Contract with MCNA Dental

The Texas Medicaid and CHIP programs have over 3,000,000 enrollees. We invite you to join our network of general and specialized oral health practitioners. MCNA Dental is a provider friendly program. The key to our success has been our relationships with our providers in each region.

Credentialing Application Forms

Click each link below to download the forms. Adobe Reader may be required to view these PDF files.

  1. Welcome Letter
  2. Application
  3. Contract
  4. Contract Amendment 1
  5. W-9 Form
  6. Direct Deposit EFT Form

Other/Optional Credentialing Forms

Click each link below to download the forms. Adobe Reader may be required to view these PDF files.

  1. Additional Location Form
  2. Additional Provider Form
  3. Curriculum Vitae Form
  4. DEA/DPS Release Form

For More Information of For Questions

Click here to contact MCNA Dental's Texas Provider Hotline. You may also contact us by email for an online response at TX_PR_Dept@mcna.net.

For more information about Texas Medicaid and CHIP, visit http://www.chipmedicaid.org. You can also find information about Texas Medicaid and other state health care programs on the Texas Medicaid and Healthcare Partnership website and on the Texas Health Steps Provider Information webpage.

For more information about the Texas Health and Human Services Commission, visit http://www.hhsc.state.tx.us.

Frequently Asked Questions for Providers

Click here to view a list of frequently asked questions about becoming an MCNA Dental provider for the Texas Medicaid and CHIP enrollees.