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Provider Network Solutions of Texas and its affiliates ensures that all members, practitioners, providers, and employees involved in Utilization Management decision annually receive and acknowledge the following commitment:
Care- Driven Decisions
UM determinations are made exclusively based on the appropriateness of care and services and the existence of coverage.
No Incentives for Denials
The organization does not specifically reward practitioners or other individuals for issuing denials of coverage or care.
No Incentives Encouraging Underutilization
Financial incentives for UM decision-makers are structured not to encourage decisions resulting in underutilization of care or services.
*If you are a provider please reach out to your Texas Provider Health Network (TPHN) representative to complete attestation.
At PNS Texas, we’ve worked throughout the company to comply with privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a federal law designed to ensure the privacy of personal and health information. In addition to all federal laws, PNS Texas also complies with all state laws and regulations. If you have any questions or would like to report any issues regarding our Privacy Program, please email our Privacy team at privacy@pns-mgmt.com.
PNS Texas, its subsidiaries, and its affiliates’ certification decisions are based only on the appropriateness of care and service and the existence of coverage. PNS Texas, its subsidiaries, and its affiliates do not reward physician reviewers, case managers, employees, practitioners, or other individuals for issuing denials of coverage or service. PNS Texas, its subsidiaries, and its affiliates do not pay incentives to physician reviewers, case managers, employees, practitioners, or other individuals to reduce the provision of care which is deemed medically necessary. PNS Texas, its subsidiaries, and its affiliates do not give financial incentives to physician reviewers, case managers, employees, practitioners, or other individuals to encourage decisions that result in under-utilization of care or services.
We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. You may access the Nondiscrimination and Accessibility notice by clicking here.
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