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SL-2026-0176Ready to file Advance funded

D. Cole

Member M-09833 · NICU · Cascade Manufacturing

Member workspace
MC
Maria Chen
Assigned owner
Summary
Member
D. Cole
Diagnosis
NICU
P07.25
Carrier
Tokio Marine HCC
Total claims
$178,000
Spec deductible
$150,000
Amount to file
$28,000
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-2026-0176-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 27, 2026
Combined PDF
SL-2026-0176-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 $28,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$178,000
Last filed cumulative paid
None yet
New eligible paid
$28,000
Filing creation threshold
$0
Current filing record
SL-2026-0176-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 27, 2026
Spec applied$150,000
Amount to request$28,000
Cumulative paid through$178,000
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
2026-02-20Children's Hospital of Philadelphia — NICUP07.25$128,160
2026-03-07CHOP ImagingP07.25$28,480
2026-04-21Pediatrix Medical GroupP07.25$21,360
Total$178,000
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 16, 2026
  2. Filing packet auto-assembled
    May 16, 2026
  3. Core packet review complete
    May 27, 2026·Maria Chen
    Required support documents validated; 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