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SP
Sarah Park
Assigned owner
Summary
Member
H. Kim
Diagnosis
NICU
P07.25
Carrier
Sun Life Financial
Total claims
$137,000
Spec deductible
$100,000
Amount to file
$15,000
since last filed cumulative paid
Filed
$22,000
Reimbursed
$22,000
Source: Javelina
Packet 20 days old — stale, refresh before submitting
Packet checklist6/7
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0064-submission-2-claim-ledger.xlsx
Paid claims from Mar 19, 2026 to May 26, 2026
Combined PDF
SL-2026-0064-submission-2-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 2 · Subsequent incremental filing
Ready-to-file incremental packet. Requests $15,000 in new eligible paid claims since the last filed cumulative paid amount. Template: Platform reimbursement request form.
Current cumulative paid
$137,000
Last filed cumulative paid
$122,000
New eligible paid
$15,000
Filing creation threshold
$500
Filing records for this member
SL-2026-0064-F01 · Initial filing
ReimbursedPaid periodJan 1, 2026 to Mar 18, 2026
Spec applied$100,000
Filed amount$22,000
Cumulative paid through$122,000
Filing threshold$500
Printed claim threshold$10,000
Initial filing applied the specific deductible and set the last filed cumulative paid amount for future filings.
SL-2026-0064-F02 · Subsequent filing
DraftPaid periodMar 19, 2026 to May 26, 2026
Spec applied$0
Amount to request$15,000
Cumulative paid through$137,000
Filing threshold$500
Printed claim threshold$10,000
Subsequent filing for $15,000 in new eligible paid claims since the last filed cumulative paid amount. Deductible already applied.
Claim detail
Claim Details
| Date | Provider | Dx code | Amount |
|---|---|---|---|
| 2025-11-23 | UCSF Benioff Children's — NICU | P07.25 | $98,640 |
| 2025-12-08 | UCSF Imaging | P07.25 | $21,920 |
| 2026-01-22 | BabySteps Pediatric Specialty | P07.25 | $16,440 |
| Total | $137,000 | ||
Communication history
Communication2 messages
From usclaims@sunlifefinancial.com
Mar 18, 2026[SL-2026-0064] NICU stop-loss filing — H. Kim
Stop-loss claim filing for H. Kim (M-03012). Attached: claim ledger flat file plus combined PDF packet with supporting docs.
SL-2026-0064-claim-ledger.xlsx SL-2026-0064-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
From carrierclaims@sunlifefinancial.com
May 12, 2026Re: [SL-2026-0064] NICU stop-loss filing — H. Kim
Initial filing reimbursed $22K above the specific deductible
Submit packet to carrier
Funded — ready to submit
Plan has paid the underlying claims through the spec deductible. Ready to file for reimbursement of the amount above spec.
Documents6/7 required
Pushback risk cleared3/3 cleared
Activity
- Spec deductible triggeredFeb 16, 2026
- Filed to carrierMar 18, 2026·Sarah Park
- Reimbursement receivedMay 12, 2026·Sun LifeInitial filing reimbursed $22K above the specific deductible
- New paid claims reached filing thresholdMay 24, 2026$15K in new eligible paid claims since last filed cumulative paid; supplemental packet drafted
- Supplemental packet review completeMay 26, 2026·Sarah ParkReady to send separate subsequent filing; deductible already applied on initial filing
- Packet ready · awaiting rep approval to fileClick "Email packet to carrier" to submit. System has rebuttal packs ready for the likely carrier pushback areas.
Carrier risk checks
Carrier pushback risk