Verify pharmacy benefit eligibility before submitting claims. No BIN or PCN needed. Just patient info and a cardholder ID.
No BIN/PCN needed. Just the cardholder ID. Returns other_payers with BIN/PCN/Group/Cardholder to use for B1 billing.
~80-85% match rate depending on PBM eligibility file submissions
Add medicare: "D" to the request. Returns LICS subsidy level (0-5), plan type (MAPD/PDP), coverage dates, and up to 3 payer records for billing.
Cardholder ID accepts full SSN, last 4 SSN, or MBI
Add medicare: "AB" to the request. Returns coverage type (Part A only, Part B only, or both). Useful for DME billing, vaccine billing, and Medicare ID lookup.
Cardholder ID accepts full SSN, last 4 SSN, or MBI
curl -X POST https://starlight.claims/api/v1/eligibility \
-H "X-API-Key: sk_live_your_key" \
-H "Content-Type: application/json" \
-d '{
"patient": {
"first_name": "JANE",
"last_name": "DOE",
"date_of_birth": "19850115",
"gender": "F",
"zip_code": "12345"
},
"insurance": {
"cardholder_id": "W12234445567"
}
}'No BIN or PCN required for commercial eligibility. Starlight handles routing automatically.
{
"status": "Eligible",
"patient_confirmed": {
"first_name": "JANE",
"last_name": "DOE",
"date_of_birth": "19850115"
},
"other_payers": [
{
"bin_number": "610014",
"pcn": "OHPBCBS",
"group_id": "XYZ123",
"cardholder_id": "W12234445567"
}
]
}The other_payers array returns the BIN, PCN, Group, and Cardholder ID you need to submit a B1 billing claim.
curl -X POST https://starlight.claims/api/v1/eligibility \
-H "X-API-Key: sk_live_your_key" \
-H "Content-Type: application/json" \
-d '{
"patient": {
"first_name": "JOHN",
"last_name": "DOE",
"date_of_birth": "19400615",
"gender": "M",
"zip_code": "34567"
},
"insurance": {
"cardholder_id": "123456789",
"medicare": "D"
}
}'Cardholder ID accepts full SSN, last 4 digits, or MBI. Add medicare: "D" to switch to Part D lookup. Returns LICS subsidy level (0-5), plan type, coverage dates, and payer records for billing.
curl -X POST https://starlight.claims/api/v1/eligibility \
-H "X-API-Key: sk_live_your_key" \
-H "Content-Type: application/json" \
-d '{
"patient": {
"first_name": "JOHN",
"last_name": "DOE",
"date_of_birth": "19400615",
"gender": "M",
"zip_code": "34567"
},
"insurance": {
"cardholder_id": "123456789",
"medicare": "AB"
}
}'Returns coverage type (A only, B only, or both). Use medicare: "AB" for Part A/B lookup. Useful for DME billing, vaccine billing, and Medicare ID lookup.
Add city, state, group_id, person_code, relationship_code for higher match rates. No BIN or PCN required.
Pharmacy eligibility uses the NCPDP E1 transaction, completely separate from the X12 270/271 used for medical eligibility. Different protocol, different routing, different payer infrastructure.
Most "eligibility API" vendors only handle X12 270/271 (medical). Starlight handles the pharmacy side: NCPDP E1 through the pharmacy claims switch network.
One endpoint, three payer types. No BIN or PCN required. Just patient info and a cardholder ID.