faq2
Frequently Asked Questions

Below are the answers to some common questions about MCNA Dental and the Nebraska Medicaid Dental Program.

Questions

Provider Overview and Contracting with MCNA

  1. How do I sign up with MCNA Dental?
  2. What is the average time to complete the MCNA Dental credentialing process?
  3. Do I need to be credentialed by MCNA Dental if I am already a Nebraska Medicaid provider?
  4. Is there a number providers can call with questions about joining MCNA Dental's network or completing the credentialing application?

Pre-Authorization Requests, Claim Submissions, and Covered Services

  1. How are requests for pre-authorization accepted?
  2. What is the turnaround time for processing pre-authorization requests?
  3. Does MCNA Dental accept electronic claims?
  4. What is MCNA Dental's payor ID for electronic submission of claims and pre-authorizations?
  5. My office uses a third-party clearinghouse. Do I have to complete any forms with our clearinghouse in order to submit claims or pre-authorizations electronically to MCNA Dental's payor ID?
  6. Does MCNA Dental accept NEA FastAttach?
  7. What are the periodicity limits for preventive services?
  8. Does MCNA Dental cover pharmacy benefits?
  9. How frequently do providers receive Remittance Advices (RAs) from MCNA Dental?

Provider Portal and Provider Resources

  1. What is MCNA Dental's Provider Portal and what features are available?
  2. Is there a special application to access your online Provider Portal?
  3. Once I set up my online Provider Portal account, can I begin using it immediately?
  4. Is there a user guide that explains the functions of the Provider Portal?
  5. How do providers receive a copy of MCNA Dental's Provider Manual?
  6. I see that MCNA Dental provides training webinars and seminars for its credentialed providers. If I cannot attend a scheduled webinar or seminar, can I still receive training?

Federally Qualified Health Centers (FQHCs) and Indian Health Clinics (IHCs)

  1. Can an FQHC/IHC be considered a Dental Home Provider?
  2. Does MCNA Dental's contract have specific language about FQHCs/IHCs being paid at their prospective payment for service (PPS) rate?
  3. Are FQHCs/IHCs listed in MCNA Dental's provider directory?
  4. If an FQHC/IHC cannot attend a scheduled webinar or seminar, can MCNA Dental provide training?
  5. What is MCNA Dental's after hours coverage requirement?
  6. If an FQHC/IHC claim for a single date of service has multiple procedures, is the whole encounter denied if one service is denied?

Answers

Provider Overview and Contracting with MCNA

  1. How do I sign up with MCNA Dental?

    Click here to learn more about enrolling in our network of providers.

  2. What is the average time to complete the MCNA Dental credentialing process?

    Once MCNA Dental receives a completed application, the average turnaround time is 30 days.

  3. Do I need to be credentialed by MCNA Dental if I am already a Nebraska Medicaid provider?

    Yes, providers must complete MCNA Dental's credentialing process in order to participate in our plan.

  4. Is there a number providers can call with questions about joining MCNA Dental's network or completing the credentialing application?

    Yes. Click here to contact our Provider Hotline.

Pre-Authorization Requests, Claim Submissions, and Covered Services

  1. How are requests for pre-authorization accepted?

    MCNA Dental has an online Provider Portal where providers can submit requests for pre-authorization. Any supplemental materials such as narratives, charting, or x-rays can be attached and submitted via the Provider Portal. Pre-authorizations may also by submitted through a third-party clearinghouse (please use payor ID 65030), or mailed to MCNA at:

    MCNA Dental
    Attn: Utilization Management
    200 West Cypress Creek Road, Suite 500
    Fort Lauderdale, Florida 33309

  2. What is the turnaround time for processing pre-authorization requests?

    MCNA Dental generally processes pre-authorization requests within 48-72 hours. Providers can check the status of pre-authorization requests via MCNA Dental's online Provider Portal.

  3. Does MCNA Dental accept electronic claims?

    MCNA Dental accepts and encourages electronic claims submission. Our payor ID is 65030. Claims may be entered and submitted via MCNA Dental's online Provider Portal. Use of this portal feature enables electronic submission without the need for a third-party clearinghouse. Paper claims are also accepted. Paper claims should be submitted to MCNA Dental at:

    MCNA Dental
    Attn: Claims
    200 West Cypress Creek Road, Suite 500
    Fort Lauderdale, Florida 33309

  4. What is MCNA Dental's payor ID for electronic submission of claims and pre-authorizations?

    Our payor ID is 65030.

  5. My office uses a third-party clearinghouse. Do I have to complete any forms with our clearinghouse in order to submit claims or pre-authorizations electronically to MCNA Dental's payor ID?

    If you are already submitting claims or pre-authorizations electronically via a clearinghouse, you do not need to complete any additional forms with your clearinghouse. However, you may need to setup MCNA Dental as a new payor in your practice management system.

