emerging · -1.8 market industry

Eligibility

Score 21.5 / 100 27 providers +34 via APIs 53 APIs Search apis.io →
Workflows using this tag
Element5 — Verify eligibility and await result · Element5 Element5 — Upload document and submit authorization · Element5 Onboard a Bluecore customer and send a transactional message · Bluecore Availity Claim Attachment (X12 275) · Availity Availity Prior Authorization (X12 278) · Availity Availity Eligibility and Benefits (X12 270/271) · Availity Availity Claim Status Inquiry (X12 276/277) · Availity
Business capabilities this tag reaches
Patient Access Management 7 Customer Relationship Management 1 Public Benefits & Entitlements Management 1 Telecom Product Catalogue Management 1 Payments & Card Management 1 Insurance Underwriting Management 1

Providers using this tag (27)

Ranked by API Evangelist rating — Exemplar and Strong are expanded by default.

Exemplar 4 Complete, well-documented, and agent-ready
StediEDIElectronic Data InterchangeHealthcareClearinghouse7 APIs78.2Candid HealthMedical BillingRevenue Cycle ManagementHealthcareClaims1 API68.0Elation HealthHealthcareUnited StatesElectronic Health RecordsFHIR19 APIs79.7OptumCompanyHealthcareHealth InsuranceClaims59 APIs69.8
Strong 5 Solid coverage with minor gaps
pVerifyHealthcareInsuranceClaims1 API54.5AvailityHealthcareClearinghouseHIPAAX12 EDI14 APIs64.8Turquoise HealthHealthcarePrice TransparencyHospital RatesPayer Rates1 API56.2Luma HealthHealthcareUnited StatesPatient EngagementScheduling1 API54.6ColorCompanyHealthHealthcareGenomics2 APIs54.4
Developing 10 Usable, with meaningful gaps to close
SilnaCompanyAutomationHealthcarePrior Authorization1 API54.0EligibleBillingHealthcareInsurance5 APIs51.0PlanSourceEmployee BenefitsBenefits AdministrationInsuranceHuman Resources1 API50.3Flume HealthHealthcareHealth PlansPayersHealthcare Data1 API50.0Vyne DentalCompanyDentalHealthcareInsurance1 API45.7Ribbon HealthHealthcareProvider DirectoryInsuranceClinical Data1 API53.6H1HealthcareUnited StatesLife SciencesProvider Data3 APIs51.5WellhubCompanyHealthWellbeingCorporate Benefits1 API45.5WaystarHealthcareRevenue Cycle ManagementClearinghouseHealthcare Payments7 APIs43.5SurescriptsHealthcaree-PrescribingHealth Information NetworkNCPDP SCRIPT8 APIs41.2
Thin 3 Limited public surface area
Nirvana HealthHealthcareInsuranceBenefits1 API27.1Change HealthcareHealthcareTechnologyAnalyticsEDI1 API26.6UnitedHealthcareHealth InsuranceHealthcareFHIRClaims2 APIs28.4
Emerging 1 Early or largely undocumented
MirzaCompanyPublic BenefitsGovernmentHealthcare18.5
Minimal 4 Almost no public developer surface
DiscoverSeniorBenefitsSeniorBenefitsArtificial IntelligenceHealthcare10.9GrantIQCompanyGrantsNon-Profit2.6Olive AIHealthcareHealthcare AutomationRevenue Cycle ManagementPrior Authorization0.0OpkitHealthcareInsuranceBenefits1 API0.0

APIs with this tag (53)

Ranked by the provider's API Evangelist rating — the Kin Score is scored per provider, not per API, so every API of a provider shares its band. How the rating works →

