Claims Processing Solutions


MedImpact's web-based eligibility and claims management system, MedAccess, sets the standard for processing pharmacy claims with a real-time interactive database. MedAccess gives plan sponsors the convenience of desktop access to benefit management. With MedImpact adjudicating claims from all three dispensing channels, clients are able to manage the entire benefit and maximize savings. The system allows plans to do real-time prior authorizations, eligibility edits (additions, changes and deletions) and direct member reimbursements.

Utilization Management

MedImpact offers a depth of utilization management (UM) services delivered by information technology tools and trained professionals to influence the behavior of patients, pharmacists and physicians. Our most aggressive interventions rely on our proprietary MedResults® communications platform for outbound messaging and correspondence with physicians and patients.

Based on each plan's economic and clinical needs, MedImpact makes data-driven recommendations on the best mix of UM services to achieve plan goals, including:

  • Point-of-service system edits
  • Concurrent drug utilization review
  • Prior authorization services
  • Step therapy
  • Therapeutic substitution
  • Dose optimization
  • Multisource brand conversion
  • Retrospective drug use evaluation with focus on disease, drug safety and patient demographics
  • Medication therapy management for Medicare Part D and commercial populations

Client Testimonial

MedImpact is delivering exactly
what we were promised during our site visit. MedImpact is holding us accountable and keeping us on track.

Senior Manager, Geisinger Health Plan
Commercial, Medicare Part D Plans
242,000 Lives