AccountId: 011433970860
ContactId: 01ac20ef-002d-43e0-abbb-f06c3ad655c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455049 ms
Total Talk Time (AGENT): 138154 ms
Total Talk Time (CUSTOMER): 128464 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/01ac20ef-002d-43e0-abbb-f06c3ad655c5_20250213T21:04_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office, checking on the claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] 01920754
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] And what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. My extension direct line?
[AGENT][NEUTRAL] OK. And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you and we're checking claim status for what date of service?
[CUSTOMER][NEUTRAL] [PII] and total charges of $542 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I show the claim was not payable because office visits are not covered under this particular policy. I'm showing a received date of [PII] processed on [PII].
[AGENT][POSITIVE] And any other questions I can help out with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have a claim number?
[AGENT][NEUTRAL] 354-700-008
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Thank you. So according to this plan, offices are not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you. Can you fax me the UB?
[AGENT][POSITIVE] Uh it was actually mailed the next day after it was processed and it's now available online. um, I'll give you that web address and then I can assist you with creating the account. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah, we have a portal. Is all this will be available in that portal.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, already we have the portal. Is that every UB can we we can we download through that portal?
[AGENT][NEUTRAL] You can, you can download it using the, the policy, the claim number provided, the patient's first name and the patient's date of birth.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can we go for, can we go for the next thing?
[AGENT][NEUTRAL] OK, how many do you have?
[CUSTOMER][NEUTRAL] Only one claim left?
[AGENT][NEUTRAL] OK. Is it for the same person or a different patient?
[CUSTOMER][NEUTRAL] Different patient?
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02462630.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges of $3480 even 3480.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] You said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What is the procedure or procedure codes on the claim?
[CUSTOMER][NEUTRAL] Procedure code is 00813.
[AGENT][NEUTRAL] Just the one code?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I see the procedure code for date of service [PII], but the total bill charge is different than what you provided.
[AGENT][NEUTRAL] So is there a modifier on your claim?
[CUSTOMER][NEUTRAL] Yeah, we have to modify it. It's QZ and P2.
[AGENT][NEUTRAL] Were there two separate claims billed on this for this state of service?
[CUSTOMER][NEUTRAL] No, only one claim bill.
[AGENT][NEUTRAL] OK, so I don't show the claim that's has the billed amount that you provided.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So uh with that bill amount, you don't have a claim?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Is that provider Gomez Quintilla juice?
[AGENT][NEUTRAL] What is the name of the?
[AGENT][NEUTRAL] Anesthesiologist's office.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Galloway Anesthesia Associates.
[AGENT][NEUTRAL] OK. And what is the doctor's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing it, OK.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] She.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, the total charge on this claim.
[AGENT][NEUTRAL] [PII] is different than the total charge that you provided. Do you show a different date of, uh, total charge?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, we have bill with only $3480 even.
[AGENT][NEUTRAL] OK, so that amount doesn't match the one that we received, so I don't have a claim for the amount that you just gave me.
[CUSTOMER][NEUTRAL] OK, so can we resubmit the claim?
[AGENT][NEUTRAL] You sure can.
[CUSTOMER][NEUTRAL] OK, may I know the timely spending limit?
[AGENT][NEUTRAL] To submit a claim, there's no timely filing limit?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Is patient active for the date of service? Can you provide me the effective dates?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The policy effective date is [PII]. The policy is no longer active [PII].
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can you provide me the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] OK, thank you for your assistance. Can I have a call reference number?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL, [PII]. Have a good day as well.
[CUSTOMER][POSITIVE] Thanks.