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SL-2026-0162Ready to file Advance funded

V. Singh

Member M-06911 · NICU · Cascade Manufacturing

Member workspace
AR
Aisha Robinson
Assigned owner
Summary
Member
V. Singh
Diagnosis
NICU
P07.25
Carrier
Tokio Marine HCC
Total claims
$198,000
Spec deductible
$150,000
Amount to file
$48,000
claims above spec deductible
Source: Javelina
Packet 19 days old — stale, refresh before submitting
Packet checklist6/7
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0162-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 27, 2026
Combined PDF
SL-2026-0162-submission-1-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 1 · Initial filing
Ready-to-file draft packet. Applies the $150,000 spec deductible and requests $48,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$198,000
Last filed cumulative paid
None yet
New eligible paid
$48,000
Filing creation threshold
$0
Current filing record
SL-2026-0162-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 27, 2026
Spec applied$150,000
Amount to request$48,000
Cumulative paid through$198,000
Filing threshold$0
Printed claim threshold$10,000

Initial filing applies the specific deductible; request amount is paid claims above deductible.

Claim detail
Claim Details
DateProviderDx codeAmount
2026-02-18Cleveland Clinic — NICUP07.25$142,560
2026-03-05Cleveland Clinic — ImagingP07.25$31,680
2026-04-19Pediatric Specialty GroupP07.25$23,760
Total$198,000
Submit packet to carrier
Advance-funded
Plan files first, carrier funds the disbursement, plan mails check to provider. Filing speed = provider wait time.
Documents6/7 required
Pushback risk cleared3/3 cleared
Activity
  1. Spec deductible triggered
    May 14, 2026
  2. Filing packet auto-assembled
    May 14, 2026
  3. Core packet review complete
    May 27, 2026·Aisha Robinson
    Required support documents are in; cover sheet generated for final review before submission
  4. Packet ready · awaiting rep approval to file
    Advance-funded — provider check is on hold pending carrier approval. File now to start the disbursement clock.
Carrier risk checks
Carrier pushback risk