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SL-2026-0178Gathering docs Advance funded

M. Reyes

Member M-10277 · Spinal Surgery · Pacific Health Network

Member workspace
MC
Maria Chen
Assigned owner
Summary
Member
M. Reyes
Diagnosis
Spinal Surgery
M48.062
Carrier
Sun Life Financial
Total claims
$212,000
Spec deductible
$175,000
Amount to file
$37,000
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-2026-0178-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 26, 2026
Combined PDF
SL-2026-0178-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 $37,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$212,000
Last filed cumulative paid
None yet
New eligible paid
$37,000
Filing creation threshold
$500
Current filing record
SL-2026-0178-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 26, 2026
Spec applied$175,000
Amount to request$37,000
Cumulative paid through$212,000
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
2026-02-17Northwestern Memorial — NeurosurgeryM48.062$131,440
2026-04-03Northwestern PTM48.062$46,640
2026-05-03Specialty PharmacyM48.062$33,920
Total$212,000
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 cleared2/3 cleared
1 carrier pushback risk flagged for review below
Stuck on
Clinical team
Waiting on case-management notes upload
1 day since last meaningful update
Activity
  1. Spec deductible triggered
    May 18, 2026
  2. Pre-cert pulled from UM
    May 18, 2026
  3. Active-at-work confirmed
    May 22, 2026·Pacific Health HR
  4. Awaiting case mgmt CSV upload
    May 26, 2026·Maria Chen
  5. Almost ready · only case management notes outstanding
    Case management notes are the last item — clinical team upload pending.
Carrier risk checks
Carrier pushback risk