Availity vs Change Healthcare (Optum)
Two Claims & Clearinghouses vendors, side by side. Facts from public sources; judgments are ours.
At a glance
Derived from public facts · a rough scale, not a ranking
| Availity | Change Healthcare (Optum) | |
|---|---|---|
| Pricing model | Free to providers (funded by payers/pharma) · Essentials free; Plus from $25/month | Per-transaction / per-chart · Clearinghouse per-transaction fees |
| Speed to go live | Self-serve portal registration | Payer enrollment and testing cycles |
| Automation model | Data / network utility · Multi-payer clearinghouse network | Data / network utility · Largest claims clearinghouse network |
| Built for | Small practices, Mid-size groups, Enterprise systems, Payers, Billing companies | Enterprise systems, Payers, Billing companies, Mid-size groups |
| Security posture | HITRUST, HIPAA | HITRUST, HIPAA |
| Company maturity | 25 yrs (est. 2001) | 9 yrs (est. 2017) |
| Financial backing | Payer-owned | Subsidiary of UnitedHealth Group (Optum) |
| Named customers | 4 named | None public |
| Published results | Specific numbers public | No public numbers |
| Documented integrations | 3 listed | 5 listed |
| Third-party validation | None found | None found |
Bottom line
- Pick Availity if you want free eligibility, claims, and auth transactions through the portal most payers already sponsor, before paying anyone for point solutions.
- Pick Change Healthcare if you need the broadest payer connectivity for claims, eligibility, and remits and can accept post-breach vendor concentration risk inside Optum.
Availity
Payer-owned network for claims and eligibility
- Founded
- 2001
- HQ
- Jacksonville, FL
- Stage
- Payer-owned
- Raised
- n/a
What it does
- Multi-payer provider portal (Availity Essentials)
- EDI clearinghouse for claims, eligibility, and claim status
- Electronic prior authorization submission and status tracking
- Clinical data normalization via Fusion (Diameter Health)
- Business continuity clearinghouse switching (Lifeline, Rapid Recovery)
Where it's strong
- It is the mandatory front door to major payers (Elevance requires new submitters to use the Availity EDI Gateway), so connectivity is unmatched where those plans dominate.
- The core Essentials portal is free to providers, which keeps baseline cost near zero for eligibility, claims, and auth status checks.
- It proved operational resilience during the 2024 Change Healthcare outage, standing up Lifeline in 48 hours and processing 186 million stranded claims worth roughly $350 billion.
What buyers should weigh
- Ownership by Elevance, HCSC, and other Blues means the roadmap follows payer priorities, and provider workflow needs can come second.
- The free portal covers basics only; advanced clearinghouse features, analytics, and premium EDI services carry separate fees that are not published.
- Payer coverage is uneven outside Blues-heavy markets, so most provider organizations still need a second clearinghouse for full payer reach.
Named customers
Elevance Health · Humana · Florida Blue · Health Care Service Corporation
Integrations
Change Healthcare (Optum)
The largest US medical claims clearinghouse, now part of Optum
- Founded
- 2017
- HQ
- Nashville, TN
- Stage
- Subsidiary of UnitedHealth Group (Optum)
- Raised
- n/a
What it does
- Medical, dental, and pharmacy claims clearinghouse
- Eligibility and benefits verification at scale
- Electronic remittance and payment services
- Claims editing and payment accuracy tools
- Clinical data exchange and attachments
- Patient billing and payment products
Where it's strong
- Unmatched payer connectivity: it remains the default clearinghouse route for a huge share of US claims volume.
- Breadth across medical, dental, and pharmacy transactions plus payments means one vendor can cover most exchange needs.
- Optum ownership gives it deep resources and long-term viability.
What buyers should weigh
- The February 2024 ransomware attack took its clearinghouse down for months, exposed data on roughly 192.7 million people, and cost UnitedHealth over $2B; restoration was not complete until late 2024 and litigation continues into 2026.
- Many providers now run a second clearinghouse for redundancy after the outage, and buyers should plan for the same.
- Being owned by UnitedHealth raises conflict-of-interest questions for providers and competing payers, and post-attack loan clawbacks strained provider trust.
Integrations
Compare against the rest of Claims & Clearinghouses
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