MCNA Dental
Dental Details  •  Monthly Provider Newsletter
Texas Edition  •  January 2020
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1-855-776-6262
Corporate Headquarters
Managed Care of North America
200 West Cypress Creek Road, #500
Fort Lauderdale, Florida 33309
 
Compliance with HIPAA Privacy and Security Rules/Laws
Compliance with HIPAA Privacy and Security Rules/Laws

HIPAA compliance for your practice revolves around protecting the privacy and security of your patients' Protected Health Information (PHI). PHI is any information that can be connected to an individual's health condition. This includes information related to an individual's past, present, or future, and physical or mental health. It also includes the provision of health care to the individual, and past, present, or future payment for the provision of health care to the individual.

There are three distinct and separate regulations under HIPAA:

  1. Privacy Rule - sets national standards for when PHI may be used and disclosed
  2. Security Rule - specifies safeguards that covered entities and their business associates must implement to protect the confidentiality, integrity, and availability of electronic PHI from circumstances such as disasters, hackers, and electronic theft.
  3. Breach Notification Rule - requires covered entities to notify affected individuals and the U.S. Department of Health & Human Services (HHS).

To comply with HIPAA regulations, it is essential to determine whether your practice is a covered entity. Covered entities are health plans, health care clearinghouses, and health care providers who transmit any health information in an electronic form. An example of this is emailing MCNA member dental records.

The HHS recognizes that covered entities range in size. The Security Rule is designed to be flexible and scalable, allowing you to analyze needs and implement appropriate security solutions according to your practice size and resources. It does not dictate the exact measures you should implement, but requires you to ...

Your Practice
Compliance with HIPAA Privacy and Security Rules/Laws

HIPAA compliance for your practice revolves around protecting the privacy and security of your patients' Protected Health Information (PHI). PHI is any information that can be connected to an individual's health condition. This includes information related to an individual's past, present, or future, and physical or mental health. It also includes the provision of health care to the individual, and past, present, or future payment for the provision of health care to the individual.

There are three distinct and separate regulations under HIPAA:

  1. Privacy Rule - sets national standards for when PHI may be used and disclosed
  2. Security Rule - specifies safeguards that covered entities and their business associates must implement to protect the confidentiality, integrity, and availability of electronic PHI from circumstances such as disasters, hackers, and electronic theft.
  3. Breach Notification Rule - requires covered entities to notify affected individuals and the U.S. Department of Health & Human Services (HHS).

To comply with HIPAA regulations, it is essential to determine whether your practice is a covered entity. Covered entities are health plans, health care clearinghouses, and health care providers who transmit any health information in an electronic form. An example of this is emailing MCNA member dental records.

The HHS recognizes that covered entities range in size. The Security Rule is designed to be flexible and scalable, allowing you to analyze needs and implement appropriate security solutions according to your practice size and resources. It does not dictate the exact measures you should implement, but requires you to ...

Go Green with MCNA!
Go Green with MCNA!

We encourage our entire network of dental providers to go green in their offices. To help you accomplish this, we provide many online tools and services through our free Provider Portal, including:

  • Electronic claims submission
  • National Electronic Attachment (NEA) FastAttach capabilities
  • Instant online eligibility check
  • Electronic Funds Transfer (EFT) for payments
  • Electronic Remittance Advice (RA)

If you have a question about how MCNA helps you go green, please call our Provider Hotline at 1-855-776-6262 (8 a.m. to 7 p.m., Central Time, Monday through Friday).

Your Practice
Go Green with MCNA!

We encourage our entire network of dental providers to go green in their offices. To help you accomplish this, we provide many online tools and services through our free Provider Portal, including:

  • Electronic claims submission
  • National Electronic Attachment (NEA) FastAttach capabilities
  • Instant online eligibility check
  • Electronic Funds Transfer (EFT) for payments
  • Electronic Remittance Advice (RA)

If you have a question about how MCNA helps you go green, please call our Provider Hotline at 1-855-776-6262 (8 a.m. to 7 p.m., Central Time, Monday through Friday).

The MCNA Commitment to CLAS
The MCNA Commitment to CLAS

MCNA is committed to ensuring the linguistic and cultural needs of our members are met through the incorporation of Culturally and Linguistically Appropriate Services (CLAS) into our dynamic Quality Improvement Program. This program guides the activities of our Quality Improvement Department and the services provided through our Member Hotline.

