AccountId: 011433970860
ContactId: 04d96fd4-95b7-45ad-b3f9-90a3e5c599e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2520209 ms
Total Talk Time (AGENT): 548720 ms
Total Talk Time (CUSTOMER): 1379719 ms
Interruptions: 13
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/04d96fd4-95b7-45ad-b3f9-90a3e5c599e8_20250305T21:02_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, ma'am. My name is [PII] calling for Doctor [PII] to check on a claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I can help you with the patient's information or provider's information?
[AGENT][NEUTRAL] Sure, and you say your name is?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK. [PII]. You're calling from which facility or provider, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] How do you spell that?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. So the first name is [PII]. And the last name is [PII].
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. The member ID number here is 02439278 M as in Mike, L [PII] in [PII] as in [PII].
[AGENT][NEUTRAL] OK, and a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name of the patient is [PII], and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The service is [PII].
[CUSTOMER][NEUTRAL] And the amount here is just a moment, it's still loading.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Amount is $1,288.67.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And you said the date of service is [PII]?
[CUSTOMER][POSITIVE] Yes, perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am, could you please spell your name for me?
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you very much. So right, [PII]
[AGENT][NEUTRAL] Correct. Yes, one moment.
[CUSTOMER][NEUTRAL] OK, uh, OK. So can I call you by your name? OK. OK. Thank you, sir.
[AGENT][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm waiting on the EOB one moment.
[CUSTOMER][POSITIVE] OK, sure. Take your time, no problem.
[CUSTOMER][NEUTRAL] Uh, for your information, Sol, uh, the latest submission is on [PII].
[CUSTOMER][NEUTRAL] Do you have the payment file?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Is that the latest submission?
[AGENT][NEUTRAL] That's when you send the claim?
[CUSTOMER][NEUTRAL] No, I submitted claim. Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, that's not gonna be the day that we receive it, so yeah, that's not gonna help, but um let me go ahead and see if this is your claim. I just need to wait for the paperwork to come up, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, OK, uh, take your time, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, yes, this is your claim. OK, it looks like we received the claim on [PII], processed [PII].
[AGENT][NEUTRAL] And we send a benefit amount.
[CUSTOMER][POSITIVE] OK, thank you very much. May I
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of $375.01.
[CUSTOMER][NEUTRAL] So it is paid?
[AGENT][NEGATIVE] Yes, it is pain.
[CUSTOMER][NEUTRAL] OK. And it, it is not processed towards deductible or anything else, right?
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, sure. The claim is paid, but it is not processed towards deductible or anything uh like coinsurance or uh any patient responsibility, right?
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] Uh, we are not the major medical. We are the secondary policy. So what we do is we help with the co-payments, co-insurance and deductibles from the major medical.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So based on the information of the major medical, they applied um 37501 to the member's responsibility and that's the payment we send.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you very much. So the payment is processed towards deductible, right?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, let me pull the primary it will be make sure. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Alright, let's see here.
[AGENT][NEUTRAL] OK, so let's see. OK, it was applied towards the deductible.
[CUSTOMER][NEUTRAL] OK, thank you very much. So it is applied towards the deductible. The claim is paid and it is applied towards patient's deductible, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Thank you very much. So, just a moment. I need some specific information regarding it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment. So, as you say, the receipt date is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you very much. And may I know the process date one more time, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And may I know the process amount?
[AGENT][NEUTRAL] The paid amount, um, let me go ahead and.
[AGENT][NEUTRAL] Hold up again, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] $375.01.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] $375.01. Thank you. What is the annual deductible amount?
[AGENT][NEUTRAL] No, we're not the primary.
[CUSTOMER][NEUTRAL] OK, so you don't have this information?
[AGENT][NEUTRAL] No, because we're not the primary. Again, we are the secondary. What we do is we help to pay the deductibles, co-payment, and co-insurance from the major medical. So what the major medical applied towards the deductible, that's what we pick up and that's what we pay. So in this case, the 37501 was applied towards the member's responsibility on the member's deductible from major medical, and that is what we paid.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Action.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and you don't have the information regarding how much patient made deductively, right?
[AGENT][NEUTRAL] No, we're not the major medical.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh, just for the documentation, I asked this question. So sorry for that. Uh, uh, do you know, is the, uh, deductible process, uh, towards in-network or out-network deductible?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not sure. We're not the major medical.
[CUSTOMER][NEUTRAL] OK, thank you for this information. Take about just a moment. You don't have this information because you're not primary. I have to mention the same here. Uh, do you have the information regarding to which address UB was mailed to?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK. Yes, um, we send the payment with the explanation of benefits to uh [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, let me just recon for you. Uh, the address on which you, uh, the UB was mailed to is [PII], right?
