MCNA shares a common goal with our valued network providers: the provision of exemplary dental care and services to our members. As such, one of the ways in which we monitor the quality of the dental services our members receive is through routine dental record audits conducted by our Quality Improvement (QI) department. During these audits, member records are chosen at random for periodic review of the following elements:

• Record of medical history, dental history, and existing dental conditions
• Radiograph evaluation and diagnostic material used
• Treatment plan and timeliness of treatment plan
• Actual care delivered in relation to proposed treatment plan
• Recall protocol and utilization analysis of ...

Did you know that more pre-authorization denials occur due to administrative reasons and rather than failure to meet dental necessity criteria? Most administrative denials can be easily avoided. After analysis of recent administrative denial trends, the Utilization Management (UM) department has identified the most common reasons for denial. The following is a list of these administrative denials and effective methods for ...