A health plan may conduct its covered transactions through a clearinghouse, and may require a provider to conduct covered transactions with it through a clearinghouse. But the incremental cost of doing so must be borne by the health plan. It is a cost-benefit decision on the part of the health plan whether to acquire the ability to conduct HIPPA transactions directly with other entities, or to require use of a clearinghouse.

A health plan may not conduct it's covered transactions through a clearinghouse

A health plan may after taking specific permission from HIPPA authorities conduct its covered transactions through a clearinghouse

is not as per HIPPA allowed to require provider to conduct covered transactions with it through a clearinghouse