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Texas Edition  •  July 2020
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Quality Improvement Working with You: Member Records and Provider Education
Quality Improvement Working with You: Member Records and Provider Education

MCNA's Quality Improvement (QI) Program actively monitors the quality and appropriateness of the services you, our network providers, deliver to our members every day. We are committed to working with your office to fulfill state and ...

Quality Improvement
Quality Improvement Working with You: Member Records and Provider Education

MCNA's Quality Improvement (QI) Program actively monitors the quality and appropriateness of the services you, our network providers, deliver to our members every day. We are committed to working with your office to fulfill state and federal requirements through our QI Program. Our goal is to ensure that members and providers are receiving the full benefit of the Medicaid and CHIP programs in which they participate.

MCNA's monitoring activities often require our representatives to request a sample of member dental records from our providers in order to complete their review. When you signed your Provider Agreement to become a participating provider in our network, you agreed to provide such information to us upon our request. Please also note that you may send an MCNA member's dental records to us without first obtaining their consent. Our team periodically requests records for a variety of reasons, so if your facility is selected and contacted there is no cause for alarm.

If you receive a records request from us, we ask that the information you supply is as complete as possible. Please include the following items for each member record that is requested by MCNA:

  • All oral exam and treatment notes
  • All radiograph x-rays (of diagnostic quality) and/or digital photos taken, labeled and dated appropriately
  • All signed patient/parent/guardian consent forms
  • All treatment plans
  • All patient information sheets
  • All patient medical/dental history forms
  • Any other documents listed in the request

We assess member records against state and federal requirements to ensure that all required information is present. We will follow up with your office about our findings, and provide the necessary guidance to you and your staff to correct any areas of non-compliance discovered. Once you and/or your staff have received and understand this informative assistance, please remember to return the completed Provider Education Form to the QI department. You may fax it to 1-954-744-5812.

We are committed to maintaining the integrity of the Medicaid and CHIP programs, and we greatly appreciate your assistance in making this review process run smoothly and effectively. If you have questions about the records review process, please call our Provider Hotline at 1-855-776-6262 (8 a.m. to 7 p.m., Central Time, Monday through Friday).