Claim.MD pricing: Plans, add-ons, and what you actually pay

Key takeaways

Claim.MD publishes three plans: Basic at $30 a month, Small Volume at $60, and Unlimited at $120.

The tiers meter volume, not capability. Every plan sends 837P and 837I claims, CSV files, print image files, and electronic appeals.

Transactions above your monthly allowance are billed per item, and paper claims, attachments, and extra tax IDs sit outside every plan.

A practice sending 300 claims a month pays $120 on Unlimited, against $385 on Small Volume. The tier choice matters more than the sticker price.

Pabau partners with Claim.MD, and the clearinghouse is included in the Pabau subscription rather than sold as a separate plan.

Claim.MD publishes three plans: Basic at $30 a month, Small Volume at $60, and Unlimited at $120. Those are the sticker prices, taken from Claim.MD and verified in 2026.

One disclosure first. Claim.MD is the clearinghouse behind insurance claims in practice management software like Pabau, and we partner with them commercially. Every figure on this page comes from Claim.MD’s own published pricing.

The tier card tells you the monthly fee. It doesn’t tell you what a practice sending 300 claims a month actually pays once eligibility checks and overage rates are counted. So this page models three real volumes and shows the arithmetic.

Claim.MD pricing plans explained

The three plans differ by how many transactions are included each month, not by what the software will let you do. That is unusual for a clearinghouse, and it changes how you pick a tier. You are buying volume, so the only question is how much of it you need.

Basic, $30 a month

Basic is the pay-as-you-go tier. Nothing is included in the monthly fee. Every claim, ERA, and eligibility check is billed at $0.30. Claim.MD positions it for submitters sending a small number of claims per tax ID, and the arithmetic backs that up.

Small Volume, $60 a month

Small Volume includes 100 claims, 100 ERAs, and 100 eligibility checks each month. Those are three separate allowances, not a shared pool of 100. Past them, every extra transaction is $0.50. Claim.MD pitches this tier at single-doctor practices.

Unlimited, $120 a month

Unlimited covers unlimited claims and unlimited ERAs, plus 1,000 eligibility checks a month. Eligibility is the only metered item left. Checks past 1,000 are $0.02 each for prime payers and $0.10 for non-prime. It is also the only plan that lists a rate for additional billing tax IDs.

Every plan accepts 837P and 837I files, CSV and XLS uploads, and print image files. Electronic appeals are on all three too. Nothing is locked behind the higher tiers, which is worth knowing before you pay for headroom you don’t need.

What costs extra

Four things sit outside the monthly fee: transactions above your allowance, paper and faxed claims, attachments, and additional billing tax IDs. Everything else in the table below is published as free.

Where Claim.MD charges nothing is the more useful half of that table. There is no setup fee on any plan and no per-provider fee, so adding a second injector to an existing account doesn’t move the bill. One billing provider tax ID is included everywhere.

Claim.MD also states that billing is monthly with no long-term contracts, and that you can upgrade, downgrade, or cancel at any time. There are no exclusivity contracts either, so you can run them alongside a second clearinghouse. For an industry fond of annual commitments, that is a genuine difference.

What you’d actually pay: Three practice scenarios

Here is the part the tier card can’t do for you. Below are three practices at different volumes, each costed on Claim.MD’s published rates. The assumptions are stated so you can swap in your own numbers.

• One ERA comes back for every claim submitted.
• One eligibility check runs per claim, plus a margin for patients checked but not billed.
• One billing provider tax ID, with no paper claims and no attachments.
• All rates are Claim.MD’s published figures, verified August 2026.

The solo practice sits inside every Small Volume allowance, so it pays the flat $60. Basic would cost more here, at $30 plus 160 transactions at $0.30, or $78. Basic only wins below roughly 33 claims a month, where the metered rate stays under the $30 gap between the two plans.

The growing practice is where the tier choice starts to bite. On Small Volume, 200 extra claims, 200 extra ERAs, and 250 extra eligibility checks all bill at $0.50. That is $325 in overage on top of $60, or $385 a month. Unlimited covers the same work for $120.

The crossover lands at roughly 140 claims a month under these assumptions. Below that, Small Volume is cheaper. Above it, Unlimited is, and the gap widens fast. Anyone approaching 200 claims a month should treat $120 as their real floor.

The multi-provider group pays $120 plus 200 eligibility checks above the 1,000 included. At the prime rate that is $4, and at the non-prime rate $20, so the bill lands between $124 and $140. There is no per-provider fee, which is why a group of six costs the same as a group of two. A second billing tax ID would add $30 a month.

How Claim.MD pricing compares to other clearinghouses

Clearinghouses price in three broad ways, and Claim.MD sits firmly in one of them. There is per-claim pricing, free at the point of use with transaction fees attached, and a flat monthly fee with metered overage. Claim.MD is the third.

Office Ally is the best-known example of the second model. Its Service Center starts free, with transaction fees that may apply. Eligibility runs at $10 a month for the first 100 checks, then $0.10 after that. Attachments are $0.55 each.

Availity takes a different route again and publishes no provider pricing on its site at all. That is its own kind of answer. You cannot model a cost you have to phone for, which is exactly why a published rate card is worth something.

The trade-off with a flat fee is that low-volume practices subsidize nobody but themselves. At 50 claims a month you pay $1.20 a claim, well above a per-claim rate. At 1,000 claims you pay about $0.13. The model rewards volume, and it punishes overpaying for a tier you don’t fill. For the wider picture, our guide to the medical claims clearinghouse covers what you are buying in the first place.

Pabau’s Claim.MD integration

In Pabau, the full Claim.MD workflow runs inside the platform. Claims are built from the invoice, which converts into a CMS-1500 claim automatically. Eligibility runs from the client card before the appointment, so coverage problems surface while you can still do something about them.

ERAs come back into the same record and settle the claim automatically, matching the payment against what you billed. Payer enrollment is tracked in Setup, so you can see which payers are live and which are still pending. That is the whole loop, on one screen, with no clearinghouse portal open in another tab.

Run claims without a second subscription

Pabau includes Claim.MD in your subscription, so claims go out from the invoice, eligibility runs from the client card, and ERAs settle themselves. There is no separate clearinghouse tier to pick, and no second bill to reconcile each month.

Book a demo

Conclusion

Claim.MD’s pricing is genuinely transparent by the standards of this market. The rates are published, the setup fee is zero, nothing is gated behind a higher tier, and you can leave whenever you like. The work was never in finding the numbers.

The work was modeling your own volume against them, and that is now done. Count your claims, your ERAs, and your eligibility checks for one honest month. Under about 33 claims, take Basic. Between roughly 33 and 140, take Small Volume. Above that, Unlimited pays for itself quickly.

The trade-off worth remembering is that a flat fee only rewards you if you fill it. A practice on Unlimited sending 40 claims a month is paying triple what it needs to. Book a demo to see what your claims workflow costs when the clearinghouse comes with the software.

Continue your research

Not sure what a clearinghouse actually does for the money? What is a medical claims clearinghouse? follows the route a claim takes out and the remittance takes back.

Wondering what the ERA allowance is counting? What is an electronic remittance advice? explains the file each of those transactions pays for.

Want fewer transactions to pay for in the first place? What is a clean claim? covers the checks that stop a claim coming back at all.

Paying to submit claims that get denied? Denial management in healthcare sets out the five-step process and the corrected claim versus appeal decision.

Weighing Claim.MD against the free option? Claim.MD vs Office Ally puts the two side by side on cost and coverage.

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