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SL-2026-0169Gathering docs Advance funded

M. Ng

Member M-07955 · Cardiac Surgery · Pacific Health Network

Member workspace
DN
David Nguyen
Assigned owner
Summary
Member
M. Ng
Diagnosis
Cardiac Surgery
I50.43
Carrier
Sun Life Financial
Total claims
$232,000
Spec deductible
$175,000
Amount to file
$57,000
claims above spec deductible
Source: Javelina
Packet 22 days old — stale, refresh before submitting
Packet checklist2/7
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0169-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 24, 2026
Combined PDF
SL-2026-0169-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 $57,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$232,000
Last filed cumulative paid
None yet
New eligible paid
$57,000
Filing creation threshold
$500
Current filing record
SL-2026-0169-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 24, 2026
Spec applied$175,000
Amount to request$57,000
Cumulative paid through$232,000
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
DateProviderDx codeAmount
2026-02-20Cedars-Sinai — Smidt Heart InstituteI50.43$143,840
2026-04-06Cedars-Sinai OutpatientI50.43$51,040
2026-05-06Optum Specialty PharmacyI50.43$37,120
Total$232,000
Submit packet to carrier
Advance-funded · 3 days late
Provider check is on hold pending carrier approval. Every day this stays unfiled, the provider has been waiting on payment.
Documents2/7 required
Pushback risk cleared2/3 cleared
1 carrier pushback risk flagged for review below
Stuck on
HR
Waiting on active-at-work attestation
3 days since last meaningful update
Activity
  1. Spec deductible triggered
    May 21, 2026
  2. Filing packet auto-assembled
    May 21, 2026
    Pre-cert, COB, and claim ledger pulled. HR AAW email fired in parallel.
  3. Active-at-work email sent to Pacific Health HR
    May 21, 2026
  4. AAW auto follow-up #1 sent — no reply yet
    May 24, 2026
  5. Waiting on employer HR · active-at-work attestation pending
    HR has been emailed for the active-at-work attestation. Auto follow-up at day 2.
Carrier risk checks
Carrier pushback risk