AccountId: 011433970860
ContactId: 1979dda2-3c07-4c84-acba-d44d3811f395
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1470140 ms
Total Talk Time (AGENT): 407562 ms
Total Talk Time (CUSTOMER): 522698 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/1979dda2-3c07-4c84-acba-d44d3811f395_20250220T14:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] May I have your name again?
[CUSTOMER][NEUTRAL] Yes my name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and I'm sorry, can you spell that for me for documentation?
[CUSTOMER][NEUTRAL] Yeah, sure. It's spelled as [PII]
[AGENT][NEUTRAL] Thank you. What is your callback number please?
[CUSTOMER][NEUTRAL] Yes, the best callback number is [PII], and I'm so sorry I didn't catch your name. Could you spell your name for me for the documentation purpose?
[AGENT][NEUTRAL] Of course. My name is [PII] Last initial is [PII].
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] Yes. So the policy ID number is 01997050.
[AGENT][NEUTRAL] OK, that was 01997050, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is uh [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you very much for the verification process, um, [PII], you're calling for claim status. I can assist you. What is that date of service and the total charges billed?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes. So for the first one, the date of service is [PII] and the total charge amount is $256 even.
[AGENT][NEUTRAL] OK, that was [PII] for the total charges of $256 is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you so much. And also [PII], you are able to check claim status by visiting our secure portal at [PII] and on that website you'll be able to obtain you be if you should need one. OK, give me one second please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] that
[AGENT][NEUTRAL] Almost there.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it shows that the claim was received. Give me one moment please, just to look at something else. Thank you.
[CUSTOMER][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Actually I do not show that claim to be on file and just want to verify, re-verify that total charge amount that was billed was $256.
[CUSTOMER][NEUTRAL] Yes, $256 even for [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, do you have that procedure code or codes that were billed?
[CUSTOMER][NEUTRAL] Yes, I do have a CPT code that was billed as 99213.
[AGENT][POSITIVE] OK, thank you so much for that information as well and I do not show that we have received that claim.
[CUSTOMER][NEUTRAL] Uh huh, so there is no claim on file. Um, is this patient active on the date of service?
[AGENT][POSITIVE] OK, let me check that for you as well. One moment please, I hope you feel better, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 423, uh, yes, the member is active for that date of service.
[CUSTOMER][NEUTRAL] Effective from?
[AGENT][NEUTRAL] Remember shows effective from [PII] and shows current.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I would just want to verify the mailing address. Could you please help me with the mailing address, claims mailing address?
[AGENT][NEUTRAL] Yeah, certainly our mailing correct, it is, excuse me, [PII] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, just give me one quick second, so attention to APO claims.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII] and the timely filing limit to submit the claim.
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, thank you, and I do have a few more claims for the same patient for the different date of service. Could you please let me know from when, uh, I mean, I, I will provide you the date of service and the charge amount. Could you please let me know the status of the claim?
[AGENT][NEUTRAL] Yeah, you're, yes, of course you're calling for claim status, so yes I can help you. One moment, OK? Just bear with me.
[CUSTOMER][NEUTRAL] Mhm, mhm, sure.
[AGENT][NEUTRAL] What is the next date of service and total charge amount?
[CUSTOMER][NEUTRAL] Yeah, the next date of service is [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] And yes, the total charge amount it's uh $355 even.
[AGENT][NEUTRAL] OK, and that procedure code, please?
[CUSTOMER][NEUTRAL] Yes, it's for 99214.
[AGENT][NEUTRAL] OK, thank you. It shows that the claim was received and denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK, just give me a second here.
[CUSTOMER][NEUTRAL] Could you please let me know when it was received?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, the claim was received on [PII].
[AGENT][NEUTRAL] And processed
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And denied [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Under the claim ID number?
[AGENT][NEUTRAL] The claim number shows 3276724.
[CUSTOMER][POSITIVE] Perfect. And you mentioned that it was denied that it will not cover the uh place of service 11, the outpatient physician services, right?
[AGENT][NEUTRAL] Does not cover office visits.
[CUSTOMER][NEUTRAL] Of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, could you please read out the description, the denial description, just to make sure.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][POSITIVE] No problem.
[AGENT][NEGATIVE] Office visits are not covered.
[AGENT][NEUTRAL] By the above numbered policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you so much for that information and uh we are good to go the next date of those.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] What is the next date of service and total charge amount?
[CUSTOMER][NEUTRAL] Yes, the next date of service is [PII].
[CUSTOMER][NEUTRAL] And it's for the total charge amount of $256 even.
[AGENT][NEUTRAL] OK, that was [PII]. Total charge is $256 even that claim is not on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] OK, there is no claim on file, so same mailing address and everything the same.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Alright, perfect, one second, almost there.
[CUSTOMER][NEUTRAL] Let me close this up and we can move to the next uh.
[CUSTOMER][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] [PII]. Alright, so the next one is for [PII].
[CUSTOMER][NEUTRAL] It's [PII] and it's for the total charge amount of $355 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the claim was received. Office visits are not covered by the policy. One moment for the receipt and process date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was received on [PII] and processed and denied [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Almost there.
[CUSTOMER][NEUTRAL] [PII] and the denied the date [PII] and it was denied for and could you please help me with the call I'm sorry claim number is it 332-7066?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I have a you be.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you for the confirmation.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] So, it was denied for office visits are not covered under the policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So, here we go with the next one. And the next date of service is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for the total charge amount of $355 even.
[AGENT][NEUTRAL] OK, claim is not on file.
[CUSTOMER][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] 1520 23, there is no claim on file?
