JSON twin: https://www.healthaidb.com/software/eligible.json
Eligible
Eligible provides API-first insurance billing and patient clearance tools that automate eligibility checks, benefit verification, claim submission/tracking, and cost estimation for healthcare applications.
Eligible is a commercial healthcare fintech platform offering developer-friendly REST APIs and webhooks to automate insurance verifications, eligibility & benefits lookups, claims filing and tracking, payment status reporting, ML-powered patient cost estimations, reporting, and enterprise data transfers. The product targets in-app patient experiences and staff-facing revenue-cycle workflows, supports direct connections to many US payers (including Medicaid and commercial plans), and offers basic free support with optional enterprise support and integration services.
yes
2011
P0519
2025-09-07
commercial proprietary
Pay-as-you-go transaction pricing. Insurance Billing: 1% of dollars remitted + $0.25 per claim (with $1/month account minimum and passthrough fees). Patient Clearance: additional $0.30 per claim (includes 10 eligibility/cost-estimate calls per claim); excess eligibility inquiries $0.05 each; excess cost estimates $0.25 each. Volume/commitment discounts and enterprise packages available; contact vendor for custom pricing.
subscription
2011
product
1.0
{
"company_name": "Eligible",
"company_url": "https://eligible.com/",
"company_offices": [
"United States",
"United Kingdom"
],
"company_founding": "2011",
"product_url": "https://eligible.com/docs/",
"categories": [
"administrative",
"patient-facing",
"revenue cycle management",
"insurance verification",
"claims processing",
"developer API",
"integrations"
],
"market_segment": [
"enterprise",
"smb",
"developers"
],
"links": [
"https://eligible.com/",
"https://eligible.com/docs/",
"https://eligible.com/pricing",
"https://eligible.com/compliance",
"https://eligible.com/providers",
"https://eligible.com/patients",
"https://status.eligible.com/",
"https://eligible.com/blog/",
"https://www.crunchbase.com/organization/eligible-api",
"https://find-and-update.company-information.service.gov.uk/company/10014296"
],
"summary": "Eligible provides API-first insurance billing and patient clearance tools that automate eligibility checks, benefit verification, claim submission/tracking, and cost estimation for healthcare applications.",
"description": "Eligible is a commercial healthcare fintech platform offering developer-friendly REST APIs and webhooks to automate insurance verifications, eligibility & benefits lookups, claims filing and tracking, payment status reporting, ML-powered patient cost estimations, reporting, and enterprise data transfers. The product targets in-app patient experiences and staff-facing revenue-cycle workflows, supports direct connections to many US payers (including Medicaid and commercial plans), and offers basic free support with optional enterprise support and integration services.",
"target_users": [
"developers",
"healthcare providers",
"revenue cycle managers/billing staff",
"patient access/registration staff",
"healthcare operations/administrators",
"payors (integration partners)",
"product managers"
],
"specialties": [
"general primary care",
"specialty clinics",
"ambulatory care",
"imaging/radiology (claims & billing workflows)",
"laboratory services",
"behavioral health",
"telehealth"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English"
],
"pricing_model": "subscription",
"pricing_details": "Pay-as-you-go transaction pricing. Insurance Billing: 1% of dollars remitted + $0.25 per claim (with $1/month account minimum and passthrough fees). Patient Clearance: additional $0.30 per claim (includes 10 eligibility/cost-estimate calls per claim); excess eligibility inquiries $0.05 each; excess cost estimates $0.25 each. Volume/commitment discounts and enterprise packages available; contact vendor for custom pricing.",
"license": "commercial proprietary",
"deployment_model": [
"SaaS"
],
"os_platforms": [
"Web",
"JavaScript (browser/Node)",
"iOS",
"Android"
],
"features": [
"Insurance eligibility & benefits checks",
"Insurance verifications",
"Insurance enrollments",
"Insurance claims (billing) APIs",
"Real-time cost estimates (ML-powered)",
"Webhooks/event notifications",
"Reporting & analytics",
"Enterprise data transfers/ingestion",
"API monitoring",
"Claims.js JavaScript helper"
],
"optional_modules": [
"ML-powered cost estimation",
"Enterprise data transfer/ingestion",
"Advanced reporting/analytics",
"Enterprise support plan"
],
"integrations": [
"Insurers (payer networks)"
],
"data_standards": [
"CAQH CORE",
"NIST 800-53"
],
"api_available": "yes",
"system_requirements": "",
"compliance": [
"SOC 2 (Type II)",
"HITRUST",
"CAQH CORE Phases I-IV",
"EHNAC",
"NIST 800-53"
],
"certifications": [
"SOC 2 Type II",
"HITRUST CSF",
"CAQH CORE Phase I-IV certification",
"EHNAC accreditation"
],
"security_features": [
"Encryption at rest and in transit (TLS)",
"Hardware Security Modules (HSM) for key storage",
"Approved cipher suites with PFS (DHE/ECDHE)",
"Multi-factor authentication",
"Network and host-based firewalls",
"Role-based access controls (RBAC)",
"24/7 monitoring and alerting",
"Automated vulnerability scanning and patch management",
"Audit logging"
],
"privacy_features": [
"HIPAA-aligned controls (HITRUST)",
"BAA available",
"Data minimization and confidentiality controls",
"Anonymization/pseudonymization capabilities"
],
"data_residency": "",
"customers": [
"Radnet",
"Blue Shield (Blue Shield of California)",
"Quest Diagnostics",
"Kareo",
"Omada"
],
"user_reviews": [],
"ratings": [],
"support_channels": [
"email",
"phone",
"chat",
"ticketing",
"community",
"system status"
],
"training_options": [
"documentation",
"live_online",
"community"
],
"release_year": "2011",
"integration_partners": [],
"id": "P0519",
"slug": "eligible",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/eligible.json"
}
}