  6. Does MCNA Dental accept NEA FastAttach?

    MCNA Dental participates as an NEA FastAttach payor. You are able to transmit x-rays, perio charts, narratives, and any other documentation required by MCNA Dental to adjudicate your claim or pre-authorization. Once you transmit your documentation to NEA FastAttach, you can provide your NEA Tracking Number when you submit your claim or pre-authorization via MCNA Dental's online Provider Portal or electronically via your clearinghouse.

  7. What are the periodicity limits for preventive services?

    Preventive services follow the AAPD's periodicity schedule. All periodicity limits are outlined in MCNA Dental's Provider Manual.

  8. Does MCNA Dental cover pharmacy benefits?

    Pharmacy benefit coverage remains with the member's medical benefit either through fee-for-service Medicaid or their health plan.

  9. How frequently do providers receive Remittance Advices (RAs) from MCNA Dental?

    MCNA Dental runs regularly occurring RA cycles each week. Please contact our Provider Hotline for specific information about the frequency of this cycle for your office. In order to enjoy the most convenient claims payment experience possible, MCNA Dental encourages your office to sign up for payments using electronic funds transfer (EFT). EFT payments are made with each RA cycle. To take advantage of this convenience, download a Payment Method Selection Form.

Provider Portal and Provider Resources

  1. What is MCNA Dental's Provider Portal and what features are available?

    MCNA Dental's Provider Portal is a free, all-in-one tool that allows you to carry out a variety of administrative functions for your office. Using your Provider Portal account you can:

    • Instantly submit claims, referrals (if needed), and pre-authorization requests.
    • Track the progress of all of your submissions online.
    • Instantly verify member eligibility.
    • Download important forms and resources like your Provider Manual.
    • View a history of your activity with MCNA.
    • Stay up to date with important program reminders and updates.
    • Sign up for our monthly provider newsletter delivered to your email inbox.
    • Access many more convenient tools!

    We encourage all of our valued network providers to take advantage of our Provider Portal.

  2. Is there a special application to access your online Provider Portal?

    Once you have successfully completed MCNA Dental's credentialing process and are an active provider in our network, you automatically qualify to establish your account for our online Provider Portal. You need only complete a simple online form to validate your information before you can access our online Provider Portal. Registration will open a few weeks prior to the implementation date (October 1, 2017).

  3. Once I set up my online Provider Portal account, can I begin using it immediately?

    Complete Provider Portal functionality will be available to all Nebraska providers beginning October 1, 2017.

  4. Is there a user guide that explains the functions of the Provider Portal?

    Yes, you can download MCNA's Provider Portal User Guide by clicking here. We also offer a series of tutorial videos that will walk you through the most important functions of our Provider Portal. To see our videos, go to http://portal.mcna.net and click on "Online Provider Portal Tutorial Videos" at the bottom of the screen.

  5. How do providers receive a copy of MCNA Dental's Provider Manual?

    MCNA Dental's Provider Manual is posted online in our Provider Portal.

  6. I see that MCNA Dental provides training webinars and seminars for its credentialed providers. If I cannot attend a scheduled webinar or seminar, can I still receive training?

    Yes, MCNA Dental will be happy to schedule either an office-specific webinar or other type of training event for any of our credentialed providers. Please email your request to NebraskaSeminars@mcna.net, or call your Provider Relations Representative.

Federally Qualified Health Centers (FQHCs) and Indian Health Clinics (IHCs)

  1. Can an FQHC/IHC be considered a Dental Home Provider?

    Yes. Dental Home providers can be general dentists, pediatric specialists, FQHCs, or IHCs.

  2. Does MCNA Dental's contract have specific language about FQHCs/IHCs being paid at their prospective payment for service (PPS) rate?

    Yes. MCNA Dental's contract (Appendix A) states on page 10 that FQHCs/IHCs will be reimbursed at the PPS rate in effect on the date of service for each encounter.

  3. Are FQHCs/IHCs listed in MCNA Dental's provider directory?

    All contracted and credentialed dentists are listed by type in alphabetical order. The FQHC/IHC where they practice is also listed along with address, telephone number, and other relevant information for members when selecting a dentist.

  4. If an FQHC/IHC cannot attend a scheduled webinar or seminar, can MCNA Dental provide training?

    Yes. MCNA Dental is happy to schedule a webinar or on-site training session for any of our providers. Please email your request to NebraskaSeminars@mcna.net.

  5. What is MCNA Dental's after hours coverage requirement?

    When a provider's office is closed the office should have an answering service or answering machine that offers the following information:

    • Instructions for contacting someone who can render clinical decisions or someone who can reach a dentist for clinical decisions
    • Instructions for emergency services (including directing the member to dial 9-1-1 if necessary)
    • List of the office hours
    • Instructions for the caller to leave a message so that someone can return their call

    The answering service or machine must also offer all of the information listed above in any additional languages based on cultural population.

  6. If an FQHC/IHC claim for a single date of service has multiple procedures, is the whole encounter denied if one service is denied?

    No, the PPS rate is paid as long as any service on the claim is approved.