UPDATE: MCNA has responded to our recent request for a contact for provider complaints and provided information about their complaint process. See information below.
Managed Care Organizations (MCOs) received significant mention in the report issued by the Health and Human Services Commission Inspector General Stuart Bowen that was released a few weeks ago. Rightfully so, as per legislation, it is up to the IG and HHSC to work together on audits of managed care organizations and their performance.
Within the IG’s report, Texas Medicaid Director Gary Jesse is quoted:
“While we can’t do anything about provider rates, we can reduce the administrative overhead. This will attract and retain more providers; if we achieve that then we’ve been successful. We are continuing our efforts to improve the experience for both members and providers by increasing transparency. On the provider side, we know the administrative burden of contracting and doing business with multiple MCOs increases the need for additional office staff for time spent with administrative work. The reality is we are a big Medicaid system and providers must interface with commercial, private pay, Medicaid, and Medicare systems, so we will never alleviate the responsibility they have as a provider and the work they have to do. But where we can, we will try to improve processes to make things more transparent. We need to focus on what we can change and make a note of what we can’t, and move forward.”
TDMR receiving complaints about dental MCOs
TDMR has received several complaints relating to MCOs. These range from the byzantine assignment of dental homes and patients being shifted from practice to practice, to lack of due process for a Medicaid provider put on a payment hold by an MCO, to questions about an overpayment received by one provider that wasn’t getting resolved.
Issues relating to Dentaquest have been brought to the attention of Brenda Walker, their Regional Director for Provider Relations, who has been responsive. One problem was sorted out for a provider.
However, some of the issues appear to be systemic but Walker says Dentaquest is working on
UPDATE: MCNA provides information on complaint process
Previously, we have not been able to reach someone at MCNA. However, Shannon Turner, Vice President of Operations, responded to a recent email from TDMR and provided the following, along with a contact for TDMR:
Providers are able to lodge complaints with MCNA by calling our Provider Hotline located here in San Antonio, by contacting their regional provider relations representative, by mail, or by email. Our complaints process is outlined in MCNA’s Provider Manual. The manual is located on our website at www.mcnatx.net. All complaints are addressed within 30 days of receipt.
IG and legislature also getting complaints
Complaints have also reached the state. Specifically, they have reached the House Human Services Committee and its chairman Rep. Richard Peña Raymond. Raymond told a group of dentists in Harlingen last month that both he and IG Bowen have talked about concerns they have over the performance of the companies and their relations with Medicaid dental providers.
IG to review and House committee to have hearings
The upshot is that it has already been decided that the IG will be conducting a review of the performance of the dental MCOs this year and the House Human Services Committee will be having public hearings sometime within the next few months.
Make your problems known
Below is the contact information for Brenda Walker if you are having a problem with Dentaquest.
Regional Director, Provider Relations – Texas / Colorado
Stratum Executive Center
11044 Research Blvd, Suite D-400
Austin, Texas 78759
Again for MCNA, “providers are able to lodge complaints with MCNA by calling our Provider Hotline located here in San Antonio, by contacting their regional provider relations representative, by mail, or by email.”
You can also let TDMR know via the Medicaid Difficulty Alert.