[AGENT][NEUTRAL] Mhm, right.
[CUSTOMER][NEUTRAL] OK, thank you very much. So, uh, could you please send us the UB uh to our fax number?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] Yeah, sure. Thank you very much. So, uh, so the fax number is [PII]. Attention to the patient's account number.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so [PII]. And that's tension on 576-035-7 V as in Victor, 22724.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes, perfect.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][POSITIVE] Yeah, sure. Take your time, no problem.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEGATIVE] Yeah. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, uh, just a moment here. Uh, may I know the, uh, claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, the claim number is 3,569,500.
[CUSTOMER][NEUTRAL] 3,569,500. Uh, and the call reference number is your name and today's date, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, I have a few more claims here. Uh, so, could you please help me with those two, please.
[AGENT][NEUTRAL] How many more do you have?
[CUSTOMER][NEUTRAL] Uh, 3 more only.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] OK. OK, thank you very much.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] job.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] So the next uh member ID number here is 1293667 M as in Mike L as in Lima 7.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name of the patient is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah I I have that.
[AGENT][NEUTRAL] What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data service here [PII].
[AGENT][NEUTRAL] How much is the total?
[CUSTOMER][NEUTRAL] And the bill amount is 300, OK, $300 even.
[AGENT][NEUTRAL] 38, OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And again, that was [PII]?
[CUSTOMER][NEUTRAL] Uh, just a moment here. Uh, [PII] you. OK. Yes, it is, uh, no, no, no, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] So sorry for that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a moment here. OK all set.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, it is [PII]. So.
[AGENT][NEUTRAL] OK, so that's 10.
[CUSTOMER][NEUTRAL] And the bill amount is 300. OK.
[AGENT][NEUTRAL] OK, 1015 of 24, correct?
[CUSTOMER][POSITIVE] 1015 24, perfect.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, let me see if there's any other.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] this one.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And they recently submitted claim is on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I I I.
[AGENT][NEUTRAL] OK, we received the claim [PII].
[AGENT][NEGATIVE] And the claim was denied. The reason for this denial is that the service was rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] And I'm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK. Uh, so as for the previous follow-up here, uh, uh, dated on [PII], as for the previous follow-up, the pay, the claim is denied because the patient may not be eligible on the, the date of service. Is that correct?
[AGENT][NEUTRAL] Correct, the policy was terminated.
[CUSTOMER][NEUTRAL] OK, so, mm, so it says rented.
[CUSTOMER][NEUTRAL] So, uh, the reason for denial is the patient is not active on data of service, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][POSITIVE] OK, thank you very much. [PII], just a minute. I will note it down the same here.
[CUSTOMER][NEUTRAL] Just a resort.
[CUSTOMER][NEGATIVE] Patient is not.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] of service. Just a moment. I need some few questions regarding this denial. Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I really appreciate your patience too just a moment the system is loading. OK, mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yes yes.
[CUSTOMER][NEUTRAL] OK, thank you very much for waiting. Um, so as you see, the received date is uh [PII], right?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK. May I know the Dial it?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Bear with me, let me go back to it again.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, please.
[AGENT][NEUTRAL] OK. The received date is the [PII], the process is the [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Receive date [PII].
[CUSTOMER][NEUTRAL] OK, received date is [PII] and process date is [PII]. So let me just reconfirm the receive date is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the date is [PII]. Perfect. OK, thank you very much. Uh, what is the patient's policy effective and term date?
[AGENT][POSITIVE] Correct. Mhm.
[AGENT][NEUTRAL] OK, let me go back to that again. OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, the policy was effective [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it terminated [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. Thank you very much. So, when was the last year be updated?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Not sure. We're just a secondary and this policy terminated back in [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So, um, that's the question for the major medical, not from us.
[CUSTOMER][NEUTRAL] OK, so you don't have.
[CUSTOMER][NEUTRAL] OK, thank you very much. You, so you don't have that information. Just one, thank you very much. I have to mention the same. Do you see any, any other pay listed for this patient?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] OK, so may I know the time you finding to submit credit correct claim?
[AGENT][NEGATIVE] There's no timely filing for corrected claim. The policy is terminated.
[CUSTOMER][NEUTRAL] OK, no time filing.
[CUSTOMER][NEUTRAL] Thank you. And mailing address to submit credit claim?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, thank you very much, sir. And there is no any specific form for appeal, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] There is no any specific form for appeal, right?
