EligibilityOne

What EligibilityOne does

EligibilityOne (legal entity: EligibilityAdvocates LLC) is a privately held U.S. healthcare eligibility services company founded in 2019 and headquartered in Elgin, Illinois (with firmographic references to Kansas City, Missouri). The company serves hospitals and medical centers by deploying dedicated, locally hired Eligibility Advocates on-site at client facilities — including in Emergency Departments — to screen uninsured and self-pay patients for coverage and enroll them in Medicaid, SSI/SSDI, charity care, and other financial assistance programs. Services are sold exclusively through a B2B field-sales motion directly into healthcare facility administration and revenue cycle teams, with on-site coverage hours of at least 12 hours/day, 6 days/week (extending up to 24/7 based on peak analysis).

The product platform is organized around Third-Party Eligibility & Enrollment, Out-of-State Medicaid, Insurance Coverage Discovery, Medical Billing, Prior Authorizations, Denial Management, and Provider Enrollment & Credentialing (added via the March 2023 acquisition of CredentialingOne). Underlying technology includes AdvocatorAI for AI-powered patient screening with presumptive scoring and automated forms processing, EAPulse for real-time reporting dashboards, a mobile screening stack (convertible laptops/tablets with HL7 integration posting coverage to client systems within 72 hours), and the E1 Help Patient Portal mobile application built with Moxo. HealthWare Systems provides the underlying RPA-enabled workflow infrastructure.

EligibilityOne operates a contingent-fee, performance-based pricing model — clients pay only a percentage of reimbursement collected from successful eligibility determinations, with no upfront costs, no facility enrollment fees, and no payroll/benefits overhead. This aligns the company's economics directly with successful patient enrollments and coverage discovery. The company maintains SOC 2 Type 2 certification, BBB accreditation, and HIPAA-compliant infrastructure, and currently has 51–100 employees serving healthcare facilities nationwide.

Name

EligibilityOne

Legal name

EligibilityAdvocates LLC

Website

https://eligibilityone.com

Company type

Private

Founded year

2019

Operating status

Operating

Headcount range

51–100 employees

Short description

EligibilityOne is a U.S. healthcare eligibility services company that deploys on-site advocates and AI-powered screening tools at hospitals to enroll uninsured patients in Medicaid and financial assistance programs on a contingent-fee basis.

Ownership category

akta.pro rank

Product category

Healthcare Patient Eligibility & Revenue Cycle Services

NAICS

Health and Welfare Funds (525120)

SIC

Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro industry

PRIMARYHLAEALAH

Eligibility, Enrollment & Benefits Administration

Healthcare & Life Sciences/Health Insurance & Managed Care/Third-Party Administration (TPA) & Administrative Services Only (ASO)

SECONDARYHLACACAD

Eligibility & Benefits Verification

Healthcare & Life Sciences/Digital Health & Health IT/Revenue Cycle Management (RCM) & Billing Software

Keywords

• Patient eligibility services
• Healthcare revenue cycle
• Insurance coverage discovery
• Medicaid enrollment services
• Provider credentialing

Headquarters

HQ city

Elgin

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Performance-Based Eligibility Services: EligibilityOne offers contingent fee pricing to healthcare facilities. Clients only pay a percentage of the reimbursement collected from successful eligibility determinations and enrollment conversions. There are no upfront costs or facility enrollment fees. The company pursues every possible source of funding for each patient account, ensuring the healthcare organization is the 'payer of last resort'.
2. On-Site Eligibility Advocacy Services: Dedicated Eligibility Advocates deployed on-site at healthcare facilities to screen patients for coverage, assist with enrollment, and manage the eligibility process. Services include expanded coverage hours (12+ hours/day, 6+ days/week) compared to typical in-house teams.
3. Coverage Discovery and Verification: Technology-powered service that automatically identifies existing patient coverage, verifies it's active and billable, and posts coverage information directly to client systems. Includes screening for financial assistance eligibility if no coverage is found.

