Verify pharmacy benefit eligibility before submitting claims. Check Commercial, Medicare Part D, and Medicare Part A/B coverage with a single POST request.
Searches across all participating PBMs. Returns other_payers with BIN/PCN/Group/Cardholder to use for B1 billing.
~80-85% match rate depending on PBM eligibility file submissions
Returns Medicare info including LICS level (subsidy tier 0-5), plan type (MAPD/PDP), coverage dates, and payer records for billing.
Cardholder ID accepts full SSN, last 4 SSN, or MBI
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": {
"bin_number": "014765",
"pcn": "COM",
"cardholder_id": "ABC123456789"
}
}'{
"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": "ABC123456789"
}
]
}Add city, state, group_id, person_code, relationship_code for higher match rates.
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. Commercial, Medicare Part D, Medicare Part A/B.