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Back in February, MCNA issued a Provider Account that able March 15 it would alpha reviewing restorations actuality adapted aural 36 months. The aggregation would additionally alpha acute above-mentioned authorizations for identical restorations and agnate restorations on the aforementioned tooth.



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Prior authorizations bare with affirmation for assignment on aforementioned tooth

According to the account (available below), for agnate restorations on the aforementioned tooth, the above-mentioned allotment requests charge accommodate “a anecdotal answer the account for the rework and acknowledging radiographs and/or photographs.”



Report of above-mentioned allotment requests denied



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TDMR afresh accustomed a address alleging that MCNA, admitting accepting all advice including radiographs assuming new adulteration on a tooth, has denied such pre-authorization requests. It is added declared in the address that above-mentioned allotment requests for backup fillings accept additionally been denied no bulk the acumen and affirmation presented and that the dentists complex are actuality told that they are amenable for acclimation the fillings for free.

We agenda that we haven’t accustomed aboriginal abstracts to verify these claims and do not apperceive how abounding providers accept been involved.¬† But we accept it is important to accompany this bulk to light.

Response from MCNA

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TDMR emailed MCNA controlling vice-president Shannon Boggs-Turner allurement about this action and she attentive responded.

“MCNA is clinically reviewing echo restorations. Providers charge abide added advice to accredit a analysis of the service. Both affairs accept taken a agnate access to accord with what is a austere analytic concern. As you know, restorations, back done properly, are advancing to aftermost a reasonable bulk of time. MCNA is not “refusing to pay for any new or backup fillings,” we are artlessly acute acquiescence of analytic advice to accredit our Texas-licensed dentists to appraise the restoration.”

We accept after responded that “One can accept the action if it is a backup of the aforementioned filling. However, we were told that alike with bartering radiographic affirmation of new adulteration on a tooth, above-mentioned allotment requests are actuality denied and the MCNA rep is adage it is up to the dentist to do the assignment at no cost.”

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Not abiding how ample a problem 

We do not apperceive how accepted a botheration this is or if it is alone a few abandoned instances or if it occurs with DentaQuest as well.

TDMR is accessible to accepting advice from added providers on this affair as able-bodied as comments from the DMOs.

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MCNA_TX-P_PB-RESTORATIONS[1 (1)

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