Medimpact claim 2026

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4.8 out of 5

36 votes

The document is a Commercial Prescription Drugs Claim Form that provides detailed instructions for members on how to complete and submit claims for prescription medications. It includes sections for member information, receipt details, and pharmacy information, emphasizing the importance of providing required data to avoid claim rejection. The form also contains legal warnings regarding fraudulent claims specific to various states.

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Click ‘Get Form’ to open the medimpact claim in the editor.
Begin with Part 1: Member Information. Fill in your member/cardholder ID Number, which can be found on your insurance card. Ensure all required fields are completed accurately.
In Part 2: Receipt Information, gather your prescription receipts. If necessary, have your pharmacist complete this section. Remember to tape receipts to a separate page instead of stapling them.
For each medication, provide details such as Date Filled, RX Number, Quantity, and Copay. Ensure all required information is included to avoid delays in processing.
Complete Part 3: Pharmacy Information by affixing the pharmacy label or entering the required details manually. Don’t forget to obtain the pharmacist's signature.
Review all sections for accuracy before submitting the completed form and receipts via mail or email as specified.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (36 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are the benefits of using MedImpact?

With more than 1 million users, and a 4.3 mobile app star rating, MedImpacts intuitive consumer portal allows members to better understand their medications and costs to make healthier, more informed choices.

How do I contact MedImpact?

Contact us. For assistance with registration, login, username, and password reset, please contact Customer Support at (877) 403-6032 between the hours of 8am and 8pm Eastern Time. Our friendly staff is here to help.

Did MedImpact change their name?

Member customer care. The Interactive Voice Response (IVR) branding will change to, Thank you for calling MedImpact, formerly Elixir Solutions. Additional customer call center talking points will be available about the name change.

What pharmacy takes MedImpact?

Accepted at pharmacies nationwide including: Sams ClubCVS/Pharmacy Publix Rite Aid Pharmacy Target Pharmacy Walgreens Kroger Pharmacy Safeway Pharmacy Winn Dixie And more!

What is the new name for MedImpact?

We are changing our name on December 9, 2022. MedImpact Direct Mail pharmacy will become Birdi, Inc. Birdi will appear on your medicine bottle label and paperwork.

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Is MedImpact now birdi?

MedImpact Direct Mail pharmacy will become Birdi, Inc. Birdi will appear on your medicine bottle label and paperwork. You will continue to log in to .medimpact.com or the mobile app to manage your medications.

What is the new name for Ozempic?

Ozempic is a brand of the medicine called semaglutide and is only subsidised on the Pharmaceutical Benefits Scheme (PBS) for treatment of type 2 diabetes when certain conditions are met. Wegovy is another brand of semaglutide.

Is MedImpact legitimate?

MedImpact was awarded the three-year accreditation by NCQA in Utilization Management following a rigorous assessment of its systems, processes, and personnel in utilization management to ensure NCQAs high standards are met.

Medimpact claim 2026

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