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Texas Department of Insurance
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Managed Care Quality Assurance Other Forms

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TDI form number Description Format Language
FIN306 Officers and Directors Page
Complete Listing of all Current Officers and Directors
PDF English
LHL658 Application for Approval Exclusive Provider Benefit Plan (EPO) and Preferred Provider Benefit Plan (PPO)
PDF English
LHL707 HMO Network Access Plan Requirements
PDF English
LHL715 Provider Network Contracting Entity Registration and Exemption of Affiliates Form
PNCE Registration and Exemption Form
PDF English
LHL716 Health Maintenance Organization Annual Network Adequacy Report and Access Plan Checklist
PDF English
LHL719 HMO Delegation Agreement Checklist
PDF English

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