FAQs - Preferred Provider Network (PPN)

What documents are required to be submitted with a PPN application?

**NOTE: PLEASE DO NOT SEND ANY PAPER DOCUMENTS VIA REGULAR MAIL TO THE DEPARTMENT.

For PPN license applicants, as per C.G.S. 38a-479aa(b), please upload the following to the NAIC “Attachment Warehouse” once you’ve submitted an application:

  • PPN Application – needed in addition to the NIPR e-application.
  • Certificate from the CT Secretary of State regarding the PPN’s good standing to do business in Connecticut;
  • A copy of the PPN’s and controlling company’s financial statement completed in accordance with sections 38a-53 (annual statement) and 38a-54, (CPA Audited Report), as applicable for the end of its most recently concluded fiscal year, along with the name and address of any public accounting firm or internal accountant which prepared the financial statement;
  • A list of names, official positions and occupations of members of the PPN’s and the controlling company’s board of directors and of those executive officers who are responsible for the PPN’s and controlling company’s activities with respect to the health care services network;
  • A list of the PPN’s and the controlling company’s principal owners;
  • In the case of out-of-state PPN, a certificate that such PPN is in good standing in its state of organization;
  • In the case of a Connecticut or out-of-state PPN, a report of the details of any suspension, sanction or other disciplinary action relating to such PPN;
  • The identity, address and current relationship of any related or predecessor controlling company or organization.
  • A general description of the PPN and participation in the PPN, including:
    • The geographical service area of and the names of the hospitals included in the PPN;
    • The primary care physicians, the specialty physicians, any other contracting providers and the number and percentage of each group’s capacity to accept new patients;
    • A list of all entities on whose behalf the PPN has contracts or agreements to provide health care services;
    • A table listing all major categories of health care services provided by the PPN;
    • An approximate number of total enrollees served in all of the PPN’s contracts or agreement;
    • A list of subcontractors of the PPN, not including individual participating providers, that assume financial risk from the PPN and to what extent each subcontractor assumes financial risk;
    • A contingency plan describing how contracted health care services will be provided in the event of insolvency; and
    • Any other information requested by the CID.
  • The name and address of the person to whom applications may be made for participation.

Many of the above are part of the application form found in the first bullet point.

The following are also worth noting, and it is expected that documentation will be uploaded to the NAIC Attachment Warehouse that shows compliance with the provisions below:

  • Each PPN shall maintain a minimum net worth of either (1) the greater of (A) $500,000, or (B) an amount equal to 8% of its annual expenditures as reported on its most recent financial statement completed and filed with the CID, or (2) another amount determined by the CID.
  • Each PPN shall maintain or arrange a letter of credit, bond, surety, reinsurance, reserve or other financial security acceptable to the CID for the exclusive use of paying any outstanding amounts owed participating providers in the event of insolvency or nonpayment except that any remaining security may be used for the purpose of reimbursing managed care organizations. Such outstanding amount shall be at least an amount equal to the greater of (1) an amount sufficient to make payments to participating providers for four months determined on the basis of the two months within the past year with the greatest amounts owed by the PPN to participating providers, (2) the actual outstanding amount owed by the PPN to participating providers, or (3) another amount determined by the CID. Such amount may be credited against the PPN’s minimum net worth requirements set forth above.
Do I have to submit all the above every year? Are the requirements different for new and renewal PPN license applicants?

The documentation requirements for new and renewal PPN License applicants are identical. If you upload a document (ex: professional qualifications of a board member) to the Warehouse and there have been no changes by the time you apply for renewal, you are welcome to refer us back to the initial document. Most documents (financials, applications, etc.) must be refreshed annually, however.

I am having trouble with the Attachment Warehouse. Will you accept documents submitted in other ways?

Documents may also be submitted to us via Secure Fax (860.297.3872) or e-mail (cid.tpa@ct.gov).

My license renews soon, but I don’t have all the necessary supporting documentation required. Can a new or renewal license be issued pending receipt of required documents?

No license may be issued or renewed until such time as all required documentation is submitted and reviewed. There is no way to issue or renew a license pending receipt of required documents.

I’m having a technical issue with the NIPR licensing system. Who should I contact?

Please contact NIPR at (855) 674-6477.

How do I reinstate a lapsed license?

Please apply as “new” via National Insurance Producer Registry (NIPR).

How do I surrender my PPN License?

Please complete the form linked to here (License Voluntary – Surrender Request), and return it to us at cid.tpa@ct.gov.