Specific Stop-Loss Filing Stages – Ringmaster Technologies

Specific Stop-Loss filings follow a stage workflow in Smart-LinQ. This is to convey status and guide administrators through common activities at different milestones of the filing lifecycle.

Stage Logic & Actions

See Filing Types Article

ACCUMULATING
Filing Types	Action	Description	Note
Initial Subsequent Advanced Funded Final	No action at this stage	Claims are placed under the filing on a daily basis and will continue to do so until the following have been met: Spec Deductible Agg Spec Deductible (if applicable) Min Filing Amount or Advanced Funded Threshold if an Advanced Funded Filing type If there are not filings in this stage at the time of processing then Smart-LinQ will create a new filing in Accumulating.
IN REVIEW
Filing Types	Action	Description	Note
Initial	Find unpaid claims to split; meeting the deductible and min filing Paid Claims threshold. TPA splits the claims in their Adjudication system.	After Accumulating, filings will go into this stage if: Policy is Advanced Funded Filing Type is Initial Both Paid & Unpaid claims are present The filing will move out of In Review when there are only Paid Claims left in it. Typically this will be accomplished when the TPA has performed their desired Paid Claims splits in their Adjudication System which supplies the updates to Smart-LinQ via the daily feed.
ELIGIBILITY
Filing Types	Action	Description	Note
Initial Note that the following types will skip this Stage if the Initial filing has already surpassed Eligibility Subsequent Advanced Funded Final	Issue Work Status Request Clear Work Status Pends Clear Supporting File Pends	After Accumulating or In Review, this stage is generally for an Initial filing type. The filing will land in Eligibility when a Work Status and/or Supporting File Pends need cleared.	Plan dependents will not require work status, and will automatically move to Ready to File status.
READY TO FILE
Filing Types	Action	Description	Note
Initial Subsequent Advanced Funded Final	Review & Submit filing	The filing has passed all previous stages and is queued up for the administrator to review, add documents, make adjustments and ultimately submit the filing.
FILED
Filing Types	Action	Description	Note
Initial Subsequent Advanced Funded Final	Monitor aging since the filing submission Awaiting Explanation of Reimbursement	The filing has been sent to the carrier/MGU for processing and no Explanation of Reimbursement has been posted yet. Posting an entry against the Explanation of Reimbursement will move the filing to the Reimbursement or Closed Stage.
REIMBURSEMENT
Filing Types	Action	Description	Note
Initial Subsequent Advanced Funded Final	Gather and upload additional documentation for reimbursement pends Refile	The filing has been submitted an Explanation of Reimbursement entry has been posted there is an outstanding balance (positive or negative)	A filing can move back into Reimbursement after being closed due to claim adjustments or other EOR entries.
REFILED
Filing Types	Action	Description	Note
Initial Subsequent Advanced Funded Final	Monitor aging since the re-filing submission Awaiting Explanation of Reimbursement	The filing has been re-submitted an Explanation of Reimbursement entry has been posted there is an outstanding balance (positive or negative)	The filing may move between Refiled and Reimbursement several times before moving to Closed, depending on how long the process takes.
Initial Subsequent Advanced Funded Final	No further action at this stage	The filing has been submitted and the balance is at $0

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