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.
To register, the PNCE must submit a fully completed PNCE Registration and Exemption of Affiliates Form with the required fee to TDI.
- There is a $1000 fee for PNCE Registration under 28 TAC §3.9804. §3.9802 requires the registration form and §3.9803 requires the PNCE Exemption of Affiliates form.
- There are no fees for updates or annual reporting.
- Submit to: Texas Department of Insurance at MCQA@tdi.texas.gov or by mail to: Managed Care Quality Assurance Office, Life and Health Division, Mail Code LH-MCQA Texas Department of Insurance PO Box 12030 Austin, Texas 78711
PNCE Exemption of Affiliates Form
The following entities are not required to register as a PNCE with TDI:
- A health maintenance organization operating under TIC Chapter 843;
- An entity holding a certificate of authority issued by TDI to engage in the business of insurance in Texas; or
- An affiliate named on the PNCE Exemption of Affiliates Form submitted to TDI and granted an exemption by the commissioner in writing.
Each PNCE that is a health maintenance organization or other entity holding a certificate of authority issued by TDI to engage in the business of insurance in this state is required to submit to TDI a fully completed PNCE Registration and Exemption of Affiliates Form with the required fee, unless the commissioner has granted an affiliate exemption to the PNCE.