The National CLAS Standards were developed and designed by the U.S. Department of Health & Human Services Office of Minority Health to serve as a "blueprint" for dental and health care organizations and providers to guide them in providing the care and services necessary to overcome cultural and linguistic ...

Quality Improvement
The MCNA Commitment to CLAS

MCNA is committed to ensuring the linguistic and cultural needs of our members are met through the incorporation of Culturally and Linguistically Appropriate Services (CLAS) into our dynamic Quality Improvement Program. This program guides the activities of our Quality Improvement Department and the services provided through our Member Hotline.

The National CLAS Standards were developed and designed by the U.S. Department of Health & Human Services Office of Minority Health to serve as a "blueprint" for dental and health care organizations and providers to guide them in providing the care and services necessary to overcome cultural and linguistic ...

Communicating About Wisdom Tooth Pain: How Much is Too Much?
Communicating About Wisdom Tooth Pain: How Much is Too Much?

The eruption of wisdom teeth can sometimes mean oral surgery for teens and young adults. The removal of wisdom teeth is either necessary due to anticipated issues that will develop in time, according to what is shown on a patient's x-ray, or due to pain. Patient-reported pain due to the entry of third molars into the mouth varies by individual, so how can you have a meaningful discussion about pain with a patient in order to discern whether the need for wisdom tooth removal truly exists?

When a patient experiences the eruption of third molars, they could be coming to you with complaints about pain with no understanding of what is considered within the normal range for such development. Helping them to understand what constitutes severe symptoms requiring the removal of wisdom teeth may provide them with useful perspective. Consider describing the following symptoms that would indicate that the ...

Communication
Communicating About Wisdom Tooth Pain: How Much is Too Much?

The eruption of wisdom teeth can sometimes mean oral surgery for teens and young adults. The removal of wisdom teeth is either necessary due to anticipated issues that will develop in time, according to what is shown on a patient's x-ray, or due to pain. Patient-reported pain due to the entry of third molars into the mouth varies by individual, so how can you have a meaningful discussion about pain with a patient in order to discern whether the need for wisdom tooth removal truly exists?

When a patient experiences the eruption of third molars, they could be coming to you with complaints about pain with no understanding of what is considered within the normal range for such development. Helping them to understand what constitutes severe symptoms requiring the removal of wisdom teeth may provide them with useful perspective. Consider describing the following symptoms that would indicate that the ...

Correcting Overpayments from MCNA
Correcting Overpayments from MCNA

Are you aware of the actions required to correct an overpayment received from MCNA? In accordance with 42 CFR § 438.608(d)(2), any network provider who determines that they have received an overpayment from MCNA must notify us in writing of the reason for the overpayment and return the funds within 60 calendar days of the date on which the overpayment was identified.

The provider's office may return the overpayment by check, or may choose to have the amount ...

MCNA Updates
Correcting Overpayments from MCNA

Are you aware of the actions required to correct an overpayment received from MCNA? In accordance with 42 CFR § 438.608(d)(2), any network provider who determines that they have received an overpayment from MCNA must notify us in writing of the reason for the overpayment and return the funds within 60 calendar days of the date on which the overpayment was identified.

The provider's office may return the overpayment by check, or may choose to have the amount ...

National Children's Dental Health Month - February 2020
National Children's Dental Health Month - February 2020

This year's theme for National Children's Dental Health Month (NCDHM) is focused on the importance of fluoridated water. The American Dental Association is celebrating 75 years of water fluoridation, and NCDHM 2020 promoted the message, "Fluoride in water prevents cavities. Get it from the tap!" Learn more about the annual celebration of this important campaign and get tips on how you can get involved on the ADA's website.

Upcoming Events
National Children's Dental Health Month - February 2020

This year's theme for National Children's Dental Health Month (NCDHM) is focused on the importance of fluoridated water. The American Dental Association is celebrating 75 years of water fluoridation, and NCDHM 2020 promoted the message, "Fluoride in water prevents cavities. Get it from the tap!" Learn more about the annual celebration of this important campaign and get tips on how you can get involved on the ADA's website.