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About Medicus, A Health & Lifestyle Management Company

Medicus is a wholly owned subsidiary of Berkshire Health Partners (BHP). Our staff guides, educates, and coordinates care for members, assuring both you and your employees cost-effective healthcare coverage.

Case Management

Coordinating Members' Care - One Case at a Time

The personal touch supplied by Medicus is most evident through the work of the nurse case manager. Using nationally recognized case management techniques, the registered nurse case manager assumes the following major responsibilities:

  • Investigates pertinent medical history, present illness, and the provider's preferred course of medical care for a specific condition
  • Works directly with referring physicians after a members needs have been determined to secure services within the designated network of providers
  • Follows members throughout the continuum of care, including inpatient stays, physician care, ancillary services, and pharmaceutical needs.
  • Locates facilities for appropriate care and negotiates fees in the event that in-network providers are not available
  • Works with stop-loss carriers to assure they are aware of current treatments and member progress
  • more. . .

    To contact Medicus please call 800-647-2500 or 610-372-8417.

Medicus

Utilization Management (UM) and precertification are important concepts in the area of healthcare coordination, and in the services Medicus offers to its members. UM is the process of managing the use of medical services so that a patient receives necessary, appropriate and high-quality care in a cost-effective manner. Precertification is a means of UM that requires a member to notify a medical management company to determine whether a proposed course of care or medical service is medically appropriate. more...


Precertification

Understanding Precertification

As a member of BHP, your employer has also provided you and your family with medical management services through Medicus, A Health & Lifestyle Management Company. The professional staff at Medicus assists you in determining whether proposed services are medically appropriate. The Medicus program is not intended to diagnose or treat medical conditions, guarantee benefits or validate eligibility. Instead, the medical professionals who answer inquiries focus on whether hospital stays, proposed surgery or ambulatory procedures are medically appropriate. more...