Overview
When using electronic billing features in NikoHealth, certain transactions are processed through a third-party clearinghouse. Clearinghouses act as an intermediary between providers and insurance payers, ensuring that electronic transactions are formatted correctly and delivered to the appropriate payer systems.
Because these transactions are handled outside of NikoHealth, clearinghouse transaction fees may apply depending on the type and volume of transactions submitted.
This article explains:
What clearinghouse transaction fees are
Which transactions may incur fees
How those fees are typically applied
What customers should expect when using clearinghouse-supported features
What Is a Clearinghouse Transaction Fee?
A clearinghouse transaction fee is a charge assessed by the clearinghouse for processing an electronic transaction on your behalf.
These fees are not generated by NikoHealth itself, but by the clearinghouse that routes and validates transactions between your organization and insurance payers.
Common characteristics of clearinghouse fees:
Charged per transaction
Based on transaction type
Determined by your clearinghouse agreement and enrollment setup
Transactions That May Incur Clearinghouse Fees
Depending on your setup and payer enrollments, clearinghouse fees may apply to transactions such as:
Electronic claim submissions
Electronic remittance advice (ERA) retrieval
Eligibility inquiries
Other electronic payer communications supported by the clearinghouse
Not all transactions are billable, and not all payers charge fees for the same transaction types.
How Clearinghouse Fees Are Applied
Clearinghouse transaction fees are typically:
Tracked and billed by the clearinghouse, not directly within NikoHealth
Based on usage volume (for example, number of claims or eligibility checks submitted)
Reflected on invoices or statements provided by the clearinghouse according to your contract
NikoHealth submits transactions based on your configured workflows, but does not control the fee structure or pricing model used by the clearinghouse.
Where to View or Manage Clearinghouse Fees
To understand your specific clearinghouse fees, you should refer to:
Your clearinghouse agreement or contract
Billing statements or invoices provided directly by the clearinghouse
Communication from your clearinghouse account representative
If you have questions about which clearinghouse you are enrolled with for specific transactions, NikoHealth Support can help confirm your setup.
Why These Fees Exist
Clearinghouses provide essential services such as:
Transaction validation and formatting
Payer routing and delivery
Compliance with payer and EDI standards
Error handling and reporting
Transaction fees help cover the cost of these services and vary based on transaction complexity and payer requirements.
Key Takeaways
Clearinghouse transaction fees are separate from NikoHealth platform fees
Fees are determined by your clearinghouse and payer enrollments
Charges are typically per transaction and usage-based
NikoHealth facilitates transaction submission but does not set or collect these fees