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SL-2026-0179Gathering docs Advance funded

V. Stone

Member M-10918 · Cardiac Surgery · Cascade Manufacturing

Member workspace
MC
Maria Chen
Assigned owner
Summary
Member
V. Stone
Diagnosis
Cardiac Surgery
I50.43
Carrier
Tokio Marine HCC
Total claims
$245,000
Spec deductible
$150,000
Amount to file
$95,000
claims above spec deductible
Source: Javelina
Packet 23 days old — stale, refresh before submitting
Packet checklist2/7
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0179-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 23, 2026
Combined PDF
SL-2026-0179-submission-1-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 1 · Initial filing
Ready-to-file draft packet. Applies the $150,000 spec deductible and requests $95,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$245,000
Last filed cumulative paid
None yet
New eligible paid
$95,000
Filing creation threshold
$0
Current filing record
SL-2026-0179-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 23, 2026
Spec applied$150,000
Amount to request$95,000
Cumulative paid through$245,000
Filing threshold$0
Printed claim threshold$10,000

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

Claim detail
Claim Details
DateProviderDx codeAmount
2026-02-19Mass General — Cardiac SurgeryI50.43$151,900
2026-04-05MGH Step-DownI50.43$53,900
2026-05-05CVS SpecialtyI50.43$39,200
Total$245,000
Submit packet to carrier
Advance-funded · 4 days late
Provider check is on hold pending carrier approval. Every day this stays unfiled, the provider has been waiting on payment.
Documents2/7 required
Pushback risk cleared2/3 cleared
1 carrier pushback risk flagged for review below
Stuck on
HR
Waiting on active-at-work attestation
4 days since last meaningful update
Activity
  1. Spec deductible triggered
    May 20, 2026
    Advance-funded case — provider check on hold pending stop-loss filing
  2. Filing packet auto-assembled
    May 20, 2026
    Claim ledger, pre-cert, and COB pulled. HR email + case-mgmt upload request fired in parallel.
  3. Active-at-work email sent to Cascade HR
    May 20, 2026
  4. AAW auto follow-up #1 sent
    May 22, 2026
  5. AAW auto follow-up #2 sent — escalation suggested if no reply by tomorrow
    May 25, 2026
  6. Waiting on employer HR · active-at-work attestation pending
    HR has been emailed for the active-at-work attestation. Auto follow-up at day 2.
Carrier risk checks
Carrier pushback risk