On-Site Audit
Your Pharmacy Participation Agreement with MedImpact contains a provision allowing Medica and its authorized agents, during regular business hours and upon reasonable notice, to have access to all information maintained by Pharmacy related to Pharmaceutical Services. These on-site pharmacy audits will be conducted by MedImpact to verify the integrity of the claims submitted to MedImpact and paid to Pharmacy. Any unjustified discrepancies found during audits will be adjusted and overpayments will be deducted from future payments. As an alternative, Medica or MedImpact may request direct reimbursement from Pharmacy for the amount overpaid to Pharmacy.

Post-Payment Review
Paid claims will be reviewed for accuracy to verify that claims have been dispensed in compliance with your Pharmacy Participation Agreement and Administrative Policies and Procedures. Pharmacy may be contacted by phone to verify questionable claims. MedImpact may require copies of hard copy prescriptions, signature logs, or additional information as necessary to validate the integrity of claims submitted to MedImpact and paid to Pharmacy. Any unjustified discrepancies found during audits will be adjusted and overpayments will be deducted from future payments. As an alternative, Medica or MedImpact may request direct reimbursement from Pharmacy for the amount overpaid to Pharmacy.

Hard Copy Prescription Orders
Medica requires Pharmacy to maintain a hard copy Prescription Order that contains all required prescription elements for each Pharmaceutical Service claim submitted to MedImpact.