Eligible API
Eligible publishes full REST API documentation covering eligibility, claims, cost estimates, enrollments, and webhooks, with self-serve sandbox keys. Production requires a signed BAA, a commercial contract with per transaction pricing, and payer by payer enrollment that can add weeks.
Frequently asked questions
Eligible scores D on the API Report Card. Eligible publishes full REST API documentation covering eligibility, claims, cost estimates, enrollments, and webhooks, with self-serve sandbox keys. Production requires a signed BAA, a commercial contract with per transaction pricing, and payer by payer enrollment that can add weeks.
Without a usable official API, teams fall back on manual exports, file drops, or one-off vendor integrations. The other option is an unofficial API layer like Supergood that automates the authenticated web app directly.
Eligible is an insurance billing API / clearinghouse-style platform for healthcare. It abstracts the underlying X12 EDI (270/271 eligibility & benefits, 276/277 claim status, 837 claim submission, 835 ERA/remittance) and HIPAA-compliant payer connections behind a modern JSON REST API and webhooks.
Vertical: Healthcare / Revenue Cycle Management (RCM) infrastructure. Developers integrate Eligible to: (1) run a real-time eligibility & benefits check at patient scheduling or intake, returning copay, deductible, coinsurance, out-of-pocket max, and service-type-specific benefits; (2) compute a patient cost estimate before the visit; (3) submit a professional, institutional, or dental claim (837) after the encounter; (4) poll or webhook on claim status (276/277); (5) receive electronic remittance advice (835/ERA) and post payments; (6) manage payer enrollments for ERA and EFT.
Eligible is well known inside the digital-health developer community as one of the original "Stripe for healthcare billing" plays (Y Combinator alum, Brooklyn-based, founded 2012).
Yes, for any healthcare app using Eligible, it is the system of record for the entire insurance-billing data layer: every 270 eligibility request and 271 response (with copay, deductible, coinsurance, OOP max, plan, network, and service-type benefits), every submitted 837 claim and its line-level CPT/HCPCS/ICD-10 detail, every 277 claim status update, and every 835 ERA with adjudication, payment, and adjustment reasons.
Founded in 2012 in Brooklyn by Katelyn Gleason and team; one of the Y Combinator W12/S12 era's most prominent healthcare-API startups.
Production keys are not self-serve, every new customer goes through sales, BAA, and pricing negotiation before any live transaction. Per-transaction pricing is not transparent on the public site, making it hard to compare against Stedi, pVerify, Availity Essentials. Full sourced list under Sources below.
Common alternatives include Change Healthcare / Optum (Eligibility & Claims), Availity, Waystar, Stedi, pVerify, Claim.MD. Graded alternatives appear under "More from the report card" below.
Grades measure one thing: can a customer's engineering team get their own data out programmatically? We check six things (whether a real API exists, how access is gated, data coverage, auth quality, docs and developer experience, and stability) and roll them into a letter grade. Grades get re-verified, and they only move on evidence.
Yes. Supergood maintains an unofficial Eligible API and MCP server so AI agents and internal tools can read and write Eligible data. See the Eligible integration docs at supergood.ai/docs/eligible-api.