SL-2026-0171Gathering docs Advance funded

A. Davis

Member M-08855 · Spinal Surgery · Heartland Foods

Member workspace

Sarah Park

Assigned owner

Summary

Member

A. Davis

Diagnosis

Spinal Surgery

M48.062

Carrier

Sun Life Financial

Total claims

$158,000

Spec deductible

$100,000

Amount to file

$58,000

claims above spec deductible

Source: Javelina

Packet 20 days old — stale, refresh before submitting

Packet checklist5/7

Draft filing packet

Packet ready to file

Claim ledger

SL-2026-0171-submission-1-claim-ledger.xlsx

Paid claims from Jan 1, 2026 to May 26, 2026

Combined PDF

SL-2026-0171-submission-1-filing-packet.pdf

Auto cover sheet + checklist supporting documents

Submission 1 · Initial filing

Ready-to-file draft packet. Applies the $100,000 spec deductible and requests $58,000 above deductible. Template: Platform reimbursement request form.

Current cumulative paid

$158,000

Last filed cumulative paid

None yet

New eligible paid

$58,000

Filing creation threshold

$500

Current filing record

SL-2026-0171-F01 · Initial filing

Draft

Paid periodJan 1, 2026 to May 26, 2026

Spec applied$100,000

Amount to request$58,000

Cumulative paid through$158,000

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
2026-02-17	Cleveland Clinic — Neurosurgery	M48.062	$97,960
2026-04-03	Cleveland Clinic Rehab	M48.062	$34,760
2026-05-03	CVS Pharmacy	M48.062	$25,280
Total			$158,000

Submit packet to carrier

Advance-funded

Plan files first, carrier funds the disbursement, plan mails check to provider. Filing speed = provider wait time.

Documents5/7 required

Pushback risk cleared3/3 cleared

Stuck on

Clinical team

Waiting on case-management notes upload

1 day since last meaningful update

Activity

Spec deductible triggered
May 18, 2026
Pre-cert + COB auto-pulled
May 18, 2026
Active-at-work confirmed
May 24, 2026·Heartland HR
Awaiting case mgmt notes upload from clinical team
May 26, 2026·Sarah Park
Almost ready · only case management notes outstanding
Case management notes are the last item — clinical team upload pending.

Carrier risk checks

Carrier pushback risk