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Pharmacy Claims API

B1 Claim Billing API

Submit NCPDP B1 pharmacy billing claims with a single POST request. No binary protocol parsing. No NCPDP certification. No switch contract. Just JSON.

How it works

The NCPDP Telecommunication Standard (D.0) uses a binary delimiter-based format that dates back decades. Every pharmacy system, POS vendor, and PBM integration team has to implement this protocol from scratch — parsing signed overpunch fields, building segment separators, managing payer sheets.

Starlight translates all of that into a clean JSON REST API. Send a POST request with your patient, insurance, prescription, and pricing data as JSON. We handle the NCPDP encoding, route it through the switch, and return the adjudication result as JSON.

Submit a B1 claim

terminal
curl -X POST https://starlight.claims/api/v1/submit \
  -H "X-API-Key: sk_live_your_key" \
  -H "Content-Type: application/json" \
  -d '{
    "transaction_type": "B1",
    "patient": {
      "first_name": "JANE",
      "last_name": "DOE",
      "date_of_birth": "19850115",
      "gender": "F",
      "zip_code": "12345"
    },
    "insurance": {
      "bin_number": "999999",
      "pcn": "TEST",
      "group_id": "GRP999999",
      "cardholder_id": "SAMPLE123456"
    },
    "prescription": {
      "rx_number": "999000001234",
      "product_id": "00000000000",
      "quantity_dispensed": "28",
      "days_supply": "28"
    }
  }'
Response
{
  "status": "Paid",
  "auth_number": "029401",
  "patient_pay": "10.00",
  "total_paid": "174.80",
  "claim_id": "CLM_20260101120000_abc12345"
}

What you need to submit a B1 claim

Patient

  • › First & last name
  • › Date of birth
  • › Gender
  • › ZIP code

Insurance

  • › BIN number
  • › PCN
  • › Group ID
  • › Cardholder ID

Prescription

  • › Rx number
  • › NDC product ID
  • › Quantity dispensed
  • › Days supply

Pricing

  • › Ingredient cost
  • › Dispensing fee
  • › Usual & customary
  • › Gross amount due

B1 billing features

  • DUR (Drug Utilization Review) override support — resolve clinical conflicts programmatically
  • Co-agent qualifier for coordination of benefits
  • Custom claim dates for rebilling and adjustments
  • Multiple DUR override stacking for complex rejections
  • Real-time adjudication with instant Paid/Rejected status
  • Full claim history and status tracking via API

Traditional NCPDP vs Starlight

Traditional

  • ✗ Binary delimiter protocol
  • ✗ Signed overpunch numeric encoding
  • ✗ NCPDP certification required
  • ✗ Switch contract negotiation
  • ✗ Months of integration work
  • ✗ Payer sheet management

Starlight

  • ✓ JSON in, JSON out
  • ✓ Standard REST conventions
  • ✓ No certification needed
  • ✓ Instant API key access
  • ✓ First claim in 60 seconds
  • ✓ We handle all payer routing

Ready to submit your first B1 claim?

Start with our free sandbox or go live with Instant Access — no NPI required.

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