Information, Tips, and Support

Below is some information that may be helpful to your dental office and staff. If you have any questions, please contact us.

How to Manage Your Facility and Members

MCNA Dental offers an online Provider Portal that allows you to:

  • Verify member eligibility
  • Manage your facility
  • Edit your office fee schedules
  • View a history of your activity with MCNA Dental
  • Submit claims
  • Submit pre-authorizations
  • Submit referrals
  • Download forms and documents
  • Download your Provider Manual
  • And more!

The Provider Portal is a great all-in-one tool, and we recommend that all of our network providers take advantage of its features. Once you have received your credentialing letter from MCNA Dental, you will be able to quickly and easily create an account to access the portal at http://portal.mcna.net.

For more detailed information about using our Provider Portal, click here to download our Provider Portal User Guide. To see our series of tutorial videos, go to http://portal.mcna.net and click on "Online Provider Portal Tutorial Videos" at the bottom of the screen.

How to Submit Claims, Pre-Authorizations, and Referrals

Claims can be submitted using any of the following three methods:

  1. Online through the Provider Portal.
  2. Electronically through a clearinghouse (MCNA Dental Payer ID 65030).
  3. On Paper by standard mail to MCNA Dental (Use 2012 or newer ADA Claim Form). Mail to:

    MCNA Dental
    Attn: Claims
    200 West Cypress Creek Road, Suite 500
    Fort Lauderdale, Florida 33309

Please note that we do not accept faxed claims.

Pre-Authorization (Prior Authorization) requests can be submitted using any of the following three methods:

  1. Online through the Provider Portal.
  2. Electronically through a clearinghouse (MCNA Dental Payer ID 65030).
  3. On Paper by standard mail to MCNA Dental (Use 2012 or newer ADA Claim Form and ensure the "Request for Pre-Determination" box is checked). Mail to:

    MCNA Dental
    Attn: Utilization Management
    200 West Cypress Creek Road, Suite 500
    Fort Lauderdale, Florida 33309

Referrals can be submitted using either of the following two methods:

  1. Online through the Provider Portal.
  2. On Paper by standard mail to MCNA Dental. Mail to:

    MCNA Dental
    Attn: Utilization Management
    200 West Cypress Creek Road, Suite 500
    Fort Lauderdale, Florida 33309

For more detailed information about submitting Claims, Pre-Authorizations, and Referrals, download the Provider Manual from MCNA Dental's online Provider Portal, or by clicking here.

How to Access the Texas Medicaid/CHIP Vendor Drug Program

The Vendor Drug Program (VDP) provides statewide access to covered outpatient drugs for individuals enrolled in Medicaid, CHIP, the CSHCN Services program, the HTW program, and KHC program. The cost for drug prescriptions in the Texas Medicaid program is shared by the federal government and the state. In order for Texas to receive federal funds assistance for prescription claims, any drugs prescribed must be produced by a drug manufacturer that participates in the Centers for Medicare & Medicaid Services (CMS) drug rebate program. In return for having their drugs covered by state Medicaid programs, the manufacturer agrees to pay rebates according to their state and federal contracts. VDP oversees the collection of these rebates from drug manufacturers.

Click here to visit the VDP website for more information. To search the formulary and view the Preferred Drug List, please click here.

How to Learn More About Culturally Sensitive Care

MCNA facilitates access to dental services for non-English speaking members. We recognize that the diversity of our member population can serve as a barrier to accessing dental services. MCNA has adopted the recommendations set forth by the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) as a guideline to developing our Cultural Competency Program.

To request more information about MCNA's Cultural Competency Program and how it can help you provide culturally sensitive care to members, please call our Provider Hotline or send an email to qualityprogram@mcna.net. To learn about the National CLAS Standards, visit the U.S. Department of Health and Human Services Office of Minority Health website.

MCNA's Dental Advisory Committee

MCNA's Dental Advisory Committee (DAC) is a nine-member group consisting of MCNA leadership and representatives of the Texas Dental Association (TDA), Texas Academy of Pediatric Dentists (TAPD), Texas Academy of General Dentists (TAGD), and the University of Texas Health Science Center School of Dentistry. The DAC meets on a quarterly basis to review benefit design, policies and procedures, and provider-related concerns. DAC members work with the HHSC to provide evidence-based recommendations to improve utilization rates and the delivery of oral health and dental care services, including prevention and education services and dental managed care. Please contact your local MCNA Provider Relations Representative or Dental Organization Representative for more information about MCNA's Dental Advisory Committee.

How to Stay Current with MCNA News and Announcements

To stay up-to-date with all MCNA Dental news and announcements, you can periodically check our main news page on MCNA.net.

Important news and announcements exclusive to our network providers (including MCNA Dental procedure changes, change in Medicaid/CHIP dental rules, reminders about claims processing guidelines, etc.) will be posted on the main page of the Provider Portal once you log in to your account.

MCNA Dental sends monthly newsletters to all of our providers, delivered right to their email inboxes! These newsletters include the latest updates from MCNA Dental, information about upcoming changes, dental industry news, and much more. To sign up for these email newsletters, log in to the Provider Portal and add your email address to the mailing list.

Where to Submit a Complaint or Appeal

You can submit a Medicaid or CHIP complaint by calling our Provider Hotline at 1-855-776-6262 or by sending an email to TX_PR_Dept@mcna.net.

Send a written complaint to:

MCNA Dental
Attn: Complaints Department - Provider Relations
P.O. Box 29008
San Antonio, Texas 78229

Fax: 1-210-745-4264

If you have exhausted MCNA's complaint process and are still not happy, you may submit a complaint directly to the HHSC using the following email address: HPM_Complaints@HHSC.state.tx.us.

MCNA encourages you to contact the Provider Hotline if would like to file an appeal with us. Our representatives will discuss the process with you. All appeals must be submitted in writing to:

MCNA Dental
Attn: Appeals Department - Provider Appeals
200 West Cypress Creek Road, Suite 500
Fort Lauderdale, Florida 33309

Email: TX_PR_Dept@mcna.net
Fax: 1-210-745-4264

Help Stop Fraud, Waste, and Abuse

If you think a dentist or another MCNA member is doing something that could be fraud, waste, or abuse please report it to the Office of the Inspector General (OIG). You can make a report by going to the OIG website at https://oig.hhsc.state.tx.us/. You may also call the OIG Hotline at 1-800-436-6184.