Texas Insurance Code Section 1458.051 requires 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.
PNCE Exemption of Affiliates Form
The following entities are not required to register as a PNCE with TDI:
- A health maintenance organization operating under Insurance Code 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.