Medicus will effectively Manage Resources – Both Yours and Ours

Medicus will work with you to make your healthcare experience satisfying and hassle free. Whether you’re a BHP provider, an employer in any state, or an individual member, Medicus can help you with clinical resource matters relating to your healthcare.

Medicus uses Milliman Care Guidelines, a set of objective, clinically based guidelines to help manage and evaluate healthcare. Cases involving special concerns may be reviewed by our full-time Medical Director. This provides medical decisions in instances where something other than the “standard” course of treatment is required. Additionally, Medicus staff will discuss a case with the attending physician to obtain any other pertinent medical information required to make an informed decision relative to medical necessity. Consultants in a variety of specialities are available to assist as needed.

Medicus also provides the following services:

• They compare requested services against standard criteria and respond to authorization requests promptly, usually within two business days. Both members and physicians receive notification upon approval, or with the anticipated date of concurrent review. Claims administrators and hospitals also receive copies of the precertification.
• Review urgent and emergency admissions that are not subject to pre-admission review. (Notification of emergency admission is required within two business days.)
• Follow up on surgeries, which are expected to be performed on the day of admission unless the attending physician demonstrates a medical need to admit the patient prior to the operation.
• Facilitate answers to questions regarding the appropriateness of an admission or procedure. Refer attending physicians to the full-time Medical Director, who will review the necessary clinical information with the Medicus team.
• Provide individual attention to each case through physician to physician review.