[AGENT][NEUTRAL] No. Mm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] Just a moment. I don't mention the same here. And uh timely filing to submit an appeal, uh, there's no timely filing, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For an appeal, it's 180 days from the decision date.
[CUSTOMER][NEUTRAL] OK, for appeal, 180 days from denial date, right? OK. So the timely filing to submit an appeal is 180 days from denial date. OK. The mailing address to submitted an appeal, is that the same one?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment, I wrote it down same you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And there's no any specific form for a bill, right?
[AGENT][NEUTRAL] There's no what? I'm sorry?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, there is no any specific form for appeal, right?
[AGENT][NEUTRAL] No. Mm mm.
[CUSTOMER][POSITIVE] OK, thank you very much. May I know the claim number for this one?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, that is 3542575.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 575 thank you very much and the call reference number is your name [PII] and today's date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, so your, uh, first name, uh last name initially is [PII], right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thanks. Thank you very much, sir. Uh, could you proceed further for the next one?
[AGENT][NEUTRAL] Bear with me, let me make a note. You don't need any other information on this one?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, uh, no any other information. I just have one confusion here, uh, so, because, uh, by the previous representative, I asked the same question regarding the timely filing to submit an appeal, and she told me there is no any timely filing for, uh, appeal too.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] For appeal, it's 180 days. That's incorrect. It's always been 180 days.
[CUSTOMER][NEUTRAL] Is that correct or incorrec[PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] For correcting, uh, so there is no any uh other information I needed. Uh, you just gave me everything here. Thank you very [PII]h for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today? Any other queries?
[CUSTOMER][NEUTRAL] No, I have a few more claims here. Uh, I just need, uh, uh, just a moment, uh, OK. I just missed with one question here. Do you need deny you before your submission?
[AGENT][POSITIVE] I'm sorry, do we need what? I'm sorry?
[CUSTOMER][NEUTRAL] Denied UB for his submission.
[AGENT][NEUTRAL] Um, no, especially on this one that is terminated.
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] OK. So, noting that you'll be required for resubmission. Thank you very much. So could you proceed further for the next claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] What's the next, OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Just 2 more.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, sure. So the next policy number here is, uh, member ID number is 02559255.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK. Date of service here is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] And the bill, yeah, just a moment. The system is loading, just a moment.
[CUSTOMER][NEUTRAL] OK. Uh, the total charge is $286.34.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Total charge is 266.34.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 286 34286.34.
[AGENT][NEUTRAL] OK, then this is probably not your claim then. Bear with me just a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the procedure code?
[CUSTOMER][NEUTRAL] OK, just a moment. So the procedure code here is uh just a moment. I'm checking.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the.
[CUSTOMER][NEUTRAL] I uh.
[CUSTOMER][NEUTRAL] CPD code here is 99213.
[AGENT][NEUTRAL] Is it just one procedure card?
[CUSTOMER][POSITIVE] Yes, yes, uh, here is just one, outstanding for $25 even and the others are, uh, there is no any outstanding amount here.
[AGENT][NEUTRAL] And you said the amount is 28634?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes, uh, this amount is for, uh, the primary.
[CUSTOMER][NEUTRAL] Bill amount, total charges. OK.
[AGENT][NEUTRAL] Marry me.
[AGENT][NEUTRAL] I will have to pull the images of the usual claim. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The recently submitted a claim is on [PII].
[AGENT][NEUTRAL] It's OK, we don't need that information.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah I guess.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It was
[AGENT][NEUTRAL] OK, got that.
[CUSTOMER][NEUTRAL] Limerick.
[AGENT][NEUTRAL] I'm gonna have to put you on hold. I need to put more documents. One moment.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, Mr. [PII]. OK, I, I need you to look at the claim and tell me how much is for that code.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, just a moment. Uh, I'm going to tell you, uh, the claim submission, uh, bill amount here. I just moved, uh, from the claims, claim forms. Just a moment. OK. So the totally bill, uh, for this claim, which is on [PII]. Just a moment, system is loading.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Uh, oh, so this is billed for $266.34.
[AGENT][NEUTRAL] OK, that's the one we have, OK? We don't have the 286. So let me give you the information based on the 266 34, which is processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And it was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, it is processed on [PII]. Just a moment, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment here. I have to note down the same.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it is denied, right? Denied because not covered under this uh patient's policy. Perfect.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Office visits are not covered under the member's policy.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Office, uh, visits are not.
[CUSTOMER][NEUTRAL] Go what window.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Patient's policy. Thank you very much. Let me just reconfirm one more time. Uh, so the claim is denied and it is denied because office visits are not covered under the patient's policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you very much. Uh, so just a moment. I need specific information from you regarding this. OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so, uh, may I know the received date first?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the process date is uh [PII], right?
