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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.


 Click to open category Appeals and Grievances Improvement Team  
 Click to open category California SB260  
 Click to open category Claims  
 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 QI and UM Required Reports Team  
 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 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 open category UM Templates & Tools (Medi-Cal) - Health Plan-Specific Templates  
 Click to close category UM Templates & Tools (Medicare Advantage Templates for Marketing Guidelines)  
     Click to open category 1_Document Posting Instructions
     Click to open category Aetna
     Click to open category Alignment Health Plan
     Click to open category Anthem Blue Cross
     Click to close category Click to Download All Documents in Subfolder Blue Shield of California
       File   Upload   Review
  Title     Size   Date   Date
 Blue Shield of California Expedited Criteria Not Met_12-26-17   60 KB   1/5/2018   
 Blue_Shield_of_California_Carve_Out_Notice_12192017   26 KB   1/9/2018   
 Blue_Shield_of_California_CMS_Detailed_Explanation_of_Non-Coverage_DENC_12192017   33 KB   1/9/2018   
 Blue_Shield_of_California_CMS_Detailed_Explanation_of_Non-Coverage_DENC_Spanish_12192017   35 KB   1/9/2018   
 Blue_Shield_of_California_CMS_Detailed_Notice_of_Discharge_DND_12192017   35 KB   1/9/2018   
 Blue_Shield_of_California_CMS_Detailed_Notice_of_Discharge_DND_Spanish_12192017   37 KB   1/9/2018   
 Blue_Shield_of_California_CMS_Integrated_Denial_Notice_NDMCP_12192017   45 KB   1/9/2018   
 Blue_Shield_of_California_CMS_Integrated_Denial_Notice_NDMCP_Spanish_12192017   42 KB   1/9/2018   
 Blue_Shield_of_California_CMS_Notice_of_Medicare_Non-Coverage_NOMNC_12192017   40 KB   1/9/2018   
 Blue_Shield_of_California_CMS_Notice_of_Medicare_Non-Coverage_NOMNC_Spanish_12192017   43 KB   1/9/2018   
 H0504_17_317B Accepted 08282017 2018 MAPD BSC Multi-language Insert   25 KB   10/17/2017   
 H0504_17_317B Accepted 08282017 2018 MAPD BSC Multi-language Insert   371 KB   10/17/2017   
 Y0118_16_383A2 NM 10052016 REVISED Section 1557 NonDiscrimination Notice...   96 KB   11/9/2016   
A Nondiscrimination Notice must be attached to any notices and correspondence going to Blue Shield’s individual and employer group Medicare Advantage members. This Notice of Nondiscrimination must be sent with any Notices of Denial (pre-service), Requests for Additional Information, and Notices of Approval (pre-service).
     Click to open category Brand New Day
     Click to open category Central Health Plan
     Click to open category Health Net
     Click to open category Inter Valley Health Plan
     Click to open category Sharp Health Plan
     Click to open category UnitedHealthcare Medicare & Retirees
 Click to open category UM Templates & Tools (Medicare Advantage)  

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