SL-2026-0168Ready to file Advance funded

G. Kumar

Member M-07891 · NICU · Pacific Health Network

Member workspace

Sarah Park

Assigned owner

Summary

Member

G. Kumar

Diagnosis

NICU

P07.25

Carrier

Sun Life Financial

Total claims

$204,000

Spec deductible

$175,000

Amount to file

$29,000

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-2026-0168-submission-1-claim-ledger.xlsx

Paid claims from Jan 1, 2026 to May 27, 2026

Combined PDF

SL-2026-0168-submission-1-filing-packet.pdf

Auto cover sheet + checklist supporting documents

Submission 1 · Initial filing

Ready-to-file draft packet. Applies the $175,000 spec deductible and requests $29,000 above deductible. Template: Platform reimbursement request form.

Current cumulative paid

$204,000

Last filed cumulative paid

None yet

New eligible paid

$29,000

Filing creation threshold

$500

Current filing record

SL-2026-0168-F01 · Initial filing

Draft

Paid periodJan 1, 2026 to May 27, 2026

Spec applied$175,000

Amount to request$29,000

Cumulative paid through$204,000

Filing threshold$500

Printed claim threshold$10,000

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

Claim detail

Claim Details

Date	Provider	Dx code	Amount
2026-02-19	Texas Children's Hospital — NICU	P07.25	$146,880
2026-03-06	Texas Children's Imaging	P07.25	$32,640
2026-04-20	Pediatrix Medical Group	P07.25	$24,480
Total			$204,000

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 cleared2/3 cleared

1 carrier pushback risk flagged for review below

Activity

Spec deductible triggered
May 15, 2026
Filing packet auto-assembled
May 15, 2026
Core packet review complete
May 27, 2026·Sarah Park
Required support documents are in; cover sheet generated for final review before submission
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