Healthcare Privacy & HIPAA BotDATE: March 22, 2026 at 02:16PM
SOURCE: PsychBilling Coach In the News by Susan Frager
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TITLE: Data Breach! Why discovering your clearinghouse matters.
URL: https://psychbillingcoach.com/news/discover-your-clearinghouse/
TriZetto is a major electronic data interchange (EDI) clearinghouse. It’s not one of the more well-known ones in mental health billing, but it powers more systems than one might realize. If you’re a Tebra user, your clearinghouse is TriZetto. Other systems that may be using TriZetto include PracticeQ, ICANotes, Pimsy, Valant (if you contracted with them before they began using Waystar exclusively). Typically these systems allow a choice of clearinghouse do you remember what you chose? Was it someone else’s choice?
Any system can have a data breach, and health care systems contain all the information hackers need to steal identities, blackmail individuals, and probably more heinous things than I can even dream up. So I’m certainly not minimizing the effect of this one, which exposed 3.4 million people’s information for 10 months before it was discovered in October 2025. Worse, the owner of TriZetto, Cognizant Technologies, didn’t disclose the data breach to providers until December 2025. Affected patients didn’t learn about it until February 2026.
Why the delay? Unknown. Read more about the data breach here.
Data breaches in systems that we use and have Business Associate Agreements with aren’t under our control but this latest breach emphasizes the need for you to know what’s under the hood of your Electronic Health Record (EHR).
Many clinicians I consult with don’t know what a clearinghouse is or what it does, let alone which one(s) their system uses. Often, you don’t get to choose your clearinghouse your system has chosen it for you. Some systems integrate with only one clearinghouse (or own the clearinghouse used). Others, such as the systems mentioned above, allow at least a limited choice of external vendors.
Think of the clearinghouse as the engine that drives your practice management system. The software platform upon which your client portal is based, and where you complete clinical documentation, can’t perform the three major insurance EDI transactions without external connectivity to payers: eligibility/benefits, claims, and electronic remittance advice (ERA). That connectivity to payers is typically handled by the clearinghouse, which converts the data you view in an intuitive format, to the HIPAA-mandated language of electronic commerce, ANSI 5010X12. (I know! It sounds intimidating, and if you look at ANSI transmissions, you’d think it gobbledygook). Think about it this way: you may be able to sit in a lovely, comfortable car, but it will go nowhere without an engine.
Not all clearinghouses are able to transmit directly to all payers. Insurance companies have bought up some of the major clearinghouses and have restricted EDI gateways in and out to gain economic control. For example, one of the largest clearinghouses is everyone’s “love-to-hate,” Availity, which is owned by a partnership of about half the Blue payers in the US plus Humana. Anthem BC/BS dictated that as of January 1, 2019, all EDI transactions must route through Availity. This consolidation has meant that smaller vendors are forced to partner with larger ones, called intermediaries. Common intermediaries are Availity, Office Ally, and Change Healthcare which is owned by UnitedHealth Group, and had its own massive data breach in February 2024.
None of us are 100% safe, and what’s scary is how little control we have. Especially if the systems we rely on are less than immediately forthcoming with customers and intermediaries.
What do I need to do if TriZetto is my clearinghouse?
If you think you might have been affected by the TriZetto breach, your obligations as a covered entity under HIPAA may involve contacting your EHR system to ask:
1. Which clearinghouse(s) do you use?
2. Does it/they have any intermediary agreements with TriZetto?
3. If yes, which insurance payers are connected via TriZetto?
4. Has/have the clearinghouse(s) instituted any alternative routes for EDI transactions until TriZetto can confirm the integrity of their systems?
5. What, if any, notifications to patients/clients are the EHR’s responsibility?
6. What notification actions is the EHR taking?
Ask for the answers in writing via email. Or, ask if they’ve set up a FAQ / web page devoted to the incident response. Are they keeping it up to date via regular contact with TriZetto?
While we may not have much choice in terms of the EDI routes dictated by payers and intermediaries, it shouldn’t be too much to ask that the vendors we contract with be responsive and communicative when there are adverse events. Our own protected health information, and that of our clients, depends on honesty and transparency.
This blog is for informational purposes only and doesn’t constitute legal or compliance advice in any individual situation.
URL: https://psychbillingcoach.com/news/discover-your-clearinghouse/
Articles can be found by scrolling down the page at https://psychbillingcoach.com/news/ under the title "In the News".
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