How Medicus Handles the Precertification Process

Precertification conducted by Medicus is necessary to approve the physician’s plan of care for elective hospital admissions. The review examines the following issues :

• Medical necessity
• Second surgical opinions (depending upon the patient’s benefit plan).
• Adherence to Milliman Guidelines
• Redirection to an alternative procedure unit or outpatient setting
• Discharge planning including home care, skilled nursing, hospice, or rehabilitation care
• Quality review concerns
• Case management services