Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

Services List

Berkshire Health Partners (BHP), a Preferred Provider Organization (PPO), service area includes Berks, Upper Bucks, Carbon, Northern Lancaster, Montgomery, Northampton, and Schuylkill counties. Through relationships with Third-Party Administrators (TPA's), insurance carriers, and insurance brokers, employer groups can access our valuable services encompassing: medical and case management; a comprehensive network of credentialed physician, hospitals, and ancillary providers; wellness and disease management programs, short-term disability case management, and Pennsylvania's Preferred Health Networks (PPHN), a statewide PPO network.

Services Overview

Provider Network

Our provider network gives members access to over 3700 physicians, hospitals, medical equipment suppliers, and home and healthcare agencies. Our network of providers delivers healthcare services at negotiated rates and are credentialed based on NCQA standards. In-network referrals are not required, allowing members freedom of choice in their healthcare options.

Provider Discounts

Our provider discounts are very competitive. Participating providers are contracted to accept BHP's fee schedule as the total payment for any covered medical services, and are not permitted to balance bill the patient to collect the difference, unless the plan applies a deductible, co-payment or co-insurance.

Repricing

Our repricing department accepts both hard copy and Electronic Data Interchange (EDI) claims from providers. Our efficient repricing service affords contracted employer groups accurate discounting of participating provider services. Claims are repriced quickly and forwarded to the appropriate Third-Party Administrator (TPA) or insurance company for benefit determination and claim adjudication.

Medicus, A Health & Lifestyle Management Company

The medical management arm of BHP, closely monitors the medical necessity and appropriateness of treatment for our members. Reviews are conducted prospectively by nurse case managers who use medical resources and evidence based guidelines. Medicus' goal is to provide high quality, cost efficient healthcare for its members.

Wellness and Disease Management Programs

Through relationships with nationally known vendors; Medicus is able to offer comprehensive, state-of-the-art wellness and disease management programs. By offering these services, Medicus can help employer groups control the rising cost of healthcare related to those members with chronic conditions.