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Looking for an approved ICE document/template? They can be found in the Approved ICE Documents folder - click here for a list of available documents for each ICE team: APPROVED ICE DOCUMENTS.

ICE documents can be altered for use by organizations/other regions as needed; however, the ICE logo/any ICE references should be removed if the document is not being used in its original format.


ICE is a voluntary 501(c)3 organization that includes participation by and advice from accrediting and regulatory agencies. The goal of ICE work products is to offer ICE participating organizations standardized tools and best practices toward optimizing efficiencies to implement health industry requirements. ICE heeds feedback from accrediting and regulatory agency partners regarding ICE work products; however, ICE does not obtain official regulatory approval for its work products. As such, ICE work products are not to be considered exempt from any approval process required by regulatory agencies.


APPROVED ICE DOCUMENTS

 Click to open category Appeals and Grievances Improvement Team  
 Click to open category California SB260  
 Click to open category Claims  
 Click to open category Claims Cal MediConnect Health Plan-Specific Member Denial Templates  
 Click to open category Claims CMS Health Plan-Specific Member Denial Letter Templates  
 Click to open category Claims Commercial Health Plan-Specific Member Denial Letter Templates  
 Click to open category CMS Universe Templates  
 Click to open category Contracting & Compliance Team  
 Click to open category Credentialing Shared Audit Policy Team - Main / California  
 Click to open category Credentialing Shared Audit Policy Team - Main / Mid-Atlantic  
 Click to open category Credentialing Shared Audit Policy Team - Main / Northwest  
 Click to open category Cultural & Linguistic Services Team  
 Click to open category Cultural and Linguistics Provider Toolkit  
 Click to open category DMHC Access Regulations Team  
 Click to open category Provider Directory Updates Team  
 Click to open category QI / UM Team - Main  
 Click to open category Risk Adjustment Data Acquisition & Reporting (RADAR) Team  
 Click to open category Site Visit Team (falls under Credentialing Shared Audit Policy Team - Main / California)  
 Click to open category UM Required Reports Team (formerly QI and UM Required Reports Team)  
 Click to open category UM Templates & Tools (1) - Health Plan Posting Request Instructions  
 Click to open category UM Templates & Tools (Cal MediConnect) - Health Plan-Specific Templates  
 Click to open category UM Templates & Tools (Commercial UM LAP Templates for LAP Regulations Effective on and after 1/1/09)  
 Click to open category UM Templates & Tools (Commercial)  
 Click to open category UM Templates & Tools (Medi-Cal)  
 Click to close category UM Templates & Tools (Medi-Cal) - Health Plan-Specific Templates  
     Click to open category 00-Template Availability
ICE posts whatever templates have been provided by participating health plans. Please contact the health plans directly for any templates not available on the ICE website.
     Click to close category Click to Download All Documents in Subfolder Anthem Blue Cross
       File   Upload   Review
  Title     Size   Date   Date
 01_Anthem_Blue_Cross_NOA Ltrs, Your Rights, Nondiscrimination Notice_English_7.1.17   1701 KB   10/24/2017   
The Anthem Blue Cross Medicaid Notice of Translation and Nondiscrimination must be included with all Medicaid member-facing letters. Use the Anthem Blue Cross Medicaid English Translation and Nondiscrimination Notice for letters sent in English or English/Spanish bilingual letters. If letters are sent in the member's threshold language, use the matching Notice from the list below.
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Arabic   3321 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Armenian   3323 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Chinese   3321 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_English   3325 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Farsi   3322 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Hmong   3323 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Khmer   5168 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Korean   3328 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Russian   3323 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Spanish   3321 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Tagalog   3321 KB   4/20/2018   
 Anthem_Blue_Cross_Specialist Term Notif Ltr_LEP_Nondiscrimination_Vietnamese   3320 KB   4/20/2018   
 Anthem_UM_TAT_Medi-Cal_4-17-18   135 KB   5/15/2018   
 Arabic NOA Ltrs, Your Rights, Nondiscrimination Notice   211 KB   10/24/2017   
 Armenian NOA Ltrs, Your Rights, Nondiscrimination Notice   209 KB   10/24/2017   
 Chinese NOA Ltrs, Your Rights, Nondiscrimination Notice   222 KB   10/24/2017   
 Farsi NOA Ltrs, Your Rights, Nondiscrimination Notice   209 KB   10/24/2017   
 Hmong NOA Ltrs, Your Rights, Nondiscrimination Notice   213 KB   10/24/2017   
 Khmer NOA Ltrs, Your Rights, Nondiscrimination Notice   1935 KB   10/24/2017   
 Korean NOA Ltrs, Your Rights, Nondiscrimination Notice   233 KB   10/24/2017   
 Russian NOA Ltrs, Your Rights, Nondiscrimination Notice   218 KB   10/24/2017   
 Spanish NOA Ltrs, Your Rights, Nondiscrimination Notice   209 KB   10/24/2017   
 Tagalog NOA Ltrs, Your Rights, Nondiscrimintion Notice   213 KB   10/24/2017   
 Vietnamese NOA Ltrs, Your Rights, Nondiscrimination Notice   209 KB   10/24/2017   
     Click to open category Health Net
 Click to open category UM Templates & Tools (Medicare Advantage Templates for Marketing Guidelines)  
 Click to open category UM Templates & Tools (Medicare Advantage)  

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