Medical Management Programs

With the Scripps Medical Plans, you have the added value of the following special programs offered by HealthComp’s Utilization Management Team.

Utilization Review

Issuing pre-certification based on medical necessity for all inpatient hospitalizations, outpatient surgeries, elective procedures, imaging, diagnostics, outpatient therapies, and durable medical equipment before services are provided. For more information on pre-certification requirements please click the “pre-certification” tab on the left side of this page.

Please note: Failure to obtain proper pre-certification may result in substantial penalties.

To minimize disruption to you and your family, please be assured that HealthComp Administrators will honor all pre-certification requests that were already approved by your current utilization management company. If you are currently in treatment that cannot be disrupted please contact Scripps Medical Plans Member Service Center at (877)552-7247 so we can ensure a smooth transition.

Case Management Program

This program is designed to provide nursing intervention and coordination of care for those patients identified with having long-term, devastating, or costly healthcare needs. The focus of case management is to identify the needs of the patient and help obtain medically appropriate care in a coordinated and cost effective manner. The nurse will work with the member, their family, community resources, and healthcare providers to reach the optimum level of care necessary in the treatment of the health condition. Please contact the Scripps Medical Plans Member Service Center at (877)552-7247 for more information.

Mommies 2-B Program

This prenatal program is focused on providing a strong foundation of support for you and your baby. The program is also used as a screening tool to identify the possibility of a high or moderate risk pregnancy and coordinate effective medical care along with your medical providers.

It is highly recommended that the expectant mother contact the “Mommies 2-B” nurse during the first trimester of pregnancy or upon confirmation of pregnancy by calling Scripps Medical Plans Member Service Center at (877)552-7247.

Those participating in the program will receive personalized attention to include: Educational materials, periodic newsletters, magazines, coupons, personal contact from the prenatal nurse to the patient, providers, and family, if advisable. A gift will be sent upon the birth of your baby, compliments of the Scripps Medical Plans.

Disease Management

This is a focused approach to chronically-ill patients who have potential for treatment or lifestyle modifications, which may improve their outcomes and/or reduce healthcare expenditures. Cardiac related illnesses, diabetes, and respiratory illnesses have been identified as the three most common chronic health conditions in the healthcare industry.

To participate in the Disease Management program please complete the Health Risk Assessment (HRA) questionnaire at the link above or you can call the Scripps Medical Plans Member Service Center at (877)552-7247 and ask to speak to the Disease Management nurse. You will receive your “health score” upon completion of the HRA. The Disease Management nurse develops a customized plan to assist patients in achieving beneficial outcomes based on your “health score” results. There are many great educational resources available to you through this program as well.

Preventive Care

HealthComp identifies those members who have not had their recommended preventative screening exams, based on national guidelines. The Wellness Management team provides personalized reminders asking members to utilize prevention benefits for their age-appropriate cancer screenings, physical exams, immunizations, and well-baby check-ups.

Medical Claims Review

Certified coders and medical professionals review certain claims to ensure that the provider billings are accurate, reasonable and appropriate for services that have actually been provided.

Note: Our medical management programs do not replace the advice of your healthcare providers but rather are a compliment to it. The programs are voluntary and provided at no additional cost to you.