[AGENT][NEUTRAL] No claim is on file for [PII] $355.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 355355. All right. So, here we go with the next one then.
[CUSTOMER][NEUTRAL] And the next date of service is [PII] and it's for same charge amount $355 even.
[AGENT][NEGATIVE] Claim is not on file.
[CUSTOMER][NEUTRAL] [PII] uh date of service [PII].
[CUSTOMER][NEUTRAL] No claim on file, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] So here we go with the next one for the date of service, uh, [PII].
[AGENT][NEUTRAL] Charge them out
[CUSTOMER][NEUTRAL] For the same charge amount, same charge amount, $355 even.
[AGENT][NEUTRAL] Claim was received and denied as office visits are not covered by the policy.
[AGENT][NEUTRAL] Um, that claim number shows 3509446. 1 moment, let me get, sure.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 1 2nd, 1 2nd.
[CUSTOMER][NEUTRAL] I'm so sorry. Just a second, just a second. Let me get back to the denied one, yeah.
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] OK, this is the one, yeah.
[CUSTOMER][NEUTRAL] Mm, yes, uh, you can go ahead with the claim number I'm sorry.
[AGENT][NEUTRAL] It shows 3509446.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and it was denied on?
[AGENT][NEUTRAL] Do you need the receipt date first?
[CUSTOMER][NEUTRAL] Yeah, sure, go ahead.
[AGENT][NEUTRAL] OK, received on [PII], denied [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Alright, denied for the same reason let me.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Get this claim number.
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] Alright, so here we go.
[CUSTOMER][NEUTRAL] With the next one.
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] And the charge amount please.
[CUSTOMER][NEUTRAL] It's 2 yeah it's $235 even.
[AGENT][NEUTRAL] Claim denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3,509,450.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim was received on [PII] and denied [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] Yeah, denied it.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] On the claim number over here.
[CUSTOMER][NEUTRAL] All those there just do more claims to go.
[CUSTOMER][NEUTRAL] For the same patient.
[CUSTOMER][NEUTRAL] Alright, so here we go with the next one which is for the date of service of [PII].
[CUSTOMER][NEUTRAL] It's for [PII] and the total charge amount is $256 even.
[AGENT][NEUTRAL] OK, claim denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number shows 349-7302.
[AGENT][NEUTRAL] One moment
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was received on excuse me, [PII] and denied [PII].
[CUSTOMER][NEUTRAL] Sorry, OK, got you, sorry.
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 868.
[CUSTOMER][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] Denied on the [PII]. All right. Thank you. And here we go with the last one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the last date of service is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the charge amount?
[CUSTOMER][NEUTRAL] $858 even.
[AGENT][NEUTRAL] 68.
[AGENT][NEUTRAL] OK, one moment if you could verify the procedure codes please.
[CUSTOMER][NEUTRAL] Yeah, yes, it's 99203 and 20,610.
[AGENT][NEUTRAL] OK, so it's only 2. OK, one moment.
[CUSTOMER][NEUTRAL] Uh, there's another one, J as in Juliet 33012.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] OK, that claim was received on [PII] and processed on [PII]. There was a payment on this and the amount of $88.40.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Procedure code 99203 was no payment on that particular line item.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just give me a second.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] One second was processed.
[CUSTOMER][NEUTRAL] Processed on [PII] and claim was paid for CPT code 20,610.
[AGENT][NEUTRAL] And J 3301?
[CUSTOMER][NEUTRAL] Oh, CPD code 20,610 and 3301 and paid amount is $88.40 right?
[AGENT][NEUTRAL] I'm sorry, what was that question?
[CUSTOMER][NEUTRAL] The paid amount is $88.40.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And there is no payment on CPT code.
[CUSTOMER][NEUTRAL] 99203.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you please let me know the claim number?
[AGENT][NEUTRAL] Of course, it is 349-556-9.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 349-5069. All right, thank you and just a second.
[CUSTOMER][NEUTRAL] Process on [PII] claim number. Could you please let me know whether it was paid through a check or an EFT?
[AGENT][NEUTRAL] It was a single paper check.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Alright, so check and the check number.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 1869214.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Uh huh 1869214 and it was issued on?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] Alright, and could you please let me know the pay to address?
[AGENT][NEUTRAL] Sure, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was sent to Ashar Clinic LLC.
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm no. Could you please repeat one more time slowly?
[AGENT][NEUTRAL] OK, of course it is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII], uh, just give me one quick second, let me check.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] All right, so could you please let me know the clear date?
[AGENT][NEUTRAL] OK, currently that check shows outstanding. One moment please. May I place you on a brief hold?
[CUSTOMER][NEUTRAL] Only.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you so much for your patience [PII] um again.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. The check has not cleared, so I can put a request to have the check voided and have a new check reissued.
[CUSTOMER][NEUTRAL] Alright, and the turnaround time?
[AGENT][NEUTRAL] Please allow 5 to 7 business days.
[AGENT][NEUTRAL] It may take longer than that.
[AGENT][NEUTRAL] Now I was just checking the mailing address that the check was mailed to. It was mailed to the correct address according to the claim submission.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so perfect, and could you please help me with the call reference number for this call?
[AGENT][NEUTRAL] We do not use call reference numbers. [PII]. You can use my name [PII] last initial [PII], and today's date. Anything else I can help you with?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, that's all for today. Thank you so much for providing that information and thank you. Hope you have a great day.
[AGENT][POSITIVE] You as well. I hope you feel better. Thank you for calling APL and take care bye.
[CUSTOMER][POSITIVE] Thank you. Have a great day. Bye.