Referral

Send us the case.

Case details and records in one pass. Nothing runs automatically — a Sparx clinician opens every referral by hand.

The claim facts you enter here are what we treat as true. We use them over anything the records say, and we surface the disagreement rather than silently picking a side.

A Workers' Compensation Medicare Set-Aside, built to CMS submission standards.

Who is submitting this

Your name

Role

Phone

Street

City

State

ZIP

Claim and claimant

Claimant first name

Claimant last name

Gender

Date of birth

Date of injury

Claim number

Body parts

Compensable body parts

The injured body parts accepted on this claim. We treat these as the confirmed minimum and flag anything else the records reveal — we never quietly drop one.

Denied body parts

Body parts the carrier has refused to accept. This is a legal determination from the claim — we never infer it from the records. Leave this alone if nothing was denied.

Jurisdiction and pricing

Jurisdiction — state where the claim was filed

This drives fee-schedule pricing, so it has to be the claim's real state.

Claimant ZIP

Medical and payment records

Drop the records here, or

Choose files

PDF, TIFF, JPG or PNG. Up to 40 files, 250.0 MB each. Uploads go straight to encrypted storage from your browser.

A clinician reviews every referral

Records you upload are stored encrypted and are not used to train AI models. We delete them on request at any time, and within 30 days of returning your completed report. The same confidentiality obligations that govern every other Sparx engagement apply here.