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Texas Department of Insurance
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URA Renewal Application Naming Convention

Application Documents

 

DOCUMENTS

NAMING CONVENTION

Exhibit 1:  Categories of Personnel

1 Personnel List

Exhibit 2:  Adverse Determination (AD) Template Letters (3 types, listed below)

Initial AD Letter

2 Initial AD

IF there is separate letter for denial for step therapy; TIC Sec. 1369.0546(f)

2 Initial STPTHRPY

IF there is separate letter for denial for drug formulary; TIC Sec. 1369.056

2 Initial DRGFORM

IF there is separate letter for denial for Acquired Brain Injury (ABI); TIC Sec. 1352.006

2 Initial ABI

AD Appeal Acknowledgement Letter

2 AD Ack Ltr

AD Appeal Determination Letter

2 AD Appl Notice

IF there is separate letter for denial for step therapy; TIC Sec. 1369.0546(f)

3 APL STPTHRPY

IF there is separate letter for denial for drug formulary; TIC Sec. 1369.056

3 APL DRGFORM

IF there is separate letter for denial for Acquired Brain Injury (ABI); TIC Sec. 1352.006

3 APL ABI

Additional content: Attestation

ATTEST

Request for a Review by an Independent Review Organization (IRO) Instructions LHL009|0920

TX IRO Form

Federal External Review Process Form

FERP Form

Utilization Review Agent Application LHL005|0915

LHL005

Attestation

ATTEST

 

 

Additional Documents

If you want to include your own naming convention, add it at the end of the TDI naming convention.

Examples:

  • AD LTR_NGF_YYYYMMDD NGF = Non-grandfathered or GF = Grandfathered
  • AD LTR_N_20210716; N = only used to identify a “new” letter
  • AD LTR_ Initial AD Partial_20210716 [Company naming convention]
  • URA number_Response/Cover Letter_XXXXXXXX = 206_CVR LTR_20210825
  • URA number_Approval Letter_TYPE_XXXXXXXX = 206_APPRVL LTR_U_20210825
  • URA number_Deficiency Letter_TYPE_XXXXXXXX = 206_DEF LTR_U_20210825; U=update, R=renewal, O=original

For more information, contact: URAGrp@tdi.texas.gov

Last updated: 2/22/2022