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SL-2026-0142Info requested Advance funded

T. Anderson

Member M-08812 · Transplant · Cascade Manufacturing

Member workspace
MC
Maria Chen
Assigned owner
Summary
Member
T. Anderson
Diagnosis
Transplant
C92.00
Carrier
Tokio Marine HCC
Total claims
$185,000
Spec deductible
$150,000
Amount to file
$35,000
claims above spec deductible
Filed
$35,000
Reimbursed
$23,000
Outstanding
$12,000
Source: Javelina
Packet 33 days old — stale, refresh before submitting
Packet checklist7/7
Filing output and history
Filing output
Claim ledger
SL-2026-0142-submission-2-claim-ledger.xlsx
Paid claims from Apr 30, 2026 to May 13, 2026
Combined PDF
SL-2026-0142-submission-2-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 2 · Subsequent incremental filing
Subsequent filing is incremental: new eligible paid claims since the last filed cumulative paid amount. Template: Platform reimbursement request form.
Current cumulative paid
$185,000
Last filed cumulative paid
$185,000
New eligible paid
$0
Filing creation threshold
$0
Filing records for this member
SL-2026-0142-F01 · Initial filing
Partial reimbursement
Paid periodJan 1, 2026 to Apr 29, 2026
Spec applied$150,000
Filed amount$35,000
Cumulative paid through$185,000
Filing threshold$0
Printed claim threshold$10,000

Initial filing is still open: carrier reimbursed part of the request and the remaining dollars need denial/more-info follow-up. New filings still start after this filing’s cumulative paid amount.

SL-2026-0142-F02 · Subsequent filing
Watching
Paid periodApr 30, 2026 to May 13, 2026
Spec applied$0
New eligible paidNo new paid claims yet
Cumulative paid through$185,000
Filing threshold$0
Printed claim threshold$10,000

Future treatment would open as a separate filing once new eligible paid claims meet the configured filing creation threshold.

Claim detail
Claim Details
DateProviderDx codeAmount
2025-12-23Cleveland Clinic — MainC92.00$101,750
2026-01-07Cleveland Clinic — OutpatientC92.00$33,300
2026-02-11Walgreens Specialty RxC92.00$22,200
2026-03-23Cleveland Clinic — Bone Marrow ClinicC92.00$27,750
Total$185,000
Communication history
Communication2 messages
From usclaims@tokiomarinehcc.com
Apr 29, 2026
[SL-2026-0142] Transplant stop-loss filing — T. Anderson

Stop-loss claim filing for T. Anderson (M-08812). Attached: claim ledger flat file plus combined PDF packet with supporting docs.

SL-2026-0142-claim-ledger.xlsx SL-2026-0142-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
From carrierclaims@tokiomarinehcc.com
May 13, 2026
Re: [SL-2026-0142] Transplant stop-loss filing — T. Anderson

Carrier requested updated active-at-work attestation for 2026-Q1

Action: Send updated active-at-work attestation for 2026-Q1
Carrier asked for info
Days waiting on us: 14
Request for additional information
Carrier requested updated active-at-work attestation for 2026-Q1
System has the response drafted from existing case data — review and send.
Stuck on
HR
Waiting on updated active-at-work attestation
14 days since last meaningful update
Activity
  1. Packet assembly complete
    Apr 27, 2026·Maria Chen
  2. Filed to carrier
    Apr 29, 2026·Maria Chen
    Submitted via Tokio Marine HCC portal — confirmation #THC-887124
  3. Request for additional information
    May 13, 2026·Tokio Marine HCC
    Carrier requested updated active-at-work attestation for 2026-Q1
  4. HR emailed for refreshed AAW attestation
    May 14, 2026
  5. HR auto follow-up #1 sent — no reply yet
    May 18, 2026
  6. HR auto follow-up #2 sent — escalation suggested if no reply by tomorrow
    May 23, 2026
  7. Carrier requested more info · rep needs to respond
    Carrier requested updated active-at-work attestation for 2026-Q1
Carrier risk checks
Carrier pushback risk