Understanding the Differences Between MCNA's Appeals and Reconsideration Processes
If you receive notification from MCNA that a claim has been denied, you may either file an appeal of the adverse determination or a claims reconsideration request with us. Reconsideration: You may file a request for a claim to be reconsidered within 120 days of the denial of that claim. Claims eligible for reconsideration include:
Appeal: You may file an appeal to request that MCNA reviews an action if your claim has been denied for determinations related to medical necessity and benefit coverage. The Claims Reconsideration Unit (CRU) provides you with an opportunity to resolve claims payment issues that...
MCNA Updates
If you receive notification from MCNA that a claim has been denied, you may either file an appeal of the adverse determination or a claims reconsideration request with us. Reconsideration: You may file a request for a claim to be reconsidered within 120 days of the denial of that claim. Claims eligible for reconsideration include:
Appeal: You may file an appeal to request that MCNA reviews an action if your claim has been denied for determinations related to medical necessity and benefit coverage. The Claims Reconsideration Unit (CRU) provides you with an opportunity to resolve claims payment issues that... |
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Fluoride Checkup: Keeping Up with Current Standards
In February 2014, the American Dental Association (ADA) made news when it changed its official recommendations about the age limits for the use of fluoride with young ...
Your Practice
In February 2014, the American Dental Association (ADA) made news when it changed its official recommendations about the age limits for the use of fluoride with young ... |
All About Third Molars
Medicaid guidelines limit the extraction of third molars to teeth that are symptomatic. When you submit a referral request to send a member to an oral surgeon for the evaluation of possible extraction of third molars, it is necessary to fully document the ...
MCNA Updates
Medicaid guidelines limit the extraction of third molars to teeth that are symptomatic. When you submit a referral request to send a member to an oral surgeon for the evaluation of possible extraction of third molars, it is necessary to fully document the ... |
Charting Healthy Habits at Home!
Help kids start right by maintaining a great dental hygiene routine at home with this fun tracking chart! A regular routine of brushing and flossing established at a young age will help children keep cavity-free teeth for life and result in more happy visits to the dentist. A chart like this one is ...
Children's Corner
Help kids start right by maintaining a great dental hygiene routine at home with this fun tracking chart! A regular routine of brushing and flossing established at a young age will help children keep cavity-free teeth for life and result in more happy visits to the dentist. A chart like this one is ... |
The MCNA Commitment to CLAS
MCNA is committed to ensuring the linguistic needs and cultural differences of our members are met through the incorporation of Culturally and Linguistically Appropriate Services (CLAS) into our dynamic ...
Quality Improvement
MCNA is committed to ensuring the linguistic needs and cultural differences of our members are met through the incorporation of Culturally and Linguistically Appropriate Services (CLAS) into our dynamic ... |
Let's Talk About Wisdom Tooth Pain: How Much is Too Much?
Today, 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? As we can observe with children, a certain amount of pain and discomfort can occur when teeth erupt through the gums. When a patient experiences the eruption of third molars, they could be coming to you with complaints about pain that is considered within the normal range for such development. Explain to your patients and their parents that ...
Communication
Today, 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? As we can observe with children, a certain amount of pain and discomfort can occur when teeth erupt through the gums. When a patient experiences the eruption of third molars, they could be coming to you with complaints about pain that is considered within the normal range for such development. Explain to your patients and their parents that ... |
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UM QuickTips
In every issue of our newsletter, we include utilization management tips that alert you to program information that is important to your office. Please click "Read More" below for this helpful information.
Utilization Management
In every issue of our newsletter, we include utilization management tips that alert you to program information that is important to your office. Please click "Read More" below for this helpful information. |
Update: Provider Focus Group Initiative
MCNA held its first ever Provider Focus Group in December 2014, bringing ...
Quality Improvement
MCNA held its first ever Provider Focus Group in December 2014, bringing ... |
February 2015: National Children's Dental Health Month
The American Dental Association (ADA) sponsors National Children's Dental Health Month each year in February to raise awareness of the importance of oral health nationwide. Parents, teachers, dentists, and other dental and healthcare professionals are encouraged to promote good oral health and hygiene habits at an early age. This year, the campaign is themed around the slogan "Defeat Monster Mouth." Check out the ADA's website to read more about it and download free resources.
Upcoming Events
The American Dental Association (ADA) sponsors National Children's Dental Health Month each year in February to raise awareness of the importance of oral health nationwide. Parents, teachers, dentists, and other dental and healthcare professionals are encouraged to promote good oral health and hygiene habits at an early age. This year, the campaign is themed around the slogan "Defeat Monster Mouth." Check out the ADA's website to read more about it and download free resources. |
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