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SL-2026-0156Info requested

Q. Chen

Member M-06677 · Trauma Surgery · Heartland Foods

Member workspace
SP
Sarah Park
Assigned owner
Summary
Member
Q. Chen
Diagnosis
Trauma Surgery
S36.298A
Carrier
Sun Life Financial
Total claims
$113,000
Spec deductible
$100,000
Amount to file
$13,000
claims above spec deductible
Filed
$13,000
Reimbursed
$0
Outstanding
$13,000
Source: Javelina
Packet 23 days old — stale, refresh before submitting
Packet checklist7/7
Filing output and history
Filing output
Claim ledger
SL-2026-0156-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 23, 2026
Combined PDF
SL-2026-0156-submission-1-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 1 · Initial filing
Initial filing includes all paid claims from plan start through current paid date. Template: Platform reimbursement request form.
Current cumulative paid
$113,000
Last filed cumulative paid
$113,000
New eligible paid
$0
Filing creation threshold
$500
Current filing record
SL-2026-0156-F01 · Initial filing
Submitted
Paid periodJan 1, 2026 to May 9, 2026
Spec applied$100,000
Filed amount$13,000
Cumulative paid through$113,000
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.

Claim detail
Claim Details
DateProviderDx codeAmount
2026-01-27Penn Trauma CenterS36.298A$70,060
2026-03-13Penn Step-DownS36.298A$24,860
2026-04-12Specialty PharmacyS36.298A$18,080
Total$113,000
Communication history
Communication2 messages
From usclaims@sunlifefinancial.com
May 9, 2026
[SL-2026-0156] Trauma Surgery stop-loss filing — Q. Chen

Stop-loss claim filing for Q. Chen (M-06677). Attached: claim ledger flat file plus combined PDF packet with supporting docs.

SL-2026-0156-claim-ledger.xlsx SL-2026-0156-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
From carrierclaims@sunlifefinancial.com
May 20, 2026
Re: [SL-2026-0156] Trauma Surgery stop-loss filing — Q. Chen

Carrier asked for confirmation of member eligibility on date of service

Action: Send updated active-at-work attestation for 2026-Q1
Carrier asked for info
Days waiting on us: 4
Eligibility verification request
Carrier asked for confirmation of member eligibility on date of service
System has the response drafted from existing case data — review and send.
Stuck on
Internal
Waiting on Eligibility verification request
4 days since last meaningful update
Activity
  1. Spec deductible triggered
    Apr 27, 2026
  2. Filed to carrier
    May 9, 2026·Sarah Park
  3. Eligibility verification request
    May 20, 2026·Sun Life
    Carrier asked for confirmation of member eligibility on date of service
  4. Eligibility records pulled from Workday
    Apr 27, 2026
  5. Eligibility records compiled
    May 23, 2026·Sarah Park
    Confirmed member was active on DOS; preparing carrier reply
  6. Carrier requested more info · rep needs to respond
    Carrier asked for confirmation of member eligibility on date of service
Carrier risk checks
Carrier pushback risk