AccountId: 011433970860
ContactId: 032bc512-46c2-4cd8-bdb1-ccc5485a271d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456640 ms
Total Talk Time (AGENT): 164913 ms
Total Talk Time (CUSTOMER): 192040 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/032bc512-46c2-4cd8-bdb1-ccc5485a271d_20250404T14:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from the office for the claims.
[AGENT][POSITIVE] It would be my pleasure to assist you with claim status [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] [PII] with the extension [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please, ma'am?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The policy number is 02433298 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth please, ma'am?
[CUSTOMER][NEUTRAL] Sure. Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] And I will be happy to assist you with that claim status. And either do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have a claim number. The claim number is 353-592-1.
[AGENT][NEUTRAL] And that is for data service 916 24?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And what is the facility name and build amount?
[CUSTOMER][NEUTRAL] Name is Trenton Medical Center or Palms Medical Group.
[AGENT][NEUTRAL] Mhm. And the bill amount, please.
[CUSTOMER][NEUTRAL] And what else do you need?
[AGENT][NEUTRAL] The build amount
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Um, sure. The bill amount is $594 594.
[AGENT][NEUTRAL] I have a claim for 916-24 from Palms Medical Group but not for that build amount.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, what about the claim number that I've just given you?
[AGENT][NEUTRAL] That bill amount is 297.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The claim number of the EUB that we have received on our end has the amount of
[CUSTOMER][NEUTRAL] 594 pair.
[AGENT][NEUTRAL] Let me check something. Hang on just a second.
[AGENT][NEUTRAL] Let me pull the claim image up. Bear with me just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, it's 297 I guess.
[AGENT][NEUTRAL] Right, that's
[CUSTOMER][POSITIVE] Well they mentioned there's good.
[AGENT][NEUTRAL] OK, hang on just a second. OK, so it is 297.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right, thank you. So that claim we received on [PII] and processed on [PII]. Now the 99.
[AGENT][NEUTRAL] 214 was denied as office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Mhm. OK, we have called before.
[AGENT][NEUTRAL] And the procedure.
[AGENT][NEUTRAL] Go ahead. Mhm.
[CUSTOMER][NEUTRAL] OK. Um, thank you so much. We have called before on [PII], and as for that previous trip, the position 99214 was denied because it was not covered under the patient plan and 81002 was denied because they need the prime pair EOB for this one. So we sent the EOB to you on [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So, can you check like, did you receive the EMP on your end or not?
[AGENT][NEGATIVE] We have not received the EOB.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] And the like the denial on 81002 is for the EUB right? Can you confirm that?
[AGENT][NEUTRAL] Can you repeat that? 81002 is pending for the primary EOB.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. So that is the denial on that one, right?
[AGENT][NEUTRAL] That is correct, but we're still waiting for that primary EOB.
[CUSTOMER][POSITIVE] OK, thanks so much just a moment.
[CUSTOMER][NEUTRAL] And how do you like to receive that you'll be on it like, like do we need to fax it to you or mail it to you, like what else?
[AGENT][NEUTRAL] You can fax it directly to our claims department and our claims department fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] 3.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thanks so much. Just a moment.
[CUSTOMER][NEUTRAL] OK, um, but we have built the paper claim to you again on [PII]. So can you check if you receive another claim with the primary care information on your end or not?
[AGENT][NEUTRAL] We have not received any information regarding that procedure code and data service.
[CUSTOMER][NEUTRAL] No, the new claim because we have rebuilt the claim to you with the private information in it.
[AGENT][NEUTRAL] We, we did, and you said you mailed it on 225?
[CUSTOMER][NEUTRAL] Yes, it was a paper claim sent to you by paper.
[AGENT][NEUTRAL] We have not received it. Do you wanna verify that address?
[CUSTOMER][NEUTRAL] Sure. The address on the claim number is [PII].
[AGENT][NEUTRAL] That is no longer a valid claims mailing address. I can provide you with the correct address.
[CUSTOMER][NEUTRAL] Mhm. OK, what is it?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] This is the new claims mailing address, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And since when this media address was effective for these pairs?
[AGENT][NEUTRAL] Um, it's been about 2 years.
[CUSTOMER][NEUTRAL] OK, 2 years from which data service? Like, do you have the exact date for that?
[AGENT][NEUTRAL] The the address changed? No, ma'am, I don't. I'm sorry.
[CUSTOMER][POSITIVE] OK, thank you so much. Do you have any payers ID for this one?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] OK, thank you so much. And what is the caller reference number for this one?
[AGENT][NEUTRAL] Call reference number is my name and today's date. I spell my name [PII]
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with that claim information. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all. Thank you so much. Have a great day. Bye for now.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day as well. Take care.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Bye bye.