Frequently Asked Questions

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

Questions

Provider Overview and Contracting with MCNA

  1. How do I sign up with MCNA Dental?
  2. What is the average time to complete the MCNA Dental credentialing process?
  3. Do I need to be credentialed by MCNA Dental if I am already an Idaho Smiles Medicaid provider?
  4. Is there a number providers can call with questions about joining MCNA Dental's network or completing the credentialing application?

Program Transition Period

  1. Will I need a new prior authorization during the first 30 days of the new program if I have a valid authorization from DentaQuest?
  2. What if I am in the process of being credentialed with MCNA Dental but no determination has been made by February 1, can I still see MCNA Dental members?
  3. What if I have been denied participation through MCNA Dental's credentialing process, can I still see MCNA Dental members during the transition period through March 2, 2017?

Pre-Authorization Requests, Claim Submissions, and Covered Services

  1. How are requests for pre-authorization accepted?
  2. What do I need to do if I submit a pre-authorization request from one dentist in the office and it is approved for that dentist, but that individual is unable to perform the treatment (e.g., he or she is out sick on the day of service)?
  3. Does MCNA Dental accept electronic claims?
  4. What is MCNA Dental's payor ID for electronic submission of claims and pre-authorizations?
  5. Do I have to complete any forms with our clearinghouse in order to submit claims or pre-authorizations electronically to MCNA Dental's payor ID?
  6. Does MCNA Dental accept NEA FastAttach?
  7. What is the turnaround time for processing pre-authorization requests?
  8. What are the periodicity limits for preventive services?
  9. Does MCNA Dental cover pharmacy benefits?

Provider Portal and Provider Resources

  1. Is there a special application to access your online Provider Portal?
  2. Once I set up my online Provider Portal account, can I begin using it immediately?
  3. Is there a user guide that explains the functions of the Provider Portal?
  4. How do providers receive a copy of MCNA Dental's Provider Manual?

Federally Qualified Health Centers (FQHCs) and Indian Health Clinics (IHCs)

  1. Can an FQHC/IHC be considered a Dental Home Provider?
  2. Does MCNA Dental's contract have specific language about FQHCs/IHCs being paid at their prospective payment for service (PPS) rate?
  3. Are FQHCs/IHCs listed in MCNA Dental's provider directory?
  4. If an FQHC/IHC cannot attend a scheduled webinar or seminar, can MCNA Dental provide training?
  5. What is MCNA Dental's after hours coverage requirement?
  6. If an FQHC/IHC claim for a single date of service has multiple procedures, is the whole encounter denied if one service is denied?

Answers

Provider Overview and Contracting with MCNA

  1. How do I sign up with MCNA Dental?

    Click here to learn more about enrolling in our network of providers.

  2. What is the average time to complete the MCNA Dental credentialing process?

    Once MCNA Dental receives a completed application, the average turnaround time is 30 days.

  3. Do I need to be credentialed by MCNA Dental if I am already an Idaho Smiles Medicaid provider?

    Yes, providers must complete MCNA Dental's credentialing process in order to participate in our plan.

  4. Is there a number providers can call with questions about joining MCNA Dental's network or completing the credentialing application?

    Yes. Click here to contact our Provider Hotline.

Program Transition Period

  1. Will I need a new prior authorization during the first 30 days of the new program if I have a valid authorization from DentaQuest?

    No, MCNA Dental will honor the existing, DentaQuest-approved prior authorizations through March 2, 2017.

  2. What if I am in the process of being credentialed with MCNA Dental but no determination has been made by February 1, can I still see MCNA Dental members?

    You may see MCNA Dental members for the first 15 days. We urge you to promptly complete any items that may be outstanding on your credentialing application so that you will be in our network as soon as possible. If your credentialing application is pending but ultimately denied through MCNA Dental's credentialing process, any claims submitted will be denied or, if already paid, the payments will be recouped.

  3. What if I have been denied participation through MCNA Dental's credentialing process, can I still see MCNA Dental members during the transition period through March 2, 2017?

    No, if you have been denied participation through MCNA Dental's credentialing process you cannot see MCNA Dental members during the transition or thereafter. Your claims will be denied. If your credentialing application is pending but ultimately denied through MCNA Dental's credentialing process, any claims submitted will be denied or, if already paid, the payments will be recouped.

Pre-Authorization Requests, Claim Submissions, and Covered Services

  1. How are requests for pre-authorization accepted?

    MCNA Dental has an online Provider Portal where providers can submit requests for pre-authorization. Any supplemental materials such as narratives, charting, or x-rays can be attached and submitted via the Provider Portal. Pre-authorizations may also by submitted through a third-party clearinghouse (please use payor ID 65030), or mailed to MCNA at:

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

  2. What do I need to do if I submit a pre-authorization request from one dentist in the office and it is approved for that dentist, but that individual is unable to perform the treatment (e.g., he or she is out sick on the day of service)?

