AccountId: 011433970860
ContactId: 06e10f7b-6050-4c9f-bdcb-fde014e4aa1a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 504989 ms
Total Talk Time (AGENT): 184206 ms
Total Talk Time (CUSTOMER): 134042 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/06e10f7b-6050-4c9f-bdcb-fde014e4aa1a_20250114T15:51_UTC.wav
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[AGENT][NEUTRAL] APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling for the provider to check on our recent information about the claim that call denied. Please note this call will be monitored and recorded for quality and training purposes. And uh you will be calling for clarification. How are you doing today?
[AGENT][NEUTRAL] Fine. OK, [PII], I can help you with clarification on the denial claim in case this call is disconnected, may I have your callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, please?
[CUSTOMER][NEUTRAL] Yes. Uh, so the patient's policy number is 02286183.
[AGENT][NEUTRAL] Thank you and that was 02286183?
[CUSTOMER][NEUTRAL] 02286183, yes.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes. Uh so the patient's name is uh [PII]. It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and building amount?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service is [PII] and
[CUSTOMER][NEUTRAL] Uh, the total bill amount is?
[CUSTOMER][NEUTRAL] Uh, $73 even.
[AGENT][NEUTRAL] Thank you, so that's for data service of [PII] for $72.
[CUSTOMER][NEUTRAL] Yes, 73.
[AGENT][POSITIVE] 73, thank you.
[AGENT][NEUTRAL] And do you have the claim number that you're calling in regards to?
[CUSTOMER][NEUTRAL] Yes, it's 354-2447.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And also can you please spell your name for documentation?
[AGENT][NEUTRAL] Sure. My name is [PII] and it's spelled [PII]
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So I show this claim was processed as a duplicate claim. Looks like we initially received this claim previously let me see when we initially received this claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like we initially received this claim back on.
[AGENT][NEUTRAL] [PII], it was processed on [PII]. I show a a benefit was issued for $25.26. Would you like the claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, uh, so we're setting, uh, is in the uh original claim number is different, right?
[AGENT][NEUTRAL] The claim number is different.
[CUSTOMER][NEUTRAL] OK, so can I get the original claim number then?
[AGENT][NEUTRAL] The claim number is 3,405,340.
[CUSTOMER][NEUTRAL] Mhm. And may I know the uh the the CPD code [PII] that coin on the claim.
[AGENT][NEUTRAL] 963-72 we paid $25 on that.
[CUSTOMER][NEUTRAL] OK, so you're staying or the entire claim got paid.
[AGENT][NEUTRAL] The total payment amount on the claim was $25.26.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And it's the total, uh, total pay amount, right on the claim, the entire claim?
[AGENT][NEUTRAL] The total bill amount on the claim is, is for $73. We did not pay out $73. We only paid $25.26.
[CUSTOMER][NEUTRAL] And may I know the allowed amount? Is it the same, allowed and pay amount?
[AGENT][NEUTRAL] Looks like based off the EOB, their responsibility the patient responsibility was only $10.26. So it actually looks like this claim was overpaid. Let me take a look here to see if we, we submitted an overpayment letter yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do not show that we have. So yeah, we, this claim was overpaid because on the EOB it only shows the patient responsibility was $10.26 and that was the amount applied towards their co-insurance and co-pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, due to it's overpaid, right?
[AGENT][NEGATIVE] The claim was paid. However, we'll be requesting a refund because it was overpaid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for that and just give me a minute.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Let me check further details.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] One moment, uh, you will be slowing. Just give a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello, [PII]. So we need to uh refund the amount, right?
[AGENT][NEUTRAL] Yes, it looks like this claim.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEGATIVE] Looks like this claim was overpaid.
[CUSTOMER][NEUTRAL] And may I know how we need to uh refund the amount?
[AGENT][POSITIVE] We'll send we'll submit, we'll submit you on a request in regards to the overpayment we'll send a letter out to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so it got paid and again we need to, uh, uh, reset, uh, resend the payments, right?
[AGENT][NEUTRAL] Yes, so it looks like on the CPT code 96372, it looks like the patient responsibility was only $10 and we paid $25.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So it was overpaid on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Thank you for that. And also, can I get the uh check details and when it got process details?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, the initial claim was processed on [PII]. That check amount was for $25.26. That check number is 1,830,420.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and is it a bulk amount or a single amount?
[AGENT][NEUTRAL] Single
[CUSTOMER][NEUTRAL] OK, thank you for that. And also, uh, can you verify the patient account number for this?
[AGENT][NEUTRAL] The patient account number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I show the patient account number was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you for that. And can I get a conference for this?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It'll be just my name in today's date. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, that's it from [PII] and thank you for assisting me for the day and have a great and a great week. Bye-bye.
[AGENT][POSITIVE] You're welcome. You, you too, thanks for calling APL bye.