If I may chime in:

I would advise not skimping out on having a good clearing house. A good clearing house, such as RealMed, can be very advantageous but yes it will cost anywhere between $100 - $200 per month depending on your volume, etc.

Things such as checking eligibility, recieving remits electronically for auto-payment posting, sending claims electronically to get rid of all that annoying paper, and the reports clearing houses can provide can easily make up for that pesky $100 - $200 a month and then some. Here is a screenshot of the performance report of the custom made payment posting program we use. We could not do this without a good Clearinghouse backing us up.

JamesNT

James Summerlin
My personal site: http://www.dataintegrationsolutions.net
james@dataintegrationsolutions.net