Eligible to Act as Oscar’s Hosted Real-Time Eligibility Vendor, Supporting the Patient Protection Promise.
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Be there for your patients

Eligible is the best medical billing platform - made with revenue cycle experts, patients, and developers in mind.

Trusted by top developers in healthcare

EHNAC accreditation

These accreditations assure patients and providers that Eligible has accomplished the strictest compliance with privacy and security best practices while processing millions of healthcare cases each month.

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SOC II compliant

We fully understand the role of a mature and proven information security program in meeting Eligible and customer goals. We are happy to announce the successful completion of our Type II SOC2 review.

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HiTrust certification

Achieving this certification helps us assure our customers and the companies with which we interact that we understand our responsibilities in keeping protected health information safe.

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CAQH CORE certification

This confirms that Eligible can exchange electronic healthcare information for eligibility, benefits, claims status, and EFT and ERA, in conformance with the Phase I-III CAQH CORE Operating Rules.

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Built for developers

The best patient experiences are built with Eligible

Most medical service providers still rely on a highly manual, error-prone process for Patient and Insurance billing. Build Eligible’s dead simple APIs for Estimations, Statements, and Claims into your apps today.

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Easy integration

Our customers range from small start-ups with a few folks on staff to public companies with billions of dollars in annual revenue. Using Eligible, an integration proof of concept can be deployed in minutes.

Cross-platform

Eligible should work everywhere, so we continually add libraries with the programming languages of your choice.

Developer support

Browse Eligible’s detailed code samples, code libraries, sandbox and step-by-step tutorials or contact Eligible’s technical team to support your engineering needs.

Case study

RadNet sees dramatic time of service collections increase with Eligible integration.

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“RadNet has experienced a significant reduction in upfront patient insurance denials when using Eligible.”
Ranjan Jayanathan, CIO at RadNet
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Medical Billing Developer Platform

We're all about the patients

Eligible builds the most versatile tools for patient healthcare eligibility and insurance claims processing. Whether you’re building a consumer scheduling interface, check-in kiosk, or back office denial management solution Eligible’s simple APIs and advanced functionality help you create the best possible product for your users.

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File Insurance Claims

We help organizations avoid traditionally drawn-out integration cycles. Our approach enables an end to end setup in less than a days work.

Determine Costs of Treatment

Eligible’s toolset plays nicely with all of your existing workflows. Whether your organization prefers desktop, web or mobile platforms.

Collect from Patients & Insurers

We believe billing inaccuracies are a problem rooted in code, not people. We incorporate reconciled results to deliver continual improvements.

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  • No one wants to spend their hard earned money without knowing what they are purchasing and how much it will cost them. Eligible and Oscar are asking one simple question: Why should Healthcare be any different?

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  • Like many medical service providers, for insurance verification RadNet had relied on a highly manual, error-prone process.

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  • Heal now uses Eligible to include true pricing transparency into its app, so that their customers have up front pricing that includes copays and deductibles.

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  • Ronak Talati is the CEO and founder of SwipeMed, a company that helps healthcare providers find out the up-front costs that patients should be paying, and then guides companies through collecting what they’re owed.

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  • One of the great parts about working at Eligible is seeing the many different companies that we’re able to help. Counsyl provides DNA testing services for couples who are thinking about starting a family, those who are already pregnant and individuals who are curious about their risks for certain types of cancer.

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Feature-packed simplicity

Healthcare systems, inspired by the power of machine learning, business intelligence, automation, and technology in general, drive our continuously improving feature set.


Data-driven payer lists

Synthesizing art and machine learning, we’ve compacted a heavy-weight payer search experience into a light version that achieves instant interoperability.

Real-time interfaces

All transactions are sent to insurers in real time accessing the most recent up to date information on the patient’s health insurance benefit.

Connectivity management

Eligible does the heavy lifting maintaining connectivity to over 90% of the insured population giving you an opportunity to focus entirely on the user experience.

Best-in-class support

Real time chat, phone, email and ticket support available to all customers of all sizes 100% free of charge.

Same-day integrations

We’ve engineered Eligible to support an end to end Advanced Patient Eligibility integration in less than 10 minutes.

Advanced workflows

From claim scrubbing to estimating and back again, our singular focus on eligibility provides you with unmatched functionality.


Meet our artificially intelligent bot

Recently we welcomed a new member to Eligible, and she’s quite special. Her name is Ellie. Ellie is our company bot. She helps with various applications, with the goal of making lives easier. With her, we can do things smarter, faster, and be more productive.

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