Coordinating Healthcare to Assure Your Health and Happiness

Berkshire Health Partners and Medicus work hard to integrate the financing and delivery of healthcare services. The goal of BHP and Medicus is simply to help control the accessibility, cost, and quality of care available to you – our members – assuring that you’ll get excellent health care right here in your community, whenever you need it.

Utilization management and precertification are important concepts in the area of healthcare coordination, and in the services Medicus offers to its members. Utilization management (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 utilization management that requires a member to notify a medical management company to determine whether a proposed course of care or medical service is medically appropriate.

At BHP, Medicus Resource Management provides these services. Medicus has been working with healthcare providers for more than a decade, reviewing activities of a practice or facility and tracking quality indicators throughout the utilization management process. Medicus provides precertification, concurrent review, and case management services and is an important part of the Berkshire Health Partners network of services.

Medicus' employees include full-time registered nurses with diverse clinical backgrounds, as well as courteous and professional support staff who offer their full attention to the concerns of providers, employers, and members. Medicus has an established reputation for excellent service, and continues to fine tune its procedures and protocols. Medicus uses state-of-the-art systems to review cases and identify potential quality issues. Activities are regularly reviewed by quality and utilization management committees, made up of physicians who are part of Berkshire Health Partners.