MCNA Dental
Dental Details  •  Monthly Provider Newsletter
Texas Edition  •  August 2019
Corporate Website
Social Media Profiles
Texas Provider Hotline
1-855-776-6262
Corporate Headquarters
Managed Care of North America
200 West Cypress Creek Road, #500
Fort Lauderdale, Florida 33309
 
Coverage Determinations and Utilization Management
Coverage Determinations and Utilization Management

MCNA uses evidence-based clinical guidelines from nationally recognized authorities to make decisions in our Utilization Management (UM) program. Specifically, we review any request for the prior authorization of services to determine if members are eligible for benefits and whether the service they request is a medically necessary covered benefit under the dental plan. We also determine if the service to be delivered is consistent with established guidelines.

Our clinical reviewers, all licensed dentists, base MCNA's UM decisions on the right type of care and service to meet the needs of our members using MCNA's Utilization Criteria and Clinical Practice Guidelines. We don't pay or reward practitioners, employees or other individuals for denying coverage or care.

To enhance our network providers' experience, MCNA offers peer-to-peer consultations with our clinical reviewers. The peer-to-peer process enables our participating providers to discuss clinical determinations, including ...

Utilization Management
Coverage Determinations and Utilization Management

MCNA uses evidence-based clinical guidelines from nationally recognized authorities to make decisions in our Utilization Management (UM) program. Specifically, we review any request for the prior authorization of services to determine if members are eligible for benefits and whether the service they request is a medically necessary covered benefit under the dental plan. We also determine if the service to be delivered is consistent with established guidelines.

Our clinical reviewers, all licensed dentists, base MCNA's UM decisions on the right type of care and service to meet the needs of our members using MCNA's Utilization Criteria and Clinical Practice Guidelines. We don't pay or reward practitioners, employees or other individuals for denying coverage or care.

To enhance our network providers' experience, MCNA offers peer-to-peer consultations with our clinical reviewers. The peer-to-peer process enables our participating providers to discuss clinical determinations, including medical necessity denials. Any network provider may request a peer-to-peer consultation by contacting their Provider Relations Representative or by calling MCNA's Provider Hotline at 1-855-776-6262 (8 a.m. to 7 p.m., Central Time, Monday through Friday).