{"url":"https://newsforagent.com/news/2026-11-12/eligible-x12-certification-four-rule-sets","markdown_url":"https://newsforagent.com/news/2026-11-12/eligible-x12-certification-four-rule-sets.md","title":"Eligible Earns X12 Certification Across Four Rule Sets","headline":"Eligible Wins X12 Certification Seals for Eligibility, Claims, Payments and Claim Status","description":"Eligible earned X12 Certification Seals across four operating rule sets after third-party testing, covering eligibility checks, claim status.","section":"Regulation & Approvals","published_at":"2026-11-12T20:56:10+00:00","modified_at":"2026-11-12T20:56:10+00:00","author":"News Desk","key_takeaways":["Eligible earned X12 Certification Seals covering Eligibility & Benefits, Claim Status, Payment & Remittance, and Health Care Claim operating rules.","The seals followed third-party testing and an evaluation of Eligible's application, the company said.","X12 CEO Cathy Sheppard said operating rules achieve maximum impact when universally adopted."],"companies":[{"name":"Eligible","is_primary":true,"profile_url":"https://akta.pro/company-profiles/0000ndo/eligible","website":"https://www.eligible.com"},{"name":"X12","is_primary":false,"profile_url":"https://akta.pro/company-profiles/00q9mc1/x12","website":"https://x12.org"}],"source":{"publisher":"PR Newswire","title":"Eligible Attains X12 Certification Across All Four Rule Sets","url":"https://www.prnewswire.com/news-releases/eligible-attains-x12-certification-across-all-four-rule-sets-302938373.html"},"other_sources":[],"tags":["Regulation & Approvals","Eligible","X12"],"body_markdown":"[Eligible](https://akta.pro/company-profiles/0000ndo/eligible) Inc said on November 12, 2026 that it earned [X12](https://akta.pro/company-profiles/00q9mc1/x12) Certification Seals covering Eligibility & Benefits, Claim Status, Payment & Remittance, and Health Care Claim operating rules. The announcement was made through [PR Newswire](https://www.prnewswire.com/news-releases/eligible-attains-x12-certification-across-all-four-rule-sets-302938373.html). Eligible is a privately held Brooklyn company founded in 2011 that provides API-based health insurance billing and eligibility verification services to healthcare businesses.\n\n## What the Four X12 Seals Cover\n\nThe seals were granted after Eligible completed third-party testing and a detailed evaluation of its application, according to the announcement. The company said the certification confirms compliance in four areas. Eligibility & Benefits covers real-time confirmation of patient coverage, including co-pays, coinsurance, deductibles and eligibility dates, returned in 20 seconds or less. Claim Status gives real-time visibility into whether a claim has been accepted, rejected or flagged for error, replacing manual follow-up.\n\nPayment & Remittance covers EFT and ERA that reconcile to each other, with standardized provider enrollment and consistent adjustment and denial codes. Health Care Claim covers standardized claim submission, acknowledgments and attachment handling.\n\n\"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.\n\nX12 acquired the CORE Operating Rules and Certification Program from DataSpring in October 2026, bringing the healthcare programs under its governance, Pulse 2.0 reported. The U.S. Department of Health and Human Services appointed CORE to formulate national operating rules for HIPAA transactions.\n\n## Eligible's Earlier Certifications\n\nEligible's Platform Services System achieved HITRUST r2 Certification covering all 19 HITRUST domains, valid through May 2028, following an independent assessment by A-LIGN, according to akta.pro [company records](https://akta.pro/company-data). The same records show the system also achieved NIST Cybersecurity Framework v1.1 Certification covering all five NIST CSF Core Functions, valid through May 2028. The records list five funding rounds, including a seed round of $22.7 million in December 2015 and a total of $25.2 million raised.\n\n## How Eligible Reached the X12 Seals\n\nEligible completed its SOC 2 Type II audit for the Platform Services System with zero exceptions across all four Trust Services Categories, PR Newswire reported in September 2026. In July 2026, the company said its Platform Services System attained HITRUST r2 Certification and NIST Cybersecurity Framework v1.1 Certification following an assessment by independent third-party assessor A-LIGN, PR Newswire reported.\n\n## X12's View of the Certification\n\n\"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.\"\n","publisher":{"name":"News for Agent","url":"https://newsforagent.com"}}