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
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 ... |
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Notification About Provider Re-Credentialing
In our efforts to be an environmentally friendly organization, we have adjusted our re-credentialing process to reduce the amount of paperwork that is sent to your office. Following initial credentialing with MCNA, ...
MCNA Updates
In our efforts to be an environmentally friendly organization, we have adjusted our re-credentialing process to reduce the amount of paperwork that is sent to your office. Following initial credentialing with MCNA, ... |
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Standards for Member Dental Record Documentation
Ensuring our members have access to high quality dental care is one of MCNA's highest priorities. In support of that goal, we have established standards for dental record documentation to help promote quality care through communication and consistent, effective treatment. You can find complete information about required dental record standards in MCNA's Provider Manual, which you can always access online through your Provider Portal account. In addition to routinely documenting all required information in the member dental record, your office is responsible for ...
Quality Improvement
Ensuring our members have access to high quality dental care is one of MCNA's highest priorities. In support of that goal, we have established standards for dental record documentation to help promote quality care through communication and consistent, effective treatment. You can find complete information about required dental record standards in MCNA's Provider Manual, which you can always access online through your Provider Portal account. In addition to routinely documenting all required information in the member dental record, your office is responsible for ... |
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