Below are the answers to some common questions about MCNA Dental and the Texas Medicaid and CHIP dental programs.
Questions
General Member Questions
- How do I enroll with MCNA Dental?
- What is a Main Dental Home Provider?
- How do I find a dentist?
- How do I get my Member Handbook?
- How do I replace a lost or stolen member ID card?
- Can I get my member materials in another language?
- Can I contact MCNA Dental if I have questions or need help?
- What is a Member Advocate?
- What are my dental benefits with MCNA Dental?
- How much do I have to pay for dental services?
- Does MCNA offer any extra benefits?
- What are my member rights and responsibilities with MCNA Dental?
- Where can I learn more about good oral health?
- Where can I read about financial literacy?
- Where can I read about health literacy?
- Where can I learn about MCNA's Notice of Privacy Practices?
- What should I do if I have a complaint/grievance or appeal?
- What is Medicaid fraud in the State of Texas?
- How do I report Waste, Abuse, or Fraud?
Answers
General Member Questions
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Click here to learn more about enrolling with MCNA Dental.
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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.
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Click here to find a dentist using our online Provider Directory.
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You will get your Member Handbook in the mail when you enroll with MCNA Dental. You can download your Member Handbook in English and Spanish. To download your Member Handbook, please click here.
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If you lose your member ID card, please call our Member Hotline to ask for a new one.
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Yes! Materials you receive are available in English and Spanish. Braille and large-print versions are also available for visually impaired members. Contact our Member Hotline for more information.
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At MCNA Dental, we care about your smile. We are here to help you. Click here to contact our Member Hotline.
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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
Click here to learn more. Call MCNA's Member Hotline to speak with a Member Advocate and see how they can help you.
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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. To download a copy in English and Spanish, please click here.
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Members in the Medicaid program do not have to pay for covered dental services.
If you are a member in the CHIP program you might have to pay a copayment for certain covered services. This includes non-preventive services. You do not have to pay a copayment for things like exams, x-rays, cleanings, and sealants. If your child gets dental services before dental coverage with CHIP starts, you will have to pay for them.
CHIP copayments vary based on your family's income. The total amount that you have to pay cannot be more than 5% of your family's income during one enrollment period. Your copayment amount is on the back of your child's MCNA member ID card. Below are the CHIP office visit copayments according to a family's federal poverty level:
- Native Americans: $0
- Alaskan Natives: $0
- At or below 100%: $3
- Above 100% to 150%: $5
- Above 150% to 185%: $20
- Above 185% to 200%: $25
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Click here to learn more about the extra benefits (value-added services) we offer our members.
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To view your member rights and responsibilities, click here.
You can also find a full list of your member rights and responsibilities in your Member Handbook. To download a copy in English and Spanish, please click here.
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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. Visit MCNA's Kids Zone by clicking here.
You can also follow MCNA on Facebook, Twitter, and YouTube for frequent oral health education tips and information.
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Click here to visit the Office of Consumer Credit Commissioner website.
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Click here to visit the U.S. Department of Health and Human Services website.
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You can learn about MCNA's Privacy Policy on our main website. Click here to read more.
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We want to help. If you have a complaint/grievance or appeal, please contact our Member Hotline. 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.
You can also submit your complaint/grievance or appeal in writing to:
MCNA Dental
Attn: Member Advocate
4400 NW Loop 410, Suite 250
San Antonio, TX 78229If you are a Medicaid member and want more information, click here.
If you are a CHIP member and want more information, click here.
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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.
- Click here to read the Medicaid Fraud Notice in English.
- Click here to read the Medicaid Fraud Notice in Spanish.
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Call the OIG Hotline at 1-800-436-6184 or visit https://oig.hhsc.state.tx.us/. Under the box labeled "I WANT TO," click "Report Fraud, Waste, or Abuse" to complete the online form.
You can report directly to MCNA:
MCNA Dental
Attn: Special Investigations Unit
4400 NW Loop 410, Suite 250
San Antonio, TX 78229You 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.
