We are very pleased to announce that MCNA Dental was selected by the Louisiana Department of Health (LDH) to administer its Medicaid dental program statewide. We invite you to join our network of primary and specialized oral health practitioners. MCNA Dental is a provider friendly program. The key to our success has been our relationships with our providers in each region.
Provider Enrollment
Louisiana providers, please download, print, and complete the documents below to begin the contracting and credentialing process. (Adobe Reader may be required to view PDF files.)
- Step 1: Download and read our Provider Welcome Letter.
- Step 2: Download and complete our Credentialing Application.
- Step 3: Download and complete our IRS W-9 Form for each physical location.
- Step 4: Download and complete our Payment Method Selection Form for each physical location.
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Step 5: Fax the completed documents to 1-877-563-8560, email them to provider_enrollment@mcna.net (file attachment limit of 10MB total per email), or mail them to:
MCNA Dental
Attn: Louisiana Network Development
P.O. Box 29008
San Antonio, TX 78229 - Step 6: Download and complete our Dental Provider Agreement and Louisiana Medicaid Product Attachment.
- Step 7: Mail the Agreement and Attachment with original signatures to:
MCNA Dental
Attn: Louisiana Network Development
P.O. Box 29008
San Antonio, TX 78229
Other/Optional Credentialing Forms
Click each link below to download the forms. Adobe Reader may be required to view these PDF files.
For More Information or For Questions
Click here to contact MCNA Dental's Louisiana Provider Hotline. You may also contact us by email for an online response at provider_enrollment@mcna.net.
Frequently Asked Questions for Providers
Click here to view a list of frequently asked questions about becoming an MCNA Dental provider for the Louisiana enrollees.
