Frequently Asked Questions

Below are the answers to some common questions about MCNA Dental and the Idaho Smiles Medicaid dental program.

Questions

General Participant Questions

  1. How do I find a dentist?
  2. What are my dental benefits with MCNA Dental?
  3. What is a Dental Home?
  4. How do I download my Participant Handbook?
  5. Can I contact MCNA Dental if I have questions or need help?
  6. Where can I learn more about good oral health?
  7. Can I get my participant materials in another language?
  8. What should I do if I have a complaint?
  9. How do I file an appeal with MCNA?
  10. How do I request a State Fair Hearing with IDHW?
  11. How do I report Waste, Abuse, or Fraud?

Answers

General Participant Questions

  1. How do I find a dentist?

    Click here to find a dentist using our online Provider Directory.

  2. What are my dental benefits with MCNA Dental?

    We offer dental benefits to cover most children's dental needs.

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

    We also offer dental benefits for adults.

    • Preventive and diagnostic benefits, including: dental cleanings, exams and x-rays, and more.
    • Therapeutic benefits to treat cavities, gum or tooth pain, or other dental problems including: fillings, extractions, dentures, and more.

    If you are pregnant, please contact MCNA Dental so we can provide you with more information related to our Bright Beginnings Program for expectant and new mothers. Our Member Services Representatives are happy to explain and help you understand what is available to you as an eligible member.

    You can find more information about benefits in your Participant Handbook. To download your Participant Handbook, please click here.

  3. What is a Dental Home?

    A Dental Home is a general dentist or pediatric specialist that oversees your dental care.

  4. How do I download my Participant Handbook?

    You may download your Participant Handbook by clicking here.

  5. Can I contact MCNA Dental if I have questions or need help?

    At MCNA Dental, we care about your smile. We are here to help you. Click here to contact our Participant Hotline.

  6. Where can I learn more about good oral health?

    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.

  7. Can I get my participant materials in another language?

    Yes! Materials you receive are available in additional languages. Braille and large-print versions are also available for visually impaired participants. Contact our Participant Hotline for more information.

  8. What should I do if I have a complaint?

    If you are unhappy about things like the benefit plan, a dentist, or the way MCNA does things you can file a complaint.

    If you need help with a problem, we want to help. If you have a complaint, please contact our Participant Hotline to tell us about your problem. An MCNA Participant Advocate or Participant Hotline Representative can help you file a complaint. Most of the time we can help you right away or within a few days at the most.

    You can also file a complaint by completing our Complaint Form.

    You can find more information about the complaint process in your Participant Handbook. To download your Participant Handbook, please click here.

  9. How do I file an appeal with MCNA?

    If you are not happy with MCNA's decision to deny or limit services requested by your dentist, you can contact our Participant Hotline and file an appeal within 60 calendar days from the date the decision is mailed. You or your dentist can send us more information to show why you do not agree with our decision.

    You can also file an appeal by completing our Appeal Form.

    You can find more information about the appeal process in your Participant Handbook. To download your Participant Handbook, please click here.

  10. How do I request a State Fair Hearing with IDHW?

    You can request a State Fair Hearing if you are not satisfied after MCNA's appeal process. After July 1, 2017, you will need to file a grievance with MCNA and receive a determination prior to requesting a State Fair Hearing.

    You have the right to request a fair hearing with the Idaho Department of Health and Welfare (IDHW) if you are not satisfied with the resolution of your appeal. You have 120 calendar days from the date the decision was mailed to file your request for a fair hearing. You must explain why you disagree with this decision and include any other information you want the IDHW to know. Your request must be received by the IDHW or postmarked within 120 calendar days from the date the decision was mailed.

    To request a State Fair Hearing, notify the IDHW in writing or complete a Fair Hearing Request form. Fair Hearing Request forms are available at any IDHW local office or via e-mail at: MyBenefits@dhw.idaho.gov. Include a copy of this notice with your request. You can bring your request to any local IDHW office. You can also mail, hand deliver, or fax it using the following:

    Mail to:

    Administrative Procedures Section
    Idaho IDHW
    PO Box 83720
    Boise, Idaho 83720-0036

    Hand Deliver to:

    Administrative Procedures Section
    Idaho IDHW
    450 W. State Street, 10th Floor
    Boise, Idaho 83720-0036

    Fax to: 1-208-639-5742

    If you ask for a fair hearing, you will get a packet of information letting you know the date, time, and location of the hearing. Most fair hearings are held by telephone. At that time, you or your representative can tell why you need the service that MCNA denied.

    You can find information about the Idaho Administrative Procedures Act (IDAPA) Rules Governing Contested Case Proceedings and Declaratory Rulings from an Idaho Department of Health and Welfare office or you can go online and use this link: http://adminrules.idaho.gov/rules/current/16/0503.pdf

    You can find all IDAPA Rules at: http://adminrules.idaho.gov/rules/current/16/.

    You can find more information about the State Fair Hearing process in your Participant Handbook. To download your Participant Handbook, please click here.

  11. How do I report Waste, Abuse, or Fraud?

    To report Medicaid fraud, contact the Idaho Department of Health and Welfare toll-free at 1-866-635-7515, or send an email to welfraud@dhw.idaho.gov. You may also call MCNA Dental's Fraud Hotline toll-free at 1-855-392-6262.

    To complete a Medicaid Fraud Report online, please go to http://healthandwelfare.idaho.gov. Scroll to the bottom of the home page and click on the blue button that says "Report Public Assistance Fraud." Next, click on "How do I report welfare fraud?" and choose "ONLINE" to fill out and submit the Online Welfare Fraud Complaint Form.

    You can find more information about Waste, Abuse, and Fraud in your Participant Handbook. To download your Participant Handbook, please click here.