SL-2026-0175Gathering docs Advance funded

R. Hammond

Member M-09712 · Cardiac Surgery · Atlas Tech Group

Member workspace

James Torres

Assigned owner

Summary

Member

R. Hammond

Diagnosis

Cardiac Surgery

I50.43

Carrier

Voya Financial

Total claims

$188,000

Spec deductible

$125,000

Amount to file

$63,000

claims above spec deductible

Source: Cigna

Packet 21 days old — stale, refresh before submitting

Packet checklist6/8

Draft filing packet

Packet ready to file

Claim ledger

SL-2026-0175-submission-1-claim-ledger.xlsx

Paid claims from Jan 1, 2026 to May 25, 2026

Combined PDF

SL-2026-0175-submission-1-filing-packet.pdf

Auto cover sheet + checklist supporting documents

Submission 1 · Initial filing

Ready-to-file draft packet. Applies the $125,000 spec deductible and requests $63,000 above deductible. Template: Platform reimbursement request form.

Current cumulative paid

$188,000

Last filed cumulative paid

None yet

New eligible paid

$63,000

Filing creation threshold

$1,000

Current filing record

SL-2026-0175-F01 · Initial filing

Draft

Paid periodJan 1, 2026 to May 25, 2026

Spec applied$125,000

Amount to request$63,000

Cumulative paid through$188,000

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

Date	Provider	Dx code	Amount
2026-02-16	Mass General — Cardiac Surgery	I50.43	$116,560
2026-04-02	MGH Step-Down	I50.43	$41,360
2026-05-02	CVS Specialty	I50.43	$30,080
Total			$188,000

Submit packet to carrier

Advance-funded

Plan files first, carrier funds the disbursement, plan mails check to provider. Filing speed = provider wait time.

Documents6/8 required

Pushback risk cleared3/3 cleared

Stuck on

Clinical team

Waiting on case-management notes upload

2 days since last meaningful update

Activity

Spec deductible triggered
May 17, 2026
Pre-cert + COB auto-pulled from Cigna admin
May 17, 2026
Active-at-work confirmed
May 23, 2026·Atlas HR
COBRA premium status confirmed via WEX
May 17, 2026
Member terminated 2026-01-31, elected COBRA, premiums current through 2026-04
Requested case-mgmt CSV from Atlas clinical team
May 25, 2026·James Torres
Atlas is on Cigna admin (not Javelina) — case-mgmt notes need a manual export. Awaiting upload.
Almost ready · only case management notes outstanding
Case management notes are the last item — clinical team upload pending.

Carrier risk checks

Carrier pushback risk