Eligible

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.

Eligible publishes 5 APIs on the APIs.io network. Tagged areas include Billing, Eligibility, Healthcare, Insurance, and Claims.

Eligible’s developer surface includes documentation, engineering blog, and 3 more developer resources.

🌐 Visit website 📡 Source on GitHub
18.9/100 emerging ▬ flat Agent 3/100 human only Full breakdown ↓
scored 2026-07-28 · rubric v0.6
AccessFreemium
5 APIs
BillingEligibilityHealthcareInsuranceClaims

Kin Score

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scored 2026-07-28 · rubric v0.6
Composite quality — 18.9/100 · emerging
Contract Quality 0.0 / 25
Developer Ergonomics 2.2 / 20
Commercial Clarity 7.9 / 20
Operational Transparency 4.1 / 13
Governance 0.0 / 12
Discoverability 6.5 / 10
Agent readiness — 3/100 · human only
Machine-Readable Contract 0 / 18
Agentic Access Contract 0 / 10
MCP Server 0 / 12
Machine-Readable Auth 0 / 10
Idempotency 0 / 9
Stable Error Semantics 0 / 8
Request/Response Examples 0 / 7
Rate-Limit Signaling 7 / 7
Typed Event Surface 0 / 6
Agent Skills 0 / 5
Well-Known Catalog 0 / 4
Consent & Bot Identity 0 / 3
A2A Agent Card 0 / 8
Dry-Run / Simulate Mode 0 / 4
Improve this rating by publishing the missing artifacts — every area above can be raised, and the full rubric is at apis.io/rating/. This rating is computed from github.com/api-evangelist/eligible: open an issue to ask a question, or submit a pull request to add artifacts. Want it done for you? Prioritized profiling — $2,500 →

APIs 5

Individual APIs this provider publishes, each with its own machine-readable definition.

Eligible Coverage API

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 inf...

Eligible Claims API

The Claims API supports submission, tracking, and status checking of professional and institutional healthcare claims to payers across the Eligible network. The API also provide...

Eligible Payment Estimation API

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 c...

Eligible Enrollment API

The Enrollment API manages the trading partner enrollment workflow that providers must complete with payers in order to exchange eligibility, claims, and remittance transactions...

Eligible Payers API

The Payers API exposes the directory of insurance payers supported by Eligible, including payer identifiers, names, supported transaction types, enrollment requirements, and web...

Pricing Plans 1

Published pricing tiers and plan structures.

Eligible Plans Pricing

3 plans

PLANS

Rate Limits 1

Documented rate limits and quota policies.

Eligible Rate Limits

5 limits

RATE LIMITS

FinOps 1

Cost, billing, and metering signals for API financial operations.

Eligible Finops

FINOPS

Security Posture 1

Authentication, domain security, vulnerability disclosure, and trust-center signals.

Eligible Domain Security

TLSv1.3 · DMARC

SECURITY

Resources

Documentation 1

Reference material describing how the API behaves

Documentation
Documentation

Access & Security 1

Authentication, authorization, and security posture

DomainSecurity
DomainSecurity

Company 3

The organization behind the API

LinkedIn
LinkedIn
 Website
Website
 Blog
Blog

Source (apis.yml)

apis.yml Raw ↑ 
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
accessModel:
  pricing: freemium
  onboarding: unknown
  trial: false
  try_now: false
  public: false
  label: Freemium
  confidence: medium
  source:
  - plans
  generated: '2026-07-22'
  method: derived
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/icons/eligible.png
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: DomainSecurity
  url: security/eligible-domain-security.yml
- type: LinkedIn
  url: https://www.linkedin.com/company/eligible-api
- type: Website
  url: https://eligible.com/
- type: Documentation
  url: https://eligible.com/
- type: Blog
  url: https://eligible.com/blog/feed/
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com