Exemplar 5 Complete, well-documented, and agent-ready
Stedi Batch Eligibility Check APIThe Batch Eligibility Check API from Stedi — 4 operation(s) for submitting and polling asynchronous batches...78.2Stedi Eligibility PDF APIThe Eligibility PDF API from Stedi — 1 operation(s) for retrieving a rendered PDF of an X12 271 eligibility...78.2Optum Eligibility APIMedical Eligibility69.8Optum Real (Medical) APIOptum Real point-of-care APIs on the oihub gateway: pre-service eligibility, claim pre-check, claim actions...69.8Candid Health Eligibility APIThe Eligibility API from Candid Health — 1 operation(s) for eligibility.68.0
Strong 12 Solid coverage with minor gaps
Availity Eligibility & Benefits Value-Add APIsThe Availity Eligibility & Benefits Value-Add APIs provide supplementary data during eligibility transactio...64.8availity Eligibility APIReal-time eligibility and benefits verification64.8Orange Business Operator Eligibility (France) APICheck broadband and fibre eligibility at a French address for operator partners — feeds B2B onboarding flows.64.2Orange Business RIP Operator Eligibility (France) APIPublic-initiative network (RIP) fibre eligibility check for French regional fibre rollouts, used by alterna...64.2Bluecore Eligibility APIThe Eligibility API from Bluecore — 2 operation(s) for eligibility.62.8KORE Wireless Eligibility APIRetrieve details about the eligibility of a given account58.2Mastercard Benefit Eligibility Service APIThis API is for third-parties who want to enable eligibility checks based on input criteria including card ...57.3BTG Pactual Eligibility APIThe Eligibility API from BTG Pactual — 1 operation(s) for eligibility.56.5pVerify CGX Widget APIProvision and drive the embeddable eligibility-and-estimates widget. Setup runs against the premium portal ...54.5pVerify Dental Eligibility APIDental insurance eligibility and benefit verification, including the only version-prefixed path in the pVer...54.5pVerify Eligibility APIReal-time X12 270/271 insurance eligibility verification. Submit an EligibilitySummary inquiry, poll the pe...54.5Color Eligibility APIEligibility entries and eligibility-file uploads for a population.54.4
Developing 12 Usable, with meaningful gaps to close
Blockchain.com Eligibility APIAvailable currencies, regions, and payment methods for the partner account.51.9Eligible Coverage APIThe Coverage API performs real-time insurance eligibility and benefits verification for a patient against a...51.0Aetna Provider EDI ConnectivityHIPAA X12 electronic data interchange for health care professionals - EDI 837 claims, 270/271 eligibility a...46.9Splitit Eligibility APICheck shopper eligibility for installment plans46.8VA Community Care Eligibility APIDetermine whether a Veteran is eligible for community-care services under VA referral programs.46.2CMS — Centers for Medicare & Medicaid Services Eligibility APIThe Eligibility API from CMS — Centers for Medicare & Medicaid Services — 1 operation(s) for eligibility.46.1Vyne Dental Eligibility and Benefits API (Onederful)Real-time and asynchronous dental eligibility and benefits checks (JSON, HTML and EDI 271 responses), enhan...45.7Element5 Eligibility APIEligibility related APIs44.9Waystar Eligibility Verification APIReal-time and batch insurance eligibility and benefits verification, exchanging X12 270 inquiries and 271 r...43.5Orum Eligibility APIThe Eligibility API from Orum — 1 operation(s) for eligibility.42.3Surescripts Eligibility and FormularyVerifies patient pharmacy benefit eligibility and returns formulary and benefit coverage details so prescri...41.2AB5D Eligibility APIThe Eligibility API from AB5D — 1 operation(s) for eligibility.39.6
Thin 14 Limited public surface area
Cashplus Eligibility APIFirst-party partner API for running credit card eligibility checks against Cashplus/Zempler credit products...38.1Walgreens Eligibility APIVaccine eligibility checking36.9Cashfree Payments Eligibility APICollection of APIs to check eligible entities - payment methods, offers, affordability35.6aflac Eligibility APIEmployee eligibility verification operations.35.2Candid Nonprofit Eligibility APIEvaluates whether a given nonprofit is eligible to receive a grant or donation based on configurable rules ...34.1texasautoquotes-com Eligibility APIThe Eligibility API from texasautoquotes-com — 1 operation(s) for eligibility.33.7ALEX Partner Integration APIThe ALEX Partner Integration API lets a Jellyvision partner — typically a benefits administration or enroll...33.3Hiscox Eligibility APIPartner-facing eligibility lookup that returns the list of US states and the Hiscox products offered by pro...32.4georgiaautoquotes-com Eligibility APIThe Eligibility API from georgiaautoquotes-com — 1 operation(s) for eligibility.31.9Pie Insurance Eligibility APIThe Eligibility API from Pie Insurance — 1 operation(s) for eligibility.30.9Unum Eligibility APIMember eligibility management and verification30.1UnitedHealthcare Eligibility APIReal-time eligibility and benefit verification28.4Nirvana Health Eligibility APIActive-coverage discovery and eligibility verification.27.1Change Healthcare Medical Network APIJSON-over-REST front end to the HIPAA X12 EDI transaction set — 270/271 eligibility, 276/277 claim status, ...26.6
Emerging 8 Early or largely undocumented
Claim.MD Eligibility APIReal-time eligibility and benefit verification (270/271).25.5flautoquotes-com Eligibility APIThe Eligibility API from flautoquotes-com — 1 operation(s) for eligibility.25.1Highline Pay by Paycheck APIThe Highline API lets billers, lenders, and platforms verify consumer eligibility for paycheck-deduction pa...22.8bswift Partner APIbswift's partner-facing REST API, served from an AWS API Gateway at api.bswift.com. bswift publicly describ...22.4Adonis APIAdonis platform API for revenue cycle management, including real-time patient eligibility and benefits veri...21.3Symetra Benefits Administration APISymetra's Benefits Administration API enables HR platforms, benefits administrators, and technology partner...19.9Benefits APISecure, real-time access to read and update employee and dependent benefit data. Once a Guardian policy is ...19.7Triple-S Salud Provider PortalMi Triple-S is the online provider portal for Triple-S Salud, offering healthcare providers access to insur...14.4
Minimal 2 Almost no public developer surface
Overjet Insurance Verification APIModeled surface for Overjet's automated dental insurance verification - checking patient eligibility and be...9.5Phreesia Insurance Eligibility Verification APIReal-time insurance eligibility and benefits verification at or before check-in, returning coverage, copay,...9.5

