For most of the past two decades, running a single clearinghouse connection was normal. One vendor, one integration, one throat to choke. Simple, predictable, and cheap enough that the question of a backup rarely came up. That entire assumption stopped working in February 2024, and the two years since have made clear that it is not coming back.

If your practice or billing operation is still running single-rail in 2026, that is no longer a cost-saving decision. It is a risk decision, and it is one worth revisiting with fresh eyes.

What Single-Rail Actually Costs When It Fails

The Change Healthcare cyberattack knocked one-third of national claims traffic offline for weeks. The American Hospital Association estimated approximately $2.87 billion in delayed provider cash flow during the disruption. The practices that took the hardest hits had one thing in common: they had no alternative routing when their primary clearinghouse went dark.

A useful exercise: run the math on your own operation. If your primary clearinghouse experienced a three-week outage tomorrow, how much revenue is currently in-flight that would stall? What is your monthly claim volume, and what percentage of your cash flow does that represent? For a mid-market practice submitting 800 claims per month at an average of $250 per claim, three weeks of interrupted processing translates to roughly $150,000 in cash flow that arrives late, or not at all if some claims fall out of timely filing windows during the disruption.

That is the exposure a single-rail strategy carries. It is quiet on a normal day and existential on a bad one.

The Concentration Risk Nobody Priced In

The Change Healthcare event was not a one-time anomaly. TriZetto disclosed a breach affecting 3.4 million patient records in 2026, with a detection window that stretched nearly eleven months. Multiple smaller RCM vendor breaches have moved through the HHS OCR reporting portal in the intervening two years. The pattern is not going away. If anything, it is intensifying as the RCM market consolidates and more claims traffic concentrates through fewer vendors.

That concentration is what makes single-rail strategy fragile. Every provider connected to a large clearinghouse network shares exposure to that network’s operational risk. When the network goes down, every provider on it goes down together. There is no isolation, no partial protection, and no way to route around the failure without infrastructure that was set up in advance.

The Three Things a Second Rail Actually Protects

The case for a secondary clearinghouse rail rests on three separate but reinforcing benefits.

• Business continuity. If your primary clearinghouse experiences an outage, from any cause, your secondary rail can reroute claims, eligibility checks, and ERAs within hours instead of weeks. The Change Healthcare practices that recovered fastest were the ones that already had a warm secondary connection when the primary went dark. This is the same principle that drives every other resilience investment in healthcare operations: redundancy is cheap on a normal day and priceless when it matters.
• Pricing and service leverage. Dependence on a single vendor creates pricing vulnerability over time. Contract renewals, service-level changes, and pricing structure adjustments all become one-sided negotiations when your operation cannot credibly move volume elsewhere. A functional secondary relationship changes that dynamic. Your primary vendor knows you have options, and that knowledge tends to keep the relationship healthy.
• Payer routing optimization. Not every clearinghouse has equally strong connections to every payer. A secondary rail can be structured to handle specific payers where the routing is faster, the edit rules are tighter, or the response times are better. Some practices route Medicaid volume through one clearinghouse and commercial volume through another for exactly this reason.

Why the Delay Is Almost Always Misaligned With the Risk

Practices that delay adding a second rail usually cite one of three reasons: perceived cost, perceived operational complexity, or the belief that a serious outage is unlikely to happen to them.

The cost concern is often overstated. A secondary rail carrying baseline volume can typically be maintained for a fraction of the cost of your primary, and the cost is measured against the exposure of an outage, not against the cost of maintaining the primary rail itself. On any honest risk-adjusted comparison, the numbers favor the second rail.

The operational complexity concern is often based on a misconception that adding a second clearinghouse means replacing the first. It does not. A well-structured secondary rail sits alongside your primary and expands or contracts based on need. Enrollments run in parallel. PM system configuration is modest. The disruption to daily operations is minimal.

The it will not happen to me belief is the hardest one to argue with, but the data does not support it. Two of the largest RCM vendor incidents in industry history have occurred in the past 24 months. The next one is a matter of when, not if.

How Harris Secure Connect Fits

Harris Secure Connect has operated as a HIPAA covered entity for 26 years without a comparable disruption, backed by the institutional resources of our Harris Computer parent and Global Payments. We routinely operate as the primary clearinghouse for practices that have chosen us specifically for stability, and as the secondary rail for practices whose primary is elsewhere and who have decided that redundancy is no longer optional.

If the past two years have moved the second-rail question from someday to soon, our team is happy to walk through what setting one up would actually look like for your specific setup. No pressure, just a clearer picture of what is possible.