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SL-2026-WL-21Gathering docs Advance funded
P. Johnson
Member M-11202 · Cardiac Surgery · Cascade Manufacturing
Member workspaceMC
Maria Chen
Assigned owner
Summary
Member
P. Johnson
Diagnosis
Cardiac Surgery
I50.43
Carrier
Tokio Marine HCC
Total claims
$138,000
Spec deductible
$150,000
New eligible paid
$0
below $0 threshold
Source: Javelina
Packet 20 days old — stale, refresh before submitting
Packet checklist0/7
Filing threshold watch
Not ready to file yet
Claim ledger
SL-2026-WL-21-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 26, 2026
Combined PDF
SL-2026-WL-21-submission-1-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 1 · Initial filing
No filing draft yet. New eligible paid is $0, below the configured $0 filing creation threshold. Template: Platform reimbursement request form.
Current cumulative paid
$138,000
Last filed cumulative paid
None yet
New eligible paid
$0
Filing creation threshold
$0
Current filing record
SL-2026-WL-21-F01 · Initial filing
WatchingPaid periodJan 1, 2026 to May 26, 2026
Spec applied$150,000
New eligible paidNo new paid claims yet
Cumulative paid through$138,000
Filing threshold$0
Printed claim threshold$10,000
Member is over spec, but only $0 is newly eligible; wait until the configured $0 filing creation threshold is met.
Claim detail
Claim Details
| Date | Provider | Dx code | Amount |
|---|---|---|---|
| 2026-02-23 | Northwestern Memorial — Cardiac | I50.43 | $85,560 |
| 2026-04-09 | Northwestern Cardiac Rehab | I50.43 | $30,360 |
| 2026-05-09 | Northwestern Outpatient | I50.43 | $22,080 |
| Total | $138,000 | ||
Pre-stage monitoring
Member is at 92% of the $150,000 spec deductible. No filing yet — system is pre-assembling docs so we can file the moment cumulative claims cross spec.
Pre-staged docs0/7
Activity
- Member crossed 90% of spec — watchlist addMay 24, 2026
- Pre-emptive packet assembly startedMay 24, 2026Pulling docs now so we can file the moment cumulative claims cross the $150K spec deductible
- Just triggered · system building claim ledger and COBAuto-pulled docs landing now. Pre-cert and case management files can be uploaded locally when available.
Carrier risk checks
Carrier pushback risk