NEW YORK, Nov. 12, 2026 /PRNewswire/ — Eligible Inc today announced it has earned X12® Certification Seals covering Eligibility & Benefits, Claim Status, Payment & Remittance, and Health Care Claim Operating Rules.
Operating rules and foundational standards empower health plans, healthcare providers, and vendors to seamlessly exchange substantial volumes of administrative data with high accuracy, speed, and cost efficiency. By establishing clear operational requirements for each participant, these rules minimize expenses and boost performance across the national healthcare network.
The X12 Certification Seals were granted following Eligible Inc‘s successful completion of rigorous third-party testing and a detailed evaluation of its application. This milestone confirms compliance across several key operational areas:
- Eligibility & Benefits: Real-time confirmation of patient coverage — co-pays, coinsurance, deductibles and eligibility dates — returned in 20 seconds or less.
- Claim Status: Real-time visibility into whether a claim has been accepted, rejected or flagged for error, replacing manual follow-up.
- Payment & Remittance: EFT and ERA that reconcile to each other, with standardized provider enrollment and consistent adjustment and denial codes.
- Health Care Claim: Standardized claim submission, acknowledgments and attachment handling, accelerating the path from submission to adjudication.
“Securing X12 Certification across key operational domains highlights our ongoing commitment to simplifying administrative exchanges in healthcare and delivering maximum efficiency to our partners,” said Katelyn Gleason, Founder & CEO of Eligible Inc.
Based on estimates from the Centers for Medicare & Medicaid Services, broad implementation of these operating rules could generate billions of dollars in annual savings for the healthcare sector by reducing administrative workload and moving toward automated electronic workflows.
“Eligible Inc demonstrates exceptional industry leadership by implementing operating rules, proving compliance, and encouraging partners to follow suit,” stated Cathy Sheppard, CEO of X12. “Operating rules achieve maximum impact when universally adopted, and through Eligible Inc‘s efforts, the healthcare system makes another major step forward.”
The U.S. Department of Health and Human Services appointed CORE to formulate national operating rules for HIPAA transactions to facilitate rapid, effective electronic data sharing. Considered the benchmark for industry compliance, the X12 Certification Program allows organizations to verify that they and their partners consistently meet established operating rules and underlying standards.
For additional details regarding Eligible, please contact support@eligible.com or visit www.eligible.com To discover more about X12 certification, visit www.x12.org.
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