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
deliveryModel:
  model: saas
  open_source: false
  commercial: true
  callable_host: false
  label: Hosted service · you call their endpoint
  confidence: medium
  source:
  - pricing
  generated: '2026-08-28'
  method: derived
accessModel:
  pricing: paid
  onboarding: waitlist
  trial: false
  try_now: false
  public: false
  label: Paid
  confidence: high
  source:
  - https://eligible.com/pricing
  - https://eligible.com/signup
  generated: '2026-08-15'
  method: searched
  note: Corrected 2026-08-15. The previous "Freemium" label was derived from a scaffold plans artifact that invented a free
    tier. Eligible publishes transactional pricing (1% of dollars remitted + $0.25 per claim, $1/month account minimum) with
    no free tier, and sign-up routes to a waitlist rather than to a key.
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/icons/eligible.png
tags:
- Billing
- Eligibility
- Healthcare
- Insurance
- Claims
- Health Insurance
url: https://raw.githubusercontent.com/api-evangelist/eligible/refs/heads/main/apis.yml
created: '2024-07-02'
modified: '2026-08-15'
position: Consuming
access: 3rd-Party
specificationVersion: '0.23'
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/
  baseURL: https://gds.eligibleapi.com/v1.5
  tags:
  - Coverage
  - Eligibility
  - Healthcare
  - Insurance
  properties:
  - type: Documentation
    url: https://eligible.com/docs
- 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/
  baseURL: https://gds.eligibleapi.com/v1.5
  tags:
  - Claims
  - Billing
  - Healthcare
  - Insurance
  properties:
  - type: Documentation
    url: https://eligible.com/docs
- 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/
  baseURL: https://gds.eligibleapi.com/v1.5
  tags:
  - Payment Estimation
  - Cost Transparency
  - Healthcare
  - Billing
  properties:
  - type: Documentation
    url: https://eligible.com/docs
- 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/
  baseURL: https://gds.eligibleapi.com/v1.5
  tags:
  - Enrollment
  - Trading Partner
  - Healthcare
  - Insurance
  properties:
  - type: Documentation
    url: https://eligible.com/docs
- 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/
  baseURL: https://gds.eligibleapi.com/v1.5
  tags:
  - Payers
  - Directory
  - Healthcare
  - Insurance
  properties:
  - type: Documentation
    url: https://eligible.com/docs
common:
- type: LinkedIn
  url: https://www.linkedin.com/company/eligible-api
- type: Website
  url: https://eligible.com/
- type: Documentation
  url: https://eligible.com/docs
- type: APIReference
  url: https://eligible.com/reference
- type: Blog
  url: https://eligible.com/blog/feed/
- type: Support
  url: https://eligible.com/support
- type: GitHubOrganization
  url: https://github.com/eligible
- type: Pricing
  url: https://eligible.com/pricing
- type: SignUp
  url: https://eligible.com/signup
- type: Login
  url: https://eligible.com/users/sign_in
- type: TermsOfService
  url: https://eligible.com/terms
- type: PrivacyPolicy
  url: https://eligible.com/privacy
- type: StatusPage
  url: https://status.eligible.com
- type: Compliance
  url: https://eligible.com/compliance
- type: TrustCenter
  url: security/eligible-trust-center.yml
- type: DomainSecurity
  url: security/eligible-domain-security.yml
- type: Authentication
  url: authentication/eligible-authentication.yml
- type: Conventions
  url: conventions/eligible-conventions.yml
- type: ErrorCatalog
  url: errors/eligible-error-codes.yml
- type: Lifecycle
  url: lifecycle/eligible-lifecycle.yml
- type: Conformance
  url: conformance/eligible-conformance.yml
- type: Packages
  url: packages/eligible-packages.yml
- type: SDKs
  url: packages/eligible-packages.yml
- type: Components
  url: components/eligible-components.yml
- type: DataModel
  url: data-model/eligible-data-model.yml
- type: Sandbox
  url: sandbox/eligible-sandbox.yml
- type: Webhooks
  url: asyncapi/eligible-webhooks.yml
- type: Plans
  url: plans/eligible-plans-pricing.yml
- type: RateLimits
  url: rate-limits/eligible-rate-limits.yml
- type: FinOps
  url: finops/eligible-finops.yml
- type: LLMsTxt
  url: llms/eligible-llms.txt
maintainers:
- FN: Kin Lane
  email: kin@apievangelist.com
x-enrichment:
  date: '2026-08-15'
  status: enriched
  artifacts_added: 6
  pass: local-v1
x-coverage:
  state: covered
  detail: Enriched. Eligible publishes no machine-readable API contract of any kind and its reference is behind an account
    login, but the pass reconstructed the surface from the vendor's own first-party clients and found real published pricing,
    a real webhook surface, a real sandbox, embeddable components, and seven public machine-readable payer/passthrough-fee
    JSON documents.
  evidence:
  - url: https://eligible.com/pricing
    status: 200
  - url: https://eligible.com/resources/payers/eligibility.json
    status: 200
  - url: https://eligible.com/docs/api
    status: 200
  - url: https://gds.eligibleapi.com/v1.5/openapi.json
    status: 401
  checked: '2026-08-15'