AccountId: 011433970860
ContactId: 0d37d687-9a00-4e16-88c6-c21ccbd88918
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 835869 ms
Total Talk Time (AGENT): 234394 ms
Total Talk Time (CUSTOMER): 230986 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/0d37d687-9a00-4e16-88c6-c21ccbd88918_20250214T14:30_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi. My name is [PII] calling from provider's office regarding some claim clarifications.
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected, I can call you back?
[CUSTOMER][NEUTRAL] Yeah. Mhm. Yeah. It's [PII] with the extension of [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, just one moment.
[CUSTOMER][NEUTRAL] 254
[CUSTOMER][NEUTRAL] 9508.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] Actually, the policy number for this patient is 018.
[CUSTOMER][NEUTRAL] 13082.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What's the patient's name?
[CUSTOMER][NEUTRAL] Uh patient name is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And you're needing claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what day of service?
[CUSTOMER][NEUTRAL] data services for [PII] for the total charge amount $2460 even.
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what's the procedure code that's on that claim? One of the procedure codes?
[CUSTOMER][NEUTRAL] Procedure code.
[CUSTOMER][NEUTRAL] The anesthesia code is 00732.
[AGENT][NEUTRAL] 00732.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So we
[AGENT][NEUTRAL] And that was for 1018, 24?
[CUSTOMER][NEUTRAL] 1018, 2024. And the procedure code is 43264.
[AGENT][NEUTRAL] 43264.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And how many procedure codes was on that claim?
[CUSTOMER][NEUTRAL] There's actually only one procedure code. Actually, this claim is paid by primary, so there is special responsibility, so we submit this claim to the secondary.
[AGENT][NEUTRAL] OK, hold on one moment. I'm trying to find the claim first. Hold on one moment.
[CUSTOMER][NEUTRAL] I don't have the claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You said there's one procedure code?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it's 43264, or is it the 00732?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually, the anesthesia code is 00732.
[AGENT][NEUTRAL] OK, we do not have that claim.
[CUSTOMER][NEUTRAL] Mhm. OK. Can you please check with that procedure code 43264?
[AGENT][NEUTRAL] And what facility are you with? I mean, I have that code, but it's not the amount you're asking about and it has two other codes on the claim, so I'm trying to find the claim that you're talking about and you're giving me two different codes, so.
[CUSTOMER][NEUTRAL] I do have the claim number also. Could you please check with that?
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] 353-532-8.
[AGENT][NEUTRAL] Give it to me one more time, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3
[CUSTOMER][NEUTRAL] May I repeat the claim number again?
[AGENT][NEUTRAL] Yes, ma'am, that's what I was asking. Can you repeat it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. 353.
[CUSTOMER][NEUTRAL] 532 8.
[AGENT][NEUTRAL] 353532-8.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And you said this was on [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Hold on one moment. I'm looking, trying to figure it out.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm showing for that claim number this was put under Maritza Ortiz and it was denied information received from provider incomplete cannot process until additional corrected information received from the provider. So the claim must not have been completed. So you just need to file it again.
[CUSTOMER][NEUTRAL] OK. Uh, may I know what information is requested?
[AGENT][NEUTRAL] That I can't see the actual claim.
[AGENT][NEUTRAL] But it may be the reason it didn't have the patient's name on it or something. I'm not sure because they put it under [PII].
[AGENT][NEUTRAL] So if y'all could
[CUSTOMER][NEUTRAL] Yeah, actually upon checking my side, yeah, it's been shown like this claim is denied for some information is incomplete or requested. So, so when I make a call about the exact information you need.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] We just need a corrected claim with uh [PII]'s name on it. If you could just file it correctly.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, may I know what, what is the name in the claim form?
[AGENT][NEUTRAL] Like I said, I can't see the imaging of the claim at the moment.
[AGENT][NEUTRAL] But if you would just refile it, we can uh process it.
[CUSTOMER][NEUTRAL] So it's been denied for your name incorrect?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, we need to submit this claim as the original claim or corrected claim.
[AGENT][NEUTRAL] You can send it either way. We'll, we'll review it and process it as long as it has, it has all the information, their claim number, the name and everything on it.
[CUSTOMER][NEUTRAL] So again, you submit as a corrected claim.
[AGENT][POSITIVE] Yes, ma'am, you can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With the [PII], right? With the special name.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. And may I know the timely filing limit for corrective plan?
[AGENT][NEGATIVE] We do not have timely filing.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] May I know the claim appeal mailing address or fax number in case we submit this as an appeal.
[AGENT][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And our address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK good thank you.
[CUSTOMER][NEUTRAL] And uh I just want to confirm for this state of service, there are 2 claims for the same patient with the same bill amount. The two claims has been denied for the same reason from my side. Could you please verify whether there are 2 claims denied for the same, uh, incorrect patient name?
[AGENT][NEUTRAL] I did not see it in our system but one time, so I don't, I'm not sure.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] May I provide the claim number for that another claim?
[AGENT][NEUTRAL] 353-5328, the one you gave me.
[CUSTOMER][NEUTRAL] Yeah. May I provide another claim number?
[AGENT][NEUTRAL] What is the other claim number?
[CUSTOMER][NEUTRAL] It's 353-504-9.
[AGENT][NEUTRAL] Yes, it was put under the incorrect policy number, but it was asking for the same information. Hold on, let me see if I can pull that one up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, now this claim that you're talking about, this claim number was also filed under [PII], but you all put [PII]'s date of birth, so we need some kind of corrected claim of who the claim is on and the correct date of birth.
[AGENT][NEGATIVE] Cause it's not matching.
[CUSTOMER][POSITIVE] OK. Got it. Mhm. Yeah, I understand. Thank you so much for this information.
[AGENT][NEUTRAL] It was founded as [PII] with [PII]'s date of birth.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, thank you so much for this information. And uh could you please spell your name for me?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK. May I get your last name in issue?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for that and um may I get the reference number for this call?
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK. Yeah, thank you, [PII], for patiently assisting me. Have a great day.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day as well. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.