Application Documents
| DOCUMENTS | NAMING CONVENTION |
|---|---|
| Exhibit 1: List & explanation of changes on company letterhead, signed by authorized representative of company (URA determines who signs). | Cover Ltr Signed |
| Exhibit 2: These are the actual items that have changed (for example, template letters, P & Ps, URA primary contact name, etc.). Since these items can vary, the URA will be responsible for the naming convention. See the section below named “URA Driven Naming Conventions” for examples of how to name files. It is highly encouraged to keep file names as short as possible, to avoid issues with character limitations. | See content at left. |
| 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