MCNA is the largest dental insurer in the nation for state-sponsored Medicaid and CHIP programs. We have been in business for over 25 years, and over 5 million members trust their smile to MCNA. We are proud to provide the dental benefits for children and adults in the Texas Medicaid and CHIP program.

Becoming a member of MCNA gets you access to great dental care and an Amazon.com Gift Card. You can learn more about how to join in the Become a Member of MCNA Dental section.

We offer dental benefits to cover most everyone’s dental needs.

• Preventive and diagnostic benefits, including dental cleanings, exams, x-rays, fluoride, sealants, and more.
• Therapeutic benefits to treat cavities, gum or tooth pain, or other dental problems including fillings, extractions, root canals, dental emergencies, and more.

You can find more information about benefits in your Member Handbook.

Yes! You can read more about our Amazon.com Gift Card and other Value-Added Services we offer our members.

A Main Dental Home Provider can be a general dentist or a pediatric dentist who will oversee all dental care. We call this your Main Dentist. Your MCNA Dental ID card includes the name of your Main Dentist and their phone number. Please call the Main Dentist to schedule a dental visit. A child can start seeing a Main Dentist as early as 6 months of age.

Find a dentist using our online Medicaid Provider Directory or CHIP Provider Directory.

You will get your Member Handbook in the mail when you join MCNA Dental. You can download your Member Handbook in English and Spanish. To download your Member Handbook, click the links in the Member Resources and Documents section.

If you need another hard copy of your Member Handbook, call the MCNA Dental Member Hotline at 1-855-691-6262. We will send it to you free of charge within 5 business days. You can also call our Member Hotline to request a different version of your Member Handbook.

Yes! Materials you receive are available in English and Spanish. Braille and large-print versions are also available for visually impaired members. Call our Member Hotline at 1-855-691-6262 for more information.

If you lose your member ID card, please call our Member Hotline at 1-855-691-6262 to ask for a new one.

View the Member Rights and Responsibilities page for more information. You can also find a full list of your member rights and responsibilities in your Member Handbook.

You can learn about MCNA’s Privacy Policy on our corporate website.

An MCNA Member Advocate can help you get the dental care you need. Our Member Advocates will:

• Tell you about your rights and responsibilities
• Tell you about the MCNA Complaint and Appeals processes
• Assist you in writing and filing a complaint or an appeal, and keep track of it until the issue is resolved
• Tell you about your dental benefits and help you get dental care
• Assist you in finding resources in your community to help meet your needs

View our Member Advocate Flyer to learn more. Call MCNA’s Member Hotline at 1-855-691-6262 to speak with a Member Advocate and see how they can help you.

We want to help. If you have a complaint/grievance or appeal, please contact our Member Hotline at 1-855-691-6262. A Member Advocate will help you. When you call we will explain what happens during the complaint/grievance or appeal process and tell you how to write your complaint/grievance or appeal and send it to us. We will also send you any forms you may need to complete your appeal.

If you call to ask for an appeal, you must also write out and sign your appeal and send it to MCNA.

You can send your written complaint/grievance or appeal to:

MCNA Dental
Attn: Member Advocate
4400 NW Loop 410, Suite 250
San Antonio, TX 78229

If you are a Medicaid member, view our Medicaid Complaints and Appeals page.

If you are a CHIP member, view our CHIP Complaints and Appeals page.

You have the right to ask for a State Fair Hearing. You must first exhaust MCNA’s appeal process. In a State Fair Hearing, you may name someone to represent you (such as a doctor or other medical provider). You must ask for a State Fair Hearing within 120 days of the date on the original decision letter from MCNA. To make a request, you may write a letter that includes the name of your representative and send it to:

MCNA Dental
Attention: Member Advocate
4400 NW Loop 410, Suite 250
San Antonio, TX 78229

You can also ask for a State Fair Hearing by calling MCNA toll-free at 1-855-691-6262. Call this number at any time to ask questions or check the status of a State Fair Hearing. If you call to ask for a State Fair Hearing, you must also write out your request, sign it, and send it to MCNA.

Once you ask for the State Fair Hearing, you will get a packet of information letting you know the date, time and location of the hearing. Most State Fair Hearings are held by telephone. The Texas Health and Human Services Commission will give you a final decision within 90 days from the hearing.

If you, as a member of the dental plan, disagree with MCNA’s internal appeal decision, you have the right to ask for External Medical Review with a State Fair Hearing. An External Medical Review is an optional, extra step you can take to get your case reviewed for free before your State Fair Hearing. You, your parent, your authorized representative, or your legally authorized representative (LAR) must ask for the External Medical Review within 120 days of the date MCNA mails the letter with the decision. If you do not ask for the External Medical Review within 120 days, you may lose your right to an External Medical Review.

You, your parent, your representative, or your LAR can ask for an External Medical Review in these ways:

1. Call MCNA at 1-855-691-6262.
2. Email MCNA at ga@mcna.net.
3. Fill out the ‘State Fair Hearing and External Medical Review Request Form’ that came with the internal appeal decision letter from MCNA. You can also download a copy. Mail or fax it to MCNA:

   MCNA Dental
   200 West Cypress Creek Road, Suite 500
   Fort Lauderdale, FL 33309

   Fax: 1-954-628-3330

If you have questions about the External Medical Review Process or want to check on the status of an External Medical Review request we can help. Call MCNA toll-free at 1-855-691-6262, Monday – Friday, 7 a.m. – 7 p.m. CST. You can also learn more about the External Medical Review Process in MCNA’s Medicaid Member Handbook.

The Health and Human Services Commission (HHSC) and MCNA Dental want to help you learn more about Medicaid fraud. Choose one of the links below to read the special Medicaid Fraud Notice from the HHSC.

• Download the Medicaid Fraud Notice in English.
• Download the Medicaid Fraud Notice in Spanish.

Call the OIG Hotline at 1-800-436-6184 or visit https://oig.hhsc.texas.gov/report-fraud. You can report directly to MCNA:

MCNA Dental
Attn: Special Investigations Unit
4400 NW Loop 410, Suite 250
San Antonio, TX 78229

You can also call MCNA’s toll-free Fraud Hotline at 1-855-392-6262. You can find more information about Waste, Abuse, and Fraud in your Member Handbook.

You can learn more about good oral health online at MCNA’s Kids Zone. We offer colorful children’s activities to help you learn in a fun way.

You can also follow MCNA on Facebook, Twitter, and YouTube for frequent oral health education tips and information.

You can visit the Office of Consumer Credit Commissioner website.

You can visit the U.S. Health Resources & Services Administration website.

Call the Enrollment Broker helpline to find out more about the CHIP, STAR, and STAR Kids programs.

• For CHIP and STAR, call 1-800-964-2777 (TTY: 1-800-735-2989).
• For STAR Kids, call 1-877-782-6440 (TTY: 1-800-735-2989).

You can call Monday to Friday, from 8 a.m. to 6 p.m. Central Time. The helpline staff will tell you what you need to do to join or change your plan.

Prior authorization is a decision by your dental or health insurer or plan before you receive it that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. This process is sometimes also called pre-authorization, prior approval, or pre-certification. Prior authorization isn’t a promise your dental or health insurance or plan will cover the cost.

MCNA’s Pre-Authorization and Claims Submission Guide for Texas providers explains all that your dentist needs to know about dental benefits that need prior authorization. You may contact the Member Hotline at 1-855-691-6262 to ask about the status of prior authorization requests. We can also help you learn more about the prior authorization process.