor | What it measures |
|---|---|---|
| 35% | Customer outcomes | Whether buyers get measurable operational or clinical-workflow results after go-live |
| 30% | Product | Capability depth, reliability, and fit for the job the category buys |
| 20% | Implementation | How hard it is to stand up, integrate, train, and stabilize |
| 15% | Pricing clarity | Whether a buyer can model total cost without a mystery quote |
| Label | Meaning |
|---|---|
| Highly recommend | Strong outcomes and product with manageable caveats |
| Recommend | Solid fit for the right buyer; know the tradeoffs |
| Conditional | Only with a specific use case or heavy caveats |
| Not recommended | Avoid for most buyers in this category |
Read our full methodology for how we weight scores and assign recommend labels.