AccountId: 011433970860
ContactId: 0d7ce0ce-0057-4995-bb21-43cd364cc79d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301690 ms
Total Talk Time (AGENT): 77292 ms
Total Talk Time (CUSTOMER): 86502 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/0d7ce0ce-0057-4995-bb21-43cd364cc79d_20250515T17:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. I'm [PII] from Community Medical Associates for claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, for sure. It's [PII], and it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And you have the policy number for that patient?
[CUSTOMER][POSITIVE] Yes, I do, it's gonna be.
[CUSTOMER][NEUTRAL] 02449773.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name.
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And date of service and bill charges.
[CUSTOMER][NEUTRAL] [PII] for $99 even.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh looks like we received the claim on.
[CUSTOMER][NEUTRAL] That's just.
[AGENT][NEUTRAL] 4 1525, 4 1725.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It states that primary insurance provided full benefits, insured's primary insurance provided full benefits, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] So primer paid more than the secondary reliable amount, correct.
[AGENT][NEUTRAL] No, the primary paid in full, so there's nothing left for us to pay.
[CUSTOMER][POSITIVE] All right. Thank you.
[CUSTOMER][NEUTRAL] So just to let you know that primary didn't pay any amount, they did process the claim towards the copay.
[AGENT][NEUTRAL] We pull up what we received.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, there's nothing listed under copay on the EOB.
[AGENT][NEUTRAL] 0
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] So you guys receive the primary you'll be with the denial.
[AGENT][NEGATIVE] No, we received the primary EOB and it doesn't list anything owed under deductible or co-insurance.
[AGENT][NEUTRAL] Or co-pay, it says 0.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] It is 0. All right. Thank you. So in order to reprocess the claim, do we need to resubmit the claim along with the primary OB or just the appropriate primary OB?
[AGENT][NEUTRAL] Uh, we need a primary EOB that shows that it was applied towards deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] And then you can refer.
[CUSTOMER][NEUTRAL] Uh-huh. So at this time we only need to.
[CUSTOMER][NEUTRAL] To the claim number.
[AGENT][NEUTRAL] Yeah, you can reference the claim number. Uh it's 359.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] 0520.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So only primary UV is required that has the patient responsibility at this time.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can I get the fax number?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, and how do you spell your name?
[AGENT][NEUTRAL] Um it's [PII]
[CUSTOMER][NEUTRAL] Is there any, sorry, any time refunding limit?
[AGENT][NEGATIVE] No timely filing limit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you. And how about the call reference number for you, [PII]?
[AGENT][NEUTRAL] That's my name with today's date.
[CUSTOMER][POSITIVE] All right have a good day bye bye.
[AGENT][POSITIVE] Thank you for calling APL. You too. Bye-bye.