AccountId: 011433970860
ContactId: 05950d48-a830-4a79-854a-f6df231fbc4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 771429 ms
Total Talk Time (AGENT): 144400 ms
Total Talk Time (CUSTOMER): 322328 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/05950d48-a830-4a79-854a-f6df231fbc4f_20250522T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from doctor's office regarding the status of a plan. Can you please help me for checking over that?
[AGENT][NEUTRAL] Yes, I can help with claim status card. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII] with the extension of [PII].
[AGENT][NEUTRAL] OK, thank you. And the policy number for that patient?
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number, one moment, it is loading here.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, got it here.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The patient's uh member ID is?
[CUSTOMER][NEUTRAL] 02485255 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] So, the patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and what's the date of service and bill charges?
[CUSTOMER][NEUTRAL] Sure. The, I have 3 date of services for the same patient. The first date of service is 5-13-2024, with the amount of $175.02.
[AGENT][NEUTRAL] You said 5:13 2024?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] Uh, I don't have a claim on file.
[CUSTOMER][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Uh just a moment to verify the claim has been submitted via.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The claim has been submitted uh
[CUSTOMER][NEUTRAL] 2 times, the first time on [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII].
[CUSTOMER][NEUTRAL] Uh, that you have not received the claims. I'm not sure why it will need to see. One moment.
[CUSTOMER][NEUTRAL] It is submitted electronically. Can you please verify that?
[AGENT][NEUTRAL] Um, I, I don't show we've received it. Our payer ID is 60801.
[CUSTOMER][NEUTRAL] 11, yeah 60801 is the payer ID we have been submitted but you have not received means.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment. Uh, can you please verify the patient's eligibility?
[AGENT][NEUTRAL] Yes, the effective date is [PII].
[AGENT][NEUTRAL] And term date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, one moment. Uh, what was the effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And turn down?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So the patient was eligible at the time of this uh date of service, so we can submit the claim. What is the timely filing limit for submitting the fresh claim?
[AGENT][NEUTRAL] There's no timely filing limit. You can submit any time.
[CUSTOMER][NEUTRAL] Oh, no timely filing limit for fresh claim, OK.
[CUSTOMER][NEGATIVE] To hear that no timely filing limit.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK. Uh, can you please provide me the mailing address?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Am I right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One moment. [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Uh, and the zip code is [PII]. Am I right?
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][POSITIVE] OK, thank you, thanks for the details. One moment please.
[CUSTOMER][NEUTRAL] OK. Uh, uh, is there any fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] 9423. OK. And the payer ID is?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. And there's no timely filing limit for submitting the claim. So we can submit the claim as soon as possible. OK. Uh, and I have two more data services for the same patient. Is the reference number the same? Can you please provide me the reference number or at the end of the call, you can provide me.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, reference number is my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, sorry for that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII] OK. Can I get the spell of your, uh sorry, initial, uh last name initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Shall we go for the next patient? Uh sorry. Shall we go, go for the next date of service for the same patient?
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Yeah, the next date of service for the patient is [PII], with the amount of $1200 even.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, we received the claim on [PII], and it was processed on the same date.
[AGENT][NEUTRAL] We made a payment of 337 43.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] The claim has been paid.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK, one moment.
[CUSTOMER][NEUTRAL] OK. Uh, what was the allowed amount of the claim?
[AGENT][NEUTRAL] Um, we, we paid 337 43.
[AGENT][NEUTRAL] There's not an allowed amount. It just pays according to the policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] The claim was paid the amount of 33743 with no members responsibility.
[AGENT][NEUTRAL] Um, we can't determine patient responsibility. We're secondary policy.
[CUSTOMER][NEUTRAL] OK. No problem. OK. Uh, can you please provide me, uh, the claim has been paid through EFT or check or VCC?
[AGENT][NEUTRAL] A single check and the check number is 203.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 7008.
[CUSTOMER][NEUTRAL] 7008. OK. It is a single check. Uh, what was the date, when was it issued?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The same date it was the check was issued on the same date itself. OK. OK. Can I get the claim number?
[AGENT][NEUTRAL] My number 358-43997.
[CUSTOMER][NEUTRAL] 358-43997. Uh, OK, [PII], can you please fax me the EUB?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. What's your facts?
[CUSTOMER][NEUTRAL] Yeah, sure. My uh fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes about 5 minutes. And then what was the other date of service?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah, sure. The next date of service for the patient is
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] It's getting here.
[CUSTOMER][NEUTRAL] Yeah, sure. This is the last date of service for the patient. It is [PII] with the amount of $125 even.
[AGENT][NEUTRAL] It was received on [PII]. Proceed [PII].
[AGENT][NEUTRAL] And office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] The office visit is not uh covered under the policy, it has been denied.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, shall we, uh, change the CPT code? This is not an office visit, it is a hospital visit, and submit the claim for the process.
[AGENT][NEUTRAL] If you can submit a corrected claim if if that was incorrect.
[CUSTOMER][NEUTRAL] Yeah, uh, can we submit the corrected claim?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What is the timely filing limit for corrected claim?
[AGENT][NEGATIVE] Um, there's no timely filing limit.
[CUSTOMER][NEUTRAL] No limit. OK. The mailing address is the same which as you, you have been provided already.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thanks for the details. Can I get the claim number which has been denied.
[AGENT][NEUTRAL] If
[AGENT][NEUTRAL] 3541648.
[CUSTOMER][NEUTRAL] 3541648
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thanks for the details you have provided. Have a good day.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Bye-bye.