Since 1983, AmeriChoice MSO has provided administrative services for San Diego County’s healthcare program for indigent adults. AmeriChoice, as the single point of contact, has worked closely with the County, the provider community, and eligible recipients to provide appropriate, quality medical care while maximizing limited resources.

A full scope of services is provided to CMS and includes maintenance of the eligibility database, medical and social case management, utilization management, pharmacy oversight, network development, customer services, complaint and appeal resolution, claims processing and financial and data management and reporting. In recent years, MediCal recovery services and disease management have been added to maximize revenues and minimize the cost of caring for chronic diseases.

The scope of work has grown over time to meet the demands of an ever-changing health care system. AmeriChoice submits utilization and financial reports to the County with recommendations for modification to programs and processes that will maximize their limited resources. AmeriChoice’s management expertise and effective communication with the County and other stakeholders has contributed to this successful partnership.