It is no secret that many clearinghouses started at a time when many payers were willing to subsidize transaction costs for providers in order to receive electronic transactions in the door. The cost to process manual claims was so high that paying cents on the dollar for an electronic transaction was a no brainer for the payers. Fast forward to 2014 and most providers are submitting electronic transactions. However, most payers are also deciding to reduce their subsidies to the clearinghouses or eliminate them all together. Once again, the provider is left with the bill as the main burden of the expense of submission falls directly on the provider. However, that EDI flat fee or per transaction invoice is decreasing as competition has been heating up. With that being said, it is clearly the time for clearinghouses to “up” their game and start providing more value-add/auxiliary types of services. So much in the healthcare industry is still disjointed and pieced together that opportunity does exist for new solutions. In the coming years, it will be interesting to watch what unfolds and is introduced to help simply a very complex industry and the provider desktop. The future of the clearinghouse may just depend on it.