HICE UM Standardized Letter Templates Now Available

From: broadcast@iceforhealth.org 1
Date: 12/13/2023 3:35:06 PM
Subject: HICE UM Standardized Letter Templates Now Available
Message: The HICE Service Determination Standardization (SDS) Team UM Letter Template Standardization workgroup that was established to focus on standardizing UM letter templates has been working with many health plans to review and ultimately agree on a common†template for several high-usage letters. As HICE cannot mandate usage of these letter templates, this workgroup is seeking industry support through the HICE community to adopt the usage of these templates.†

The proliferation of letters that are quite similar is a clerical challenge for health plans, medical groups, and others, and not a market differentiator; this issue is not new, yet actions require new solutions such as a standardized approach to reviewing and approving letter templates. There is an opportunity to make this an agreed-to process going forward.†

The workgroup has been meeting regularly for several months now and the following letter templates have undergone the HICE document review process and are now available for use/adoption on the HICE website library in the Approved HICE Documents Folder / UM Templates and Tools in separate folders by respective product line at the following links:

Medi-Cal - https://www.iceforhealth.org/library.asp?sf=&scid=5448#scid5448

Commercial - https://www.iceforhealth.org/library.asp?sf=&scid=5447#scid5447

  • HICE_UM_Standardized_Letter_Template_COC Approval Letter_Medi-Cal_10.10.23
  • HICE_UM_Standardized_Letter_Template_ Deny NOA Letter DHCS_Medi-Cal_09.29.23
  • HICE_UM_Standardized_Letter_Template_Modified Singular Letter_Medi-Cal_06.23.23
  • HICE_UM_Standardized_Letter_Template_Approval_Letter_w_no_Coverage_Commercial_09.23†
It is recommended that when letter template changes/updates are needed that they be managed through the SDS Team UM Letter Template Standardization workgroup. Being disciplined in the approach and using these templates as the base would be ideal going forward to secure agreement on needed modifications, which will help reduce duplication of efforts for many of the health plans (and other entities). If this process were adopted, key objectives would be met, including decreasing†unnecessary administrative burdens/costs on the provider community, as well as helping to improve compliance results and member understanding supported by consistent language used in these letters.
For more information on this collaborative effort and to provide feedback relative to a planís willingness to adopt and utilize these standardized templates and/or join the workgroup to participate in future template development, please contact the workgroup leader, Sharon Almany, at salmany@regalmed.com.

If you would like to receive future broadcasts about the overall activities of this workgroup or be notified when additional letter templates have been made available, please sign up for the HICE Service Determination Standardization Team. Learn more at: https://www.iceforhealth.org/teamactivities.asp.

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