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+)
• Blue Care
• Blue Advantage
• Blue Advantage Plus
• Freedom Network
• Freedom Network Select
• TRICARE
• Preferred Care
• Preferred Care Blue
• Preferred Health Professionals
• Aetna all products (Commercial, HMO/PPO, Medicare)
• Humana all products (Commercial, HMO/PPO, Medicare)
• Health Care USA - HCUSA (MO HealthNet)
• Children’s Mercy Family Health Partners – CMFHP (MO HealthNet and Kansas HealthWave)
• Missouri Care (MO HealthNet)
• MO HealthNet (Fee for service)
• Kansas Medicaid/HealthWave
• Unicare (Kansas Health Wave)
• Great Western
• Aetna Medicare Open Plan – Medicare FFS
• Humana Gold Choice - Medicare Private FFS
• Sterling - Medicare Private FFS
• Today's Options - Medicare Private FFS
• Concert - Medicare FFS
• Summit - Medicare Private FFS

Behavioral Health

• Aetna
• Blue Cross/Blue Shield of Kansas City for PPO members
• Humana
• New Directions for HMO members
• MH Net for HealthCare USA and Molina Health Care
• Life Synch for Humana
• Medicare
• Aetna Medicare Open Plan
• Coventry Advantra Freedom
• MO HealthNet

Radiology

• Blue Cross/Blue Shield of Kansas City
• Children’s Mercy Family Health Partners
• Missouri Care
• HealthCare USA
• MO HealthNet
• KS Medicaid/Health Wave
• Aetna
• Humana
• Molina Health Care
• Unicare

Dental

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

Pharmacy

• Express Scripts
• CareMark
• Aetna
• Humana
• MO HealthNet & KS Medicaid
• Medicare

Vision

• March Vision Molina ONLY
• Vision Care Services - for CMFHP
• Aetna
• Humana – for PPO members only
• Medicare
• MO HealthNet
• KS Medicaid/Health Wave

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

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