Health Industry Collaboration Effort

Health plans, Providers, Associations

Simplifying Healthcare Administration

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Administrative & Organizational Folders Agency Resources Current Annual Conference Information Current Training Workshops and Materials FINAL HICE DOCUMENTS Health Plan Specific Letter Templates HICE Team Folders Working Documents Past Annual Conference Information Teams Not Currently Active

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

Health Plan Specific Letter Templates
Health Plan Specific Letter Templates
01_Template Instructions
Participating health plans that have confirmed the templates have been reviewed to determine regulatory compliance are able to use a self-service web-based tool to upload their health plan-specific templates to this site. Please contact the plans directly for any templates not available on the HICE website. To receive broadcast messages when letter templates are added/updated by participating plans, add the "Health Plan Specific Letter Template Notifications" Team to your HICE account (see Teams" page for instructions on how to do this or contact admin@iceforhealth.org if assistance is needed).
Aetna
Anthem Blue Cross
Cigna
		File	Upload	Review
	Title	Size	Date	Date
	Cigna_Claims_Commercial_ER_MemberDenialNotice_10.2023	448 KB	10/24/2023
	Implementation Date for Notice/Description: 10/2023
	Cigna_Claims_Commercial_MemberDenialNotice_10.2023	454 KB	10/24/2023
	Implementation Date for Notice/Description: 10/2023
	Cigna_UM_Comm_LAP_Option 1_Non-Discrimination Language 11_2023	514 KB	11/16/2023
	Implementation Date for Notice/Description: 12/16/2023
	Cigna_UM_Comm_LAP_Option 2_Denial_Notice_1-2025	669 KB	1/29/2025
	Implementation Date for Notice/Description: 03/01/2025
	Cigna_UM_Comm_LAP_Option 2_Notice of Non-Coverage-SNF Exhaustion of Benefits_1-2025	1172 KB	1/29/2025
	Implementation Date for Notice/Description: 03/01/2025
	Cigna_UM_Comm_LAP_Option 2_Notice_of_Non-Coverage_Termination_of_Services_(NONCTOS)_1-2025	664 KB	1/29/2025
	Implementation Date for Notice/Description: 03/01/2025
	Cigna_UM_Comm_LAP_Option 2_Refusal to Transfer_1-2025	1171 KB	1/29/2025
	Implementation Date for Notice/Description: 03/01/2025
	HICE_Cigna_Approval_Inpatient 09-2024	19 KB	9/9/2024
	Implementation Date for Notice/Description: 10/01/2024
	HICE_Cigna_Approval_Outpatient_09-2024	640 KB	9/9/2024
	Implementation Date for Notice/Description: 10/01/2024
	ICE_Cigna_Spec_Term_11-2023	882 KB	11/16/2023
	Implementation Date for Notice/Description: 12/16/2023
Clever Care Health Plan
Health Net
Sharp Health Plan

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.