Eligible raises $2.3 million for health insurance eligibility API

By Jonah Comstock
11:57 am

eligible apiEligible, which offers an API that other health tech companies use to add a streamlined insurance eligibility check feature for doctors and patients, has raised $2.3 million, according to an SEC filing.

The company raised more than $1.5 million in seed funding last year, using a combination of AngelList and SecondMarket. Backers at that time included David Lee, Esther Dyson, Anvil Capital’s Michael Liou, Accenture Managing Director Anand Swaminathan, and Andreessen Horowitz, according to Pando Daily. It is unclear whether the recent SEC filing includes the $1.5 million or is in addition to it. 

Other angel investors in the company include Fresco Capital and RTA Capital. Eligible is also a veteran of multiple accelerators including Y-Combinator and Rock Health.

Eligible is developing a REST API with the goal of standardizing and simplifying health eligibility requests to insurers. Their APIs allow apps to communicate with more than 1,000 health insurance companies, and support transactions including eligibility, policy, coverage, demographics, authorizations, coordination of benefits, claims, payments and more.

The company charges a scaling fee for accessing the API, at five cents per transaction for the first 250,000 hits, with the price dropping the more a company uses it.

Eligible counts practice management system Kareo.com as one of its largest customers. It also works with care coordination company Remedy Partners, diagnostic imaging service RadNet, healthcare payment app Simplee, and fitness incentive platform EveryMove.

"We’ve cut out nearly all of the old healthcare middle men and have built direct integrations with over 90 percent of the insurers in the United States of America," the company wrote in a blog post last year. "We’ve normalized all their painstakingly detailed variations on eligibility, claim edits, authorizations, referrals, claim rejections, report generations, claim status, remittance filings and offered that up in the cloud, as a service, to our customers. Eligible can now confidently call itself a next generation payment network for healthcare with a suite of simple, unified APIs built specifically for rapid implementation."


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