[AGENT][NEUTRAL] [PII], yes, mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, uh, and the, uh, Dina is also the same, [PII].
[AGENT][NEGATIVE] It was received on the [PII] process and denied on the [PII].
[CUSTOMER][NEUTRAL] Yeah right.
[CUSTOMER][NEUTRAL] OK, thank you very much. Pro 79 on 26. Uh, which CPD is not covered as per patient's policy?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, no, I need to know which CPT is not covered as per patient's policy, which CPT code?
[AGENT][NEUTRAL] OK, Mr. [PII], we're just talking about one CPT, so that's the CPT. So it's the office visit CPT.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, uh, I'm just for the documentation and as for the guidelines, I asked this question. So could you please reconfirm it?
[AGENT][NEUTRAL] The 99213, the same one that you, yeah, the, the one you gave me in the beginning, 99213.
[CUSTOMER][NEUTRAL] Uh, this is
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] Uh, sorry for asking that question, uh, because I have to ask that question, as for the guidelines and re-verify it. Thank you for understanding and there is no timely filing to submit claim, right?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, thank you very much. And the mailing address to submit correctly claim is as is same as the previous one which is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh timely filing to submit an appeal is 180 days from denial date, right?
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the mailing address address to submit and appeal is also the same ones, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and there is no any specific form for appeal, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you very much, sir, for this information. May I have the claim number?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] Oh, sure. That's 356-852-2.
[CUSTOMER][NEUTRAL] OK, uh, and you don't need denied you for your submissions, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, and the call reference number is your name, [PII], and today's date, right?
[AGENT][POSITIVE] Mm correct.
[CUSTOMER][POSITIVE] OK, thank you very much. Just a moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sorry, uh, could you proceed further for the last one?
[CUSTOMER][NEUTRAL] So, OK. Yeah, sure. So the next, uh, policy number here is 02342158.
[AGENT][NEUTRAL] OK, um, what's the next policy?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Yes sure take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, name of the patient here is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Your date of service here is [PII].
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] Just a moment, it's still loading. The total charge here is uh $80 even $80.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And you said the date of service, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We don't have that claim on file.
[CUSTOMER][NEUTRAL] OK, um, as for my previous follow up here.
[CUSTOMER][NEUTRAL] Uh, soon, uh, uh, the date on which, uh, [PII], the claim, uh, is in process. Do you have that, uh, follow up on your file?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Nope.
[AGENT][NEUTRAL] Claim is not here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Please start here. Uh, could you please verify one more time? The amount is $80. OK, $80.
[AGENT][NEUTRAL] I did.
[AGENT][NEGATIVE] I, I, I did 3 times already. It's not here.
[CUSTOMER][POSITIVE] OK, thank you. OK, thank you very much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Just a moment, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, just to verify, and as for the guidelines, I just uh need to verify uh this one more time that the previous follow up is on [PII] and the claim was in process. Uh, that is incorrect, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, thank you very much, so for this information. So the claim is not on file. I just need some specific information from you. May I know the patient is active on data service?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, he's not active in the data of service. Um, the policy terminated [PII].
[CUSTOMER][NEUTRAL] Be
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so the patient is not active in data service. OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, Miss [PII] fine.
[CUSTOMER][NEUTRAL] And patient.
[CUSTOMER][NEUTRAL] He's not active.
[CUSTOMER][NEUTRAL] OK date of service, OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, may I know the patient's effective and term date?
[AGENT][NEUTRAL] The effective date is [PII], terminated [PII].
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] OK. [PII]. Let me just reconfirm effective date is uh [PII] and term date is [PII], right? OK. Uh do you have the information regarding when was the last COB updated?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] We're not the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you see any other payroll listed for this patient?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, timely filing to submit the claim is, uh, no timely filing, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the mailing address to submit correct claim is the same as previous one, right? Uh, [PII], right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, thank you very much. Uh, just a moment. I have to note it down the same here. OK, uh, and the timely filing to submit an appeal is 180 days from denial date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and the mailing address submit an appeal is also the same right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And there is no any specific form for pay, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you very much, uh.
[CUSTOMER][NEUTRAL] So for this information. So there is no claim number because the claim is not on file, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, thank you very much. And for denied, uh, claims, you don't need denied for the submission, right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, thank you very much. So for this information. And the call reference number is your name and today's date. Is that correct?
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][POSITIVE] OK. Thank you very much sir for your assistance. Have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] Yes, so Mr. [PII] and thank you for calling ATL. Bye-bye.
[CUSTOMER][NEUTRAL] Uh