Pricing tiers

Go-to-market motion2 records

Distribution channels1 record

Marketing channels7 records

Core offering

EligibilityOne provides third-party patient eligibility and enrollment services for hospitals and healthcare facilities, deploying on-site Eligibility Advocates who screen uninsured and self-pay patients for Medicaid, SSI/SSDI, charity care, and other financial assistance programs. Services are delivered through an AI-assisted platform (AdvocatorAI, EAPulse) with on-site presence covering 12+ hours/day, 6+ days/week, and the company is paid on a contingent fee basis tied to reimbursement collected.

Product overview

EligibilityOne offers a unified healthcare eligibility and revenue cycle management platform centered around patient financial assistance services. The core offering consists of eligibility and enrollment services (Third-Party Eligibility & Enrollment, Out-of-State Medicaid, Insurance Coverage Discovery) combined with revenue integrity solutions (Medical Billing, Prior Authorizations, Denial Management, Provider Enrollment & Credentialing). The platform is powered by proprietary technology including AdvocatorAI for AI-powered patient screening and EAPulse for real-time reporting dashboards. A companion mobile application, E1 Help Patient Portal, enables patient self-service access to account information and communications.

Differentiator

Problem solved

Functional benefit

Products and services

• Third-Party Eligibility & Enrollment Outsourced eligibility service that screens self-pay/uninsured patients for financial assistance and eligibility programs, auto-populates application forms, collects supporting documents, and manages submittal, approval, and follow-up. Targeted at hospitals and healthcare facilities.
• Out-of-State Medicaid Service for managing out-of-state Medicaid claims and enrolling sites/providers to expedite payment across all 50 states. Targeted at hospitals and healthcare facilities.
• Insurance Coverage Discovery Technology-enabled service that automatically finds existing patient coverage so providers can direct collection efforts appropriately and maximize reimbursement; verifies coverage is active and billable and screens for financial assistance eligibility when no coverage is found. Targeted at hospitals and healthcare facilities.
• Medical Billing Full-service medical billing where EligibilityOne staff work directly in client systems remotely and handle all aspects of billing on behalf of the provider while ensuring compliance and maintaining cash flow. Targeted at healthcare providers.
• Prior Authorizations Revenue integrity service managing prior authorization requirements to prevent claim denials and payment delays. Targeted at hospitals and healthcare facilities.
• Denial Management Revenue integrity service to manage and appeal denied claims, working to maximize reimbursement recovery. Targeted at hospitals and healthcare facilities.
• Provider Enrollment & Credentialing Healthcare provider credentialing and provider enrollment services to streamline the credentialing process for healthcare organizations. Targeted at hospitals and healthcare facilities.

Quantifiable outcome

• 90% of self-pay patients screened before discharge
• +3 more outcomes

Named customers4 records

Segments3 records

Ideal customer profiles1 record

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Partnerships

Two partnerships are on record, tiered core.

• HealthWare SystemscoreTechnology or IntegrationHealthWare Systems powers EligibilityOne's state-of-the-art technology infrastructure. HealthWare Systems is a leading provider of fully integrated, customizable workflow solutions and revenue cycle and patient management software. They specialize in applying robotic process automation (RPA) to healthcare processes, utilizing RPA for insurance verification and coverage discovery solutions. This partnership enables EligibilityOne's technology platform with automated workflow capabilities.
• MoxocoreTechnology or IntegrationMoxo developed the E1 Help: Patient Portal mobile application, which is published by EligibilityOne. The app allows patients to securely access their account information, view statements, communicate with support representatives, and manage healthcare-related services provided by EligibilityOne.

Scale indicators5 records

Recent moves7 records

Expansion highlights6 records

Market position

Competitive moat6 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/eligibility_one
• YouTubeyoutube.com/channel/UCvBaqhrxR-TQwfPsFfWyKjA
• Facebookfacebook.com/eligibilityone
• LinkedInlinkedin.com/company/eligibility1
• Instagraminstagram.com/eligibilityone

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about EligibilityOne