Managed Care Services Department

The Managed Care Services Department was created in October 2006 with the goal to position Swope Health Services as a preferred provider of health care services through the:

• Development, implementation and monitoring of multiple managed care organization contracts.
• Negotiation of appropriate reimbursement rates for medical services.
• Identification of new business opportunities to provide care for citizens in SHS service areas.
• Development and implementation of a centralized, contemporary credentialing and privileging process for SHS providers.
• Pursuit of arrangements to enhance SHS revenues based upon quality performance and optimal management of health resource utilization.
• Creation of a case management program to improve patient self management of chronic medical conditions.
• Development of tools to enhance SHS staff ability to efficiently process insurance billings.

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Swope accepts the following insurances*

Health

• Blue Cross/Blue Shield of Kansas City (Commercial, HMO/PPO, MC+)
• Aetna all products (Commercial, HMO/PPO, Medicare)
• Humana all products (Commercial, HMO/PPO, Medicare)
• Health Care USA - HCUSA (Missouri MC+)
• Children’s Mercy Family Health Partners – CMFHP (Missouri MC+ and Kansas HealthWave)
• Mercy Care Plus (Missouri MC+)
• Missouri Medicaid
• Kansas Medicaid
• Great Western
• Aetna Medicare Open Plan – Medicare FFS
• Coventry Advantra Freedom – Medicare FFS

Behavioral Health

• Aetna
• Blue Cross/Blue Shield of Kansas City
• Humana
• New Directions
• MH Net for HealthCare USA
• Unity Managed Mental Health (UMMH) for Mercy Care Plus
• Corp Health for Humana
• Medicare
• Aetna Medicare Open Plan
• Coventry Advantra Freedom
• MO Medicaid

Radiology

• Blue Cross/Blue Shield of Kansas City
• Children’s Mercy Family Health Partners
• Mercy Care Plus
• HealthCare USA
• MO Medicaid
• KS Medicaid
• Aetna
• Humana

Dental

• Aetna
• Blue Cross/Blue Shield of Kansas City
• Doral Dental
• Delta Dental
• Bridgeport Dental
• MO Medicaid
• KS Medicaid
• Humana
• Assurant Dental

Pharmacy

• Express Scripts
• Coventry – for HCUSA
• CareMark
• Aetna
• Humana
• MO & KS Medicaid
• Medicare

Vision

• VSP – MercyCare Plus ONLY
• Vision Care Services - for CMFHP
• Aetna
• Humana – for PPO members only
• Medicare
• MO Medicaid

*Patients with other insurance will require a call to the company to determine eligibility for services at Swope Health Services.

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