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


 Click to open category Appeals and Grievances Improvement Team  
 Click to close category Claims Standardization Team  
     Click to open category Approved Claims Documents
Health plan-specific letter templates that used to be located in this area of the library can now be found in the Health Plan Specific Letter Templates library document section here.
     Click to open category CMS Provider Dispute Resolution (PDR) Process Documents
     Click to close category Click to Download All Documents in Subfolder Commercial Provider Dispute Resolution (PDR) Process Documents
       File   Upload   Review
  Title     Size   Date   Date
  _HICE Claims Standardization Team Commercial PDR Documents Log   21 KB   8/16/2023   
  2008 PDR LTR CHANGES   30 KB   10/17/2007   12/8/2020
  Coml_ClaimsPDR_Report_Addresses_022807   24 KB   5/1/2007   12/8/2020
  FAIL_TO_SUBMIT_INFO_CLOSURE_LTR_0823   33 KB   8/14/2023   
  HICE_PDR_101_Guide   2978 KB   8/14/2023   
  ICE Claims ComlQtrProvDisputesRpt 10-31final   52 KB   9/7/2006   12/8/2020
  MULTI_DISP_ACK_LTR_0823   33 KB   8/14/2023   
  NON_UM_UPHLD_DISC_LTR_0823   33 KB   8/14/2023   
  OVERTN_CLOSURE_LTR_PAYMT_0823   32 KB   8/14/2023   
  PDR_Form_combined_0823   93 KB   8/14/2023   
  SINGLE_DISP_ACK_ADD_INFO_NEEDED_0823   34 KB   8/14/2023   
  SINGLE_DISP_ACK_LTR_NO_INFO_0823   32 KB   8/14/2023   
  UPHELD_DISP_RES_LTR_0823   32 KB   8/14/2023   
  UPHELD_UM_CLOS_LTR_0823   33 KB   8/14/2023   
     Click to open category Training Documents
 Click to open category Compliance Team (formerly Contracting & Compliance Team)  
 Click to open category Compliance Team Delegated Entity (DE) Compliance Workgroup  
 Click to open category Compliance Team IT Systems Integrity Workgroup  
 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 (C&L) Services Team  
 Click to open category Cultural and Linguistics Provider Toolkit  
 Click to open category Encounters Standardization Team  
 Click to open category QI / UM Team - Main  
 Click to open category Service Determination Standardization Team (SDS) - UM Templates & Tools  
 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-Specific Template Location  

HICE documents can be altered for use by organizations/other regions as needed; however, the HICE logo/any HICE 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.

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


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