What is direct‑to‑payer routing?

It’s when an EMR submits 837 claims and receives 835 ERAs directly with a payer connection tied to your TIN/NPI, avoiding third‑party clearinghouse pass‑through where eligible.

Is direct always faster than a clearinghouse?

Often—but not always. Speed and fees can improve with direct connections. Actual results vary by payer, product line, market, and enrollment.

Do I still need a clearinghouse?

Yes, as a fallback and for payers that do not accept direct submissions for your configuration. PBS EMR keeps both routes available and chooses the fastest reliable path per claim.

Which payers support direct EDI?

Eligibility varies. Many MACs (Medicare) support direct; commercial and Medicaid plans differ by state and product. PBS EMR checks connectivity options during onboarding.

How do ERAs post when routing is mixed?

PBS EMR links each remit to the originating claim and auto‑posts allowed amounts, adjustments, and patient responsibility regardless of the route used.

Direct‑to‑Payer Routing — Feature Deep‑Dive

On this page How routing decisions work Why it matters Quick glossary (837/835/EDI) Related features & guides FAQ

How routing decisions work

Payer eligibility & enrollment checks by TIN/NPI and line of business
Pre‑submission scrubber flags CPT/auth/duplicate/common rule issues
Route selection: direct EDI where eligible; otherwise clearinghouse
Status sync & ERA auto‑posting; fallback paths preserved for resiliency

Why this matters

Fewer tolls: avoid per‑claim pass‑through where direct is supported
Faster cash: fewer hops can shorten days‑to‑pay
Cleaner A/R: upstream scrubbing prevents avoidable rework

Quick glossary

837: claim submission transaction
835 (ERA): electronic remittance/paid amounts, adjustments, patient responsibility
EDI: electronic data interchange between systems (payer ↔ provider)

Claim Scrubber — catch issues before submission
ERA Auto‑Posting — map allowed amounts & adjustments
Medicare (MACs) — EDI Basics
ROI · Pricing

FAQ

Education only; payer connectivity varies by plan and enrollment.