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SL-2026-0166Gathering docs Advance funded

T. Choi

Member M-07655 · Cardiac Surgery · Northern Logistics Co

Member workspace
AR
Aisha Robinson
Assigned owner
Summary
Member
T. Choi
Diagnosis
Cardiac Surgery
I50.43
Carrier
Berkley Accident & Health
Total claims
$145,000
Spec deductible
$100,000
Amount to file
$45,000
claims above spec deductible
Source: Cigna
Packet 20 days old — stale, refresh before submitting
Packet checklist5/7
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0166-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 26, 2026
Combined PDF
SL-2026-0166-submission-1-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 1 · Initial filing
Ready-to-file draft packet. Applies the $100,000 spec deductible and requests $45,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$145,000
Last filed cumulative paid
None yet
New eligible paid
$45,000
Filing creation threshold
$1,000
Current filing record
SL-2026-0166-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 26, 2026
Spec applied$100,000
Amount to request$45,000
Cumulative paid through$145,000
Filing threshold$1,000
Printed claim threshold$10,000

Initial filing applies the specific deductible; request amount is paid claims above deductible.

Claim detail
Claim Details
DateProviderDx codeAmount
2026-02-18Northwestern Memorial — CardiacI50.43$89,900
2026-04-04Northwestern Cardiac RehabI50.43$31,900
2026-05-04Northwestern OutpatientI50.43$23,200
Total$145,000
Submit packet to carrier
Advance-funded
Plan files first, carrier funds the disbursement, plan mails check to provider. Filing speed = provider wait time.
Documents5/7 required
Pushback risk cleared3/3 cleared
Stuck on
Clinical team
Waiting on case-management notes upload
1 day since last meaningful update
Activity
  1. Spec deductible triggered
    May 19, 2026
  2. Pre-cert + COB auto-pulled
    May 19, 2026
  3. Active-at-work confirmed
    May 24, 2026·Northern HR
  4. Awaiting case mgmt upload
    May 26, 2026·Aisha Robinson
  5. Almost ready · only case management notes outstanding
    Case management notes are the last item — clinical team upload pending.
Carrier risk checks
Carrier pushback risk