Registration of Provider Network Contracting Entities:
Texas Insurance Code Section 1458.051 and 28 TAC Chapter 3 Subchapter QQ require each person operating as a Provider Network Contracting Entity (PNCE) to register with TDI. A person begins acting as a PNCE when:
- The person enters into or offers to enter into a direct contract(s) with one or more providers for the delivery of health care services to covered individuals that serve to create a provider network or networks; and
- The PNCE's network or networks are accessed by another party or by an affiliate of the PNCE.
A PNCE is required to register under TIC Section 1458.051 if they:
- Are a health maintenance organization or other entity holding a certificate of authority issued by TDI to engage in the business of insurance in the state of Texas:
AND
- Are not affiliated with or by who's exemption is not being submitted on behalf of a primary provider, subsidiary provider or other provider networks holding a certificate of authority.
A PNCE that meets the prior criteria is required by TIC Section 1458.051 to register by submitting to TDI a fully completed (LHL715) PNCE Registration and Exemption of Affiliates Form with the required $1000 registration fee under 28 TAC Section 3.9804.
The PNCE must disclose per TIC Section 1458.052:
- All names used or that will be used by the provider network contracting entity, including any name under which the contracting entity intends to engage or has engaged in the business of insurance in Texas.
- Provider network contracting entity’s mailing address.
- Provider network contracting entity’s official email (Required by 28 TAC Section 1.1302).
- Provider network contracting entity’s main telephone number.
- Provider network contracting entity’s primary contact name.
- Provider network contracting entity’s primary contact telephone number.
- Disclose and clearly define the relationships between the applicant and all listed affiliates of the applicant, as required under TIC Section 1458.055 and 28 TAC Section 3.9803, including primary provider networks, subsidiary provider networks, and other provider networks as defined in 28 TAC Section 3.9801.
PNCE Exemption of Affiliates Form
Primary provider, subsidiary provider or other provider networks holding a certificate of authority and filing an exemption on behalf of their affiliated PNCEs should submit to TDI via email at MCQA@tdi.texas.gov a fully completed (LHL715) PNCE Registration and Exemption of Affiliates Form (Sections 1-7) as well as:
- List each affiliate, and the affiliate’s address, for which an exemption is requested. (Add additional pages as necessary).
- Attach a description or a copy of the applicant's basic organizational structure documents and a copy of organizational charts and lists that show:
- The relationships between the contracting entity and any affiliates of the contracting entity, including subsidiary networks or other networks; and
- The internal organizational structure of the contracting entity's management.
(No fee is required for filing an Exemption of Affiliates Form)