About

San Diego's administrative health care resource

San Diego's administrative health care resource

Scripps Health Plan Services (SHPS) is a management services organization (MSO) providing a wide range of administrative and management functions needed for providers, medical groups and hospitals to be successful in the evolving healthcare environment. Our role is to provide comprehensive health care services to our enrolled membership.


SHPS is Knox-Keene licensed by the California Department of Managed Health Care (DMHC), as it enters into plan-to-plan contracts with health care service providers in San Diego County to provide managed care services. Those health care services are provided to health plan members by SHPS’ integrated network of participating contracted providers (hospitals, physicians and ancillary providers).


SHPS provides managed care services to the following medical groups:  


  • Scripps Clinic Medical Group (SCMG)
  • Scripps Coastal Medical Center (SCMC)


SHPS also adjudicates some institutional claims for affiliated medical groups, including:


  • Mercy Physicians Medical Group (MPMG)
  • Primary Care Associates Medical Group (PCAMG)
  • Scripps Physicians Medical Group (SPMG)

Services

One of the purposes of the MSO at SHPS is to relieve providers of the business and administrative functions of their practice so they can focus on patient care. As such, we provide a range of services, including:


  • Claims payment
  • Complex care management
  • Contracting
  • Credentialing
  • Customer service 
  • Eligibility administration
  • Financial management
  • Fraud, waste and abuse
  • Provider relations
  • Quality management 
  • Regulatory compliance
  • Reporting
  • Sub-capitation administration
  • Third-party recovery
  • Utilization management 

Insurance plans

SHPS provides administrative services for the following health plans:


  • Anthem Blue Cross HMO/POS
  • Anthem Blue Cross (Medicare Advantage)
  • Blue Shield HMO
  • Blue Shield Trio HMO
  • Blue Shield (Medicare Advantage)
  • Blue Shield POS
  • Cigna HMO/POS
  • Health Net HMO
  • Health Net Cal MediConnect (Medicare Advantage)
  • Health Net Seniority Plus (Medicare Advantage)
  • SCAN (Medicare Advantage)
  • Scripps Health Plan HMO
  • UnitedHealthcare HMO
  • United Healthcare (Medicare Advantage) 
  • UnitedHealthcare Signature Value Alliance


Health plans offer a variety of networks. To confirm whether SHPS is in their covered network, members should call their health plan.