Companies reaching this through an API (34)

These companies publish an API, specification or operation carrying “Eligibility” but do not classify their business under it. Listed unranked and kept out of the count above, because one tagged operation is not a statement about what a company does.

AB5D Adonis Aetna Aflac Blockchain.com Bluecore bswift BTG Pactual Candid Cashfree Payments Cashplus Bank Claim.MD CMS — Centers for Medicare & Medicaid Services Department of Veterans Affairs (VA Lighthouse) Element5 flautoquotes-com georgiaautoquotes-com Guardian Life Highline Hiscox Jellyvision KORE Wireless Mastercard Orange Business Orum Overjet Phreesia Pie Insurance Splitit Symetra Financial texasautoquotes-com Triple-S Management Unum Walgreens

Score breakdown

Frequency
50.7
log-scaled weighted occurrences
Breadth
0.3
spread across providers
Quality lift
43.7
mean composite of providers using it
Cohesion
0.0
strength of nearest seed neighbor

Where this tag sits

Healthcare broader

Related tags

Clearinghouse 8 co-occurrences Prior Authorization 11 co-occurrences Payers 10 co-occurrences Claims 22 co-occurrences Price Transparency 6 co-occurrences Health Insurance 15 co-occurrences Benefits 10 co-occurrences

Where this tag comes from

Api tag53
Provider tag27
Openapi tag23
Openapi op tag46

Markets provisional

Kin Score markets whose measured providers carry this tag. Share is the fraction of the market's measured providers that carry it — it describes the market, not this tag.

