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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. Documents available within the Library are intended to be used as printed documents. To the extent such documents are used digitally, it shall be the user's responsibility to ensure their use of the documents adheres to the accessibility standards applicable to their organization.


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 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 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 Credentialing Shared Audit Policy Team - Main / Texas  
 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 Encounters Standardization 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 close category UM Templates & Tools (Commercial UM LAP Templates for LAP Regulations Effective on and after 1/1/09)  
     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 open category 01 - Document Remediation
Please contact the health plans directly to determine if a specific document has been remediated to meet applicable accessibility standards and any policy that the health plans may have in place for remediation of documents.
     Click to open category Instructions and Information - READ FIRST
     Click to open category Option 1 - LAP Notice of Translation
     Click to close category Click to Download All Documents in Subfolder Option 2 - Health Plan-Specific Templates (CSDN & Comml Delay-Extension) with LAP Notice Translation
       File   Upload   Review
  Title     Size   Date   Date
 Aetna Approval FI California_rev 021318   127 KB   2/21/2018   
 Aetna CA Commercial Non-Discrimination Notice 0218   16 KB   2/21/2018   
 Aetna CA State Taglines 0218 GT ID 2017 V 2.1   469 KB   2/21/2018   
 Aetna CA State Taglines 0218   29 KB   2/21/2018   
 ICE_CSDN incl LAP_ Anthem Blue Cross_eff 01.01.20   115 KB   11/7/2019   
 ICE_CSDN_Blue_Shield_of_California_1.2020   54 KB   1/29/2020   
 ICE_CSDN_OON_Modify_Blue_Shield_of_California_1.2020   29 KB   1/29/2020   
 ICE_Cigna_Approval_Outpatient_12-2019   1136 KB   1/30/2020   
 SharpHealthPlan_Commercial_Service_Denial_Notice_(CSDN)_3.27.20   312 KB   3/31/2020   
 SharpHealthPlan_Delay-Extension_3.27.20   303 KB   3/31/2020   
 SharpHealthPlan_Notice_of_Non-Coverage_Termination_of_Services_(NONCTOS)_3.27.20   310 KB   3/31/2020   
 SharpHealthPlan_Refusal_To_Transfer_(RTT)_3.27.20   312 KB   3/31/2020   
 SharpHealthPlan_SNF_Exhaustion_of_Benefits_(SNFEXH)_3.27.20   309 KB   3/31/2020   
 Aetna_CA Only_Provider_Retraction_Commercial_Letter_0320   42 KB   4/2/2020   
 Aetna_CA Only_Specialist_Termination_Commercial_Letter_0320   49 KB   4/2/2020   
 ICE_Cigna_Denial_Notice_04-2020   1164 KB   4/23/2020   
 ICE_Cigna_Notice_of_Non-Coverage_Termination_of_Services_(NONCTOS)_04-20...   1160 KB   4/23/2020   
 ICE_CSDN_Health_Net_Carve_Out_Situations_(COS)_eff 1.1.2017   22 KB   4/27/2020   
 ICE_CSDN_Health_Net_Delay-Extension_eff 1.1.2017   25 KB   4/27/2020   
 ICE_CSDN_Health_Net_Denial_eff 1.1.2017   31 KB   4/27/2020   
 ICE_CSDN_Health_Net_Notice_of_Non-Coverage_Termination_of_Services_(NONCTOS)_PPACA_eff 1.1.2017   31 KB   4/27/2020   
 ICE_CSDN_Health_Net_Refusal_To_Transfer_(RTT)_PPACA_eff 1.1.2017   31 KB   4/27/2020   
 ICE_CSDN_Health_Net_SNF_Exhaustion_of_Benefits_(SNFEXH)_PPACA_eff1.1.17   29 KB   4/27/2020   
 ICE_Cigna_Spec_Term_02-2020   1260 KB   5/5/2020   
 Aetna CA Comm Service Denial Notice (CSDN)_rev 052020   71 KB   6/23/2020   
 Anthem_Blue_Cross_Commercial_ Pended_Notification_Template_rev 5.16.17   114 KB   5/26/2017   2020-05-26
 Anthem_Blue_Cross_Commerical_Carve Out Letter Template_rev 5.16.17   164 KB   5/26/2017   2020-05-26
 Anthem_Blue_Cross_Commercial_Authorization_Notification Template_rev 5.16.17   163 KB   7/12/2017   2020-07-14
 Click to open category UM Templates & Tools (Commercial)  
 Click to open category UM Templates & Tools (Medi-Cal)  
 Click to open category UM Templates & Tools (Medi-Cal) - Health Plan-Specific Templates  
 Click to open category UM Templates & Tools (Medicare Advantage Templates for Marketing Guidelines)  
 Click to open category UM Templates & Tools (Medicare Advantage)  

  Adobe Acrobat File
  Microsoft Word File
  Microsoft Excel File
  Microsoft PowerPoint File
  Microsoft Word XML File
  Microsoft Excel XML File
  Microsoft PowerPoint XML File
  Zipped File
  Unknown File Type

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