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Comment by seanwoods | Hacker News Reader

What does this company actually do? Seems like you need to know a million buzz words, then take a leap, in order to figure out what problems this solves.

I'm a health care informatics professional (mostly clinical, not billing) and I can't seem to divine it.

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Healthcare providers in the US are paid by insurance companies. It is incredibly useful for providers to know if the patient that just walked-in for service actually has eligibile insurance benefits for the services about to be delivered. Historically this is done via phone calls and fax, if done at all.

There are ANSI standard EDI transactions designed specifically for healthcare insurance eligibility inquiries (there also exists transactions for claims, but that's the other side of the puzzle). The standards themselves are pretty simple. But unfortunately, from a business development and integration perspective, the effort required to become trading partners with healthcare insurance companies is extremely high. There are plenty of vendors and clearinghouses out there which make the process easier. But this company is trying to make the setup and integration even easier with self-service sign-up and credit card billing. It's a novel idea.

Edit: I have no affiliation with Eligible but I've been working with the underlying technology for many years.

Thanks. You answered what Eligible does much clearer than the Eligible guys (and gals :) ) themselves.

It does look very useful :)

thanks for the gals!

I can only speak of physician's offices but I would imagine the process is much the same in hospitals, if more bureaucratic.

Before a test or lab is ordered, or before a specialist visit is scheduled, one of the assistants needs to verify that your insurance will actually cover the procedure. Typically this means the assistant needs to call the insurance provider, give them your information and what procedure(s) they are checking on.

Insurers provide this data but there are close to a dozen disparate standards and formats. Eligible consolidates all that into a REST API that developers can build applications on top of. From what I can tell this is definitely not for the healthcare industry, but for our industry to build healthcare applications.

I have no affiliation with Eligible, but I've been working in healthcare IT for several years, although not at the startup level.

Traditionally health information technology has been run by non-technical bureaucracies sitting around a table creating "specs" that hackers then need to mud through (usually 300+ page pdf) in order to integrate/implement. The bureaucracies intentions are good: free up the data to build from, but the result is just the same old legacy vendors end up using it.

I appreciate your efforts, but this response doesn't really answer my question. It's too granular (and a bit biased). When I go to your web site, I need some context. I need business problems that this software solves. Based on the name I would say it's Medicare/insurance eligibility checking, but the web site should guide me through what needs the product addresses and why it's better than the alternatives.

Also, I'd advise you not to jump straight to messages about "non-technical bureaucracies." It's certainly true in some cases, but it sounds derogatory. Better to address the objectives these people are trying to meet.

She's answering the question well, I think, if you've got a basic knowledge of the problem Eligible is dealing with. Frankly, they're not selling to you if you don't understand what they do from their website.

They provide a RESTful API to insurance eligibility data, which is useful because the current (required-by-law) APIs are horrendously complicated and difficult to work worth, AND they're disparate, varying by vendor.

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