MarketShare of the market's providers
Payer Interoperability (CAQH CORE, X12, Da Vinci, WEDI)24%

Cohort brief

Auto-generated

The 27 providers in the APIs.io catalog tagged Eligibility, scored on the Kin Score. Every figure below is computed from the catalog — nothing here is written.

Providers
27
all scored
Mean Kin Score
43.7
+19.6 vs catalog 24.1
Mean Agent Readiness
27.2
+13.1 vs catalog 14.1
Spread
0–79.7
median 50.3 · σ 22.1
How the 27 split by band
Exemplar 4Strong 5Developing 10Thin 3Emerging 1Minimal 4
Facet averages, against the whole catalog
FacetThis cohortCatalogDifferenceScored
Contract Quality 40.2 18.6 +21.6 27
Developer Ergonomics 46 24.5 +21.5 27
Access Clarity 48.5 30 +18.5 27
Operational Transparency 30.7 13.2 +17.5 27
Contract Governance 20.9 9.7 +11.2 27
Discoverability 65.6 59.1 +6.5 27

A facet is averaged over the members that carry it, not over the whole cohort — the “Scored” column is that count. Averaging an absent facet as zero would score our own coverage gaps as the providers’ posture.

What this cohort publishes
ArtifactThis cohortCatalogDifference
MCP server (any) 22% 18% +4
MCP server (first-party) 22% 16% +6
Agent Skills 0% 0% 0
OAuth scopes 26% 13% +13
Security 100% 99% +1
Arazzo workflows 11% 1% +10
Governance rules 70% 36% +34

mcp_pct counts any mcp/ artifact including ones API Evangelist derived from the provider OpenAPI; mcp_first_party_pct counts only servers the provider publishes. Prefer the latter.

Top by Kin Score
  1. 1 Elation Health 79.7
  2. 2 Stedi 78.2
  3. 3 Optum 69.8
  4. 4 Candid Health 68
  5. 5 Availity 64.8
  6. 6 Turquoise Health 56.2
  7. 7 Luma Health 54.6
  8. 8 pVerify 54.5
  9. 9 Color 54.4
  10. 10 Silna 54
Top by Agent Readiness
  1. 1 Stedi 65.8
  2. 2 Turquoise Health 54.6
  3. 3 Flume Health 53.2
  4. 4 PlanSource 46.4
  5. 5 Elation Health 45.6
  6. 6 Color 41.3
  7. 7 Optum 40.6
  8. 8 Silna 39.6
  9. 9 Candid Health 36.9
  10. 10 pVerify 36
All 27 members of this roster resolve to a scored provider in the catalog.
Coverage caveat. 17 of 27 scored members had under half their catalog-attributable points satisfied at all (catalog_earned / catalog_max < 0.5). They are INCLUDED in the mean above. A large share here means the cohort mean is partly a measurement of how far our enrichment reached, not only of how these providers publish.Generated from the catalog build of 14 November 2026, across 41591 providers, using the same computation served by the APIs.io cohort API. Briefs are published for rosters of 5 or more scored providers; below that a distribution is not meaningful.

Work with this as data

Every tag here is available over the APIs.io API and to AI agents over MCP.

MCP server

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https://apis.io/mcp

Tools for tags

7 MCP tools reach this
  • find_tagsBrowse and filter every tag in the catalog.
  • get_cohortThis tag as a scored cohort — every provider carrying it, with scores.
  • cohort_statsPRO — the distribution across this tag: mean, median, band split, adoption rates.
  • cohort_rankingsPRO — the leaderboard, on composite AND agent-readiness axes.
  • apis_io_searchSTART HERE — APIs, providers and tags for one query, each with its total.
  • resolveTurn a domain, URL or GitHub org into the provider it belongs to.
  • find_cohortsEvery scored population of providers in the catalog.
All 92 tools →

Call it yourself

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This tag 
curl "https://apis.io/api/v1/tags/eligibility"
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curl "https://apis.io/api/v1/tags?limit=25"
As a scored cohort (paid plan)
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