The submitted invoice is below (client information intentionally omitted):
How would you proceed with this claim with the information provided to you? Do we need additional information? Why or why not? Think about it before proceeding to the following page!
Next
Claim Investigation Determination
Done thinking? Click on the image below to see how you should proceed with this claim!
Do we need additional information?
Do we need additional MR?
Defend your reasoning!
Next
Invoice
Bonus question! We received an additional invoice (client information intentionally omitted):
Do we need additional information?
Answer Reveal!
Do we proceed with our claim?
Defend your reasoning!
End
Do we need additional information?: Yes Do we need additional MR?: No Why?: The invoice the PH submitted is not an actual invoice. So while we don't need to delay the claim for an MRR or additional MR, we do need to delay the claim due to missing a complete, finalized invoice.
Do we need additional information?: No Do we proceed with the claim?: Yes Why?: Even though this invoice is grainy/blurry, we have all the information we require to proceed with the claim. And since we know that Percorten treats Addison's disease, and Addison's is not pre-existing, we can cover the claim without investigating further.
Claim Advo CE - Scenario #2 - Luna
Lemonade
Created on October 16, 2025
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Transcript
Scenario #2
Luna
Start
TL;DR + Claim Media
No claim media was provided since the claim was filed as a follow.
Pre-Existing Conditions
Claim Lifecycle
Next
Claim Overview
Next
Invoice
The submitted invoice is below (client information intentionally omitted):
How would you proceed with this claim with the information provided to you? Do we need additional information? Why or why not? Think about it before proceeding to the following page!
Next
Claim Investigation Determination
Done thinking? Click on the image below to see how you should proceed with this claim!
Do we need additional information?
Do we need additional MR?
Defend your reasoning!
Next
Invoice
Bonus question! We received an additional invoice (client information intentionally omitted):
Do we need additional information?
Answer Reveal!
Do we proceed with our claim?
Defend your reasoning!
End
Do we need additional information?: Yes Do we need additional MR?: No Why?: The invoice the PH submitted is not an actual invoice. So while we don't need to delay the claim for an MRR or additional MR, we do need to delay the claim due to missing a complete, finalized invoice.
Do we need additional information?: No Do we proceed with the claim?: Yes Why?: Even though this invoice is grainy/blurry, we have all the information we require to proceed with the claim. And since we know that Percorten treats Addison's disease, and Addison's is not pre-existing, we can cover the claim without investigating further.