    Pre-authorizations are valid for any participating provider who is credentialed by MCNA and of the appropriate specialty type in the requesting facility. This means if a general dentist received the pre-authorization approval, any participating general dentist in that particular facility can see the member for the approved services.

    If a group has multiple locations and wishes to change the pre-authorization to a participating provider at a different facility than indicated on the initial request, the office needs to contact MCNA's Provider Hotline. Explain the scenario to our representative and you will be connected with the Utilization Management Department to make the change.

  3. Does MCNA Dental accept electronic claims?

    MCNA Dental accepts and encourages electronic claims submission. Our payor ID is 65030. Claims may be entered and submitted via MCNA Dental's online Provider Portal. Use of this portal feature enables electronic submission without the need for a third-party clearinghouse. Paper claims are also accepted. Paper claims should be submitted to MCNA Dental at:

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

  4. What is MCNA Dental's payor ID for electronic submission of claims and pre-authorizations?

    Our payor ID is 65030.

  5. Do I have to complete any forms with our clearinghouse in order to submit claims or pre-authorizations electronically to MCNA Dental's payor ID?

    If you are already submitting claims or pre-authorizations electronically via a clearinghouse, you do not need to complete any additional forms with your clearinghouse. However, you may need to setup MCNA Dental as a new payor in your practice management system.

  6. Does MCNA Dental accept NEA FastAttach?

    MCNA Dental participates as an NEA FastAttach payor. You are able to transmit x-rays, perio charts, narratives, and any other documentation required by MCNA Dental to adjudicate your claim or pre-authorization. Once you transmit your documentation to NEA FastAttach, you can provide your NEA Tracking Number when you submit your claim or pre-authorization via MCNA Dental's online Provider Portal or electronically via your clearinghouse.

  7. What is the turnaround time for processing pre-authorization requests?

    MCNA Dental generally processes pre-authorization requests within 48-72 hours. Providers can check the status of pre-authorization requests via MCNA Dental's online Provider Portal.

  8. What are the periodicity limits for preventive services?

    Preventive services follow the AAPD's periodicity schedule. All periodicity limits are outlined in MCNA Dental's Idaho Smiles Provider Manual.

  9. Does MCNA Dental cover pharmacy benefits?

    Pharmacy benefit coverage remains with the member's medical benefit either through fee-for-service Medicaid or their health plan.

Provider Portal and Provider Resources

  1. Is there a special application to access your online Provider Portal?

    Once you have successfully completed MCNA Dental's credentialing process and are an active provider in our network, you automatically qualify to establish your account for our online Provider Portal. You need only complete a simple online form to validate your information before you can access our online Provider Portal. Registration will open a few weeks prior to the implementation date (February 1, 2017).

  2. Once I set up my online Provider Portal account, can I begin using it immediately?

    Complete Provider Portal functionality will be available to all Idaho Smiles providers beginning February 1, 2017.

  3. Is there a user guide that explains the functions of the Provider Portal?

    Yes, you can download MCNA's Provider Portal User Guide by clicking here. We also offer a series of tutorial videos that will walk you through the most important functions of our Provider Portal. To see our videos, go to http://portal.mcna.net and click on "Online Provider Portal Tutorial Videos" at the bottom of the screen.

  4. How do providers receive a copy of MCNA Dental's Provider Manual?

    MCNA Dental's Provider Manual is posted online in our Provider Portal.

Federally Qualified Health Centers (FQHCs) and Indian Health Clinics (IHCs)

  1. Can an FQHC/IHC be considered a Dental Home Provider?

    Yes. Dental Home providers can be general dentists, pediatric specialists, FQHCs, or IHCs.

  2. Does MCNA Dental's contract have specific language about FQHCs/IHCs being paid at their prospective payment for service (PPS) rate?

    Yes. MCNA Dental's contract states on page 14 that FQHCs/IHCs will be reimbursed at the PPS rate in effect on the date of service for each encounter.

  3. Are FQHCs/IHCs listed in MCNA Dental's provider directory?

    All contracted and credentialed dentists are listed by type in alphabetical order. The FQHC/IHC where they practice is also listed along with address, telephone number, and other relevant information for members when selecting a dentist.

  4. If an FQHC/IHC cannot attend a scheduled webinar or seminar, can MCNA Dental provide training?

    Yes. MCNA Dental is happy to schedule a webinar or on-site training session for any of our providers. Please email your request to IdahoSeminars@mcna.net.

  5. What is MCNA Dental's after hours coverage requirement?

    When a provider's office is closed the office should have an answering service or answering machine that offers the following information:

    • Instructions for contacting someone who can render clinical decisions or someone who can reach a dentist for clinical decisions
    • Instructions for emergency services (including directing the member to dial 9-1-1 if necessary)
    • List of the office hours
    • Instructions for the caller to leave a message so that someone can return their call

    The answering service or machine must also offer all of the information listed above in any additional languages based on cultural population.

  6. If an FQHC/IHC claim for a single date of service has multiple procedures, is the whole encounter denied if one service is denied?

    No, the PPS rate is paid as long as any service on the claim is approved.