# Eligible > Eligible Inc is a US healthcare clearinghouse that sells insurance billing as an API: > real-time eligibility and benefits verification (X12 270/271), professional and > institutional claim submission (837), claim status (276/277), remittance (835), > trading-partner enrollment, and ML-powered patient cost estimation. Production base > URL is https://gds.eligibleapi.com/v1.5. Authentication is an API key only. Eligible > publishes NO OpenAPI, GraphQL SDL, AsyncAPI or Postman collection, and its API > reference at https://eligible.com/docs serves a sign-in page, so most of what follows > is reconstructed from Eligible's own first-party client libraries and its public > community documentation. Generated by API Evangelist on 2026-08-15. Not published by Eligible. Source of record: https://github.com/api-evangelist/eligible ## What you can call - [Coverage / eligibility](https://eligible.com/): GET /coverage/all.json — real-time 270/271 benefits check. Requires provider NPI, payer_id and member identity. - [Cost estimates](https://eligible.com/): GET /coverage/cost_estimates.json — patient out-of-pocket: deductible, coinsurance, copay, stop loss. - [Claims](https://eligible.com/): POST /claims.json — submit an 837. Then GET /claims/{reference_id}/acknowledgements.json and GET /claims/{reference_id}/payment_reports. - [Payment status](https://eligible.com/): GET /payment/status.json — 276/277 claim status. - [Enrollment](https://eligible.com/): GET|POST /enrollment_npis.json — trading-partner enrollment. This is the gate: claims do not flow until the provider NPI is enrolled with the payer. - [Payers](https://eligible.com/): GET /payers.json and GET /payers/{payer_id}/search_options. - [ICD codes](https://eligible.com/): GET /icds/{type} — search, describe, and ICD-9 to ICD-10 crosswalk. - [Raw EDI](https://eligible.com/): POST /x12 — submit a raw X12 transaction. Any JSON call also accepts format=x12 to return the raw EDI instead. ## Public machine-readable data (no key required) These are the only machine-readable documents Eligible publishes. They answer 200 to a browser User-Agent with a Referer of https://eligible.com/pricing. - [Eligibility payer directory](https://eligible.com/resources/payers/eligibility.json): 414 payers with pass_through_fee, enrollment_required, signature_required, secondary_supported. - [Claims payer directory](https://eligible.com/resources/payers/claims/medical.json): 1,643 payers, same shape. - [Payer search options](https://eligible.com/resources/payers/eligibility/search-options.json): accepted member-identity field combinations per payer. - [Eligibility passthrough fees](https://eligible.com/resources/payers/coverage_passthrough.json) - [Claims passthrough fees](https://eligible.com/resources/payers/claims_passthrough.json) - [Payment status passthrough fees](https://eligible.com/resources/payers/payment_status_passthrough.json) - [Payment report passthrough fees](https://eligible.com/resources/payers/payment_reports_passthrough.json) ## Things that will break your integration - **HTTP 200 does not mean success.** A 200 can carry `errors` (or `error`) with no `success` flag. Eligible's own Node client re-raises that case as a 400. Branch on the body, not the status. - **The 401 is ambiguous.** "Could not authenticate you" means either a bad API key OR that the provider is not enrolled with the payer. The status code does not distinguish them. - **There is no idempotency contract.** No idempotency key, header or parameter exists anywhere. A retried POST /claims.json is a second claim to a real insurer. - **The error body is not an object.** The observed 401 returns a bare quoted string under an `application/json` content type, not the documented `{"error": ...}` envelope. - **Clients pin the server certificate.** Both the Ruby and Node clients pin SHA-1 fingerprints of the gds.eligibleapi.com leaf certificate and refuse to connect on a mismatch. This is why they ship a release almost every January. An un-upgraded client stops working when the certificate rotates. - **Results arrive over webhooks.** Batch submissions, claim acknowledgements, payment reports and claim status changes are pushed, not polled. No event schema is published. - **The `test` flag defaults to false.** Both clients send `test=true|false` on every request and default it to false. ## Authentication - API key only. No OAuth, no OpenID Connect, no scopes, no token endpoint. - On GET/HEAD/DELETE the key goes in the query string as `api_key`; on POST/PUT it is merged into the JSON body. The Ruby client additionally sets `Authorization: Bearer `. - Three keys per account — live, staging, sandbox — issued at https://account.eligible.com/ under Admin > API keys. - `session_token` is a short-lived alternative for browser/mobile contexts. `publishable_key` is an identifier, NOT a credential; sending it where the API key belongs is the documented cause of a 401. ## Compliance Ten dated third-party certifications: CAQH CORE Phase I–IV, HITRUST r2 (2026), HITRUST CSF, NIST CSF v1.1, SOC 2, EHNAC HNAP, EHNAC CEAP, and HIPAA covered-entity operation. See https://eligible.com/compliance. ## Pricing Transactional, published at https://eligible.com/pricing. Insurance Billing APIs: 1% of dollars remitted + $0.25 per claim, $1/month account minimum. Patient Clearance APIs: +$0.30 per claim, including ten eligibility/cost-estimation calls per claim. Excess eligibility inquiries $0.05 each, excess cost estimates $0.25 each. Per-payer passthrough fees apply on top. No free tier, no self-serve signup — access is waitlisted. ## Status https://status.eligible.com (Atlassian Statuspage; machine-readable at /api/v2/summary.json). Tracked components include Eligible API and Eligible Sandbox separately. ## Client libraries - Ruby: https://rubygems.org/gems/eligible (3.0.3, 2026-01-17) - Node: https://www.npmjs.com/package/eligible-node (1.2.9, 2026-01-17) - .NET: https://www.nuget.org/packages/Eligible.Net (3.1.2, 2026-01-17) - Java: https://central.sonatype.com/artifact/com.eligible/eligible-java (1.13.16, 2025-01-21) - Python: https://pypi.org/project/eligible/ (1.2.1, 2013-12-30 — abandoned) ## What does not exist No OpenAPI. No GraphQL. No AsyncAPI. No Postman collection. No MCP server. No A2A agent card. No llms.txt. No /.well-known/ documents of any kind — every path returns 403 or 404. No published rate limits. No security.txt and no vulnerability disclosure program. No public API changelog. No SLA. ## Access https://eligible.com/signup routes to a waitlist: "Access to Eligible has become more exclusive. Creating an account will add your information to our waitlist. Gaining access may take a considerable amount of time."