Eligible

aid: eligible
name: Eligible
description: Eligible provides insurance billing APIs for healthcare businesses, enabling the integration of insurance billing
  experiences into healthcare applications. The platform supports eligibility verification, coverage discovery, claims submission
  and tracking, payment estimation, enrollment, and remittance processing across a large network of US payers.
type: Index
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/apis-json-logo.jpg
tags:
- Billing
- Eligibility
- Healthcare
- Insurance
- Claims
url: https://raw.githubusercontent.com/api-evangelist/eligible/refs/heads/main/apis.yml
created: '2024-07-02'
modified: '2026-04-28'
position: Consumer
access: 3rd-Party
specificationVersion: '0.19'
apis:
- aid: eligible:coverage
  name: Eligible Coverage API
  description: The Coverage API performs real-time insurance eligibility and benefits verification for a patient against a
    payer. Clients submit provider NPI, payer ID, and member identity information and receive structured benefit details including
    plan status, copays, coinsurance, deductibles, and out-of-pocket maximums.
  humanURL: https://eligible.com/
  tags:
  - Coverage
  - Eligibility
  - Healthcare
  - Insurance
  properties:
  - type: Documentation
    url: https://eligible.com/
- aid: eligible:claims
  name: Eligible Claims API
  description: The Claims API supports submission, tracking, and status checking of professional and institutional healthcare
    claims to payers across the Eligible network. The API also provides claim acknowledgement, rejection, and remittance retrieval
    workflows for healthcare billing applications.
  humanURL: https://eligible.com/
  tags:
  - Claims
  - Billing
  - Healthcare
  - Insurance
  properties:
  - type: Documentation
    url: https://eligible.com/
- aid: eligible:payment-estimation
  name: Eligible Payment Estimation API
  description: The Payment Estimation API calculates expected patient out-of-pocket amounts for a service before it is rendered,
    combining benefit details from a coverage check with provider contracted rates and accumulators. The API helps providers
    offer transparent cost estimates and collect patient responsibility at the point of service.
  humanURL: https://eligible.com/
  tags:
  - Payment Estimation
  - Cost Transparency
  - Healthcare
  - Billing
  properties:
  - type: Documentation
    url: https://eligible.com/
- aid: eligible:enrollment
  name: Eligible Enrollment API
  description: The Enrollment API manages the trading partner enrollment workflow that providers must complete with payers
    in order to exchange eligibility, claims, and remittance transactions through Eligible. The API supports submission, tracking,
    and status retrieval of enrollment requests.
  humanURL: https://eligible.com/
  tags:
  - Enrollment
  - Trading Partner
  - Healthcare
  - Insurance
  properties:
  - type: Documentation
    url: https://eligible.com/
- aid: eligible:payers
  name: Eligible Payers API
  description: The Payers API exposes the directory of insurance payers supported by Eligible, including payer identifiers,
    names, supported transaction types, enrollment requirements, and webhook capabilities. Clients use this API to select
    payers and check the status of supported transactions.
  humanURL: https://eligible.com/
  tags:
  - Payers
  - Directory
  - Healthcare
  - Insurance
  properties:
  - type: Documentation
    url: https://eligible.com/
common:
- type: LinkedIn
  url: https://www.linkedin.com/company/eligible-api
- type: Website
  url: https://eligible.com/
- type: Documentation
  url: https://eligible.com/
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com