Why your claims might be costing more than they need to

Most billing platforms don't operate their own private claims network. They route your claims through a clearinghouse — Availity is one of the largest — and Availity is free to use directly for the vast majority of payers if a provider enrolls themselves. Availity's own published payer list shows enrollment is only required for a small slice of the roughly 6,670 payers in its batch network, and fewer still are tied to any paid plan.

A per-claim "convenience fee" charged by a billing platform for routing a claim isn't necessarily buying access to something otherwise unavailable — it can be a markup on a door that's already open.

Free direct submission Paid EDI plan (worth pooling) Mail-in routing

The calculator above takes the payers you bill, your monthly claim volume for each, and what you're currently paying per claim — and checks every one of them against Availity's real batch network. It tells you, payer by payer, whether you should route directly for free, pool multiple payers into Availity's paid EDI plan (worth it past a certain combined volume), mail the claims to a HIPAA-compliant vendor instead, or just stay put because the math doesn't favor switching yet.

A note on accuracy: This tool reflects how clearinghouse routing actually works — direct enrollment is genuinely free for most payers, and platforms can charge a markup for handling that routing on your behalf. It's not a claim that any one specific billing platform uses any one specific clearinghouse; it's a way to check your own numbers against the real, published rules.

Questions about what this means for your practice specifically? Reach out — this is exactly the kind of thing we help solo and small-practice providers untangle every day.