AccountId: 011433970860
ContactId: 1db5a18d-5371-4380-abd3-dcd4c42e27bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 181970 ms
Total Talk Time (AGENT): 83622 ms
Total Talk Time (CUSTOMER): 63239 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/1db5a18d-5371-4380-abd3-dcd4c42e27bb_20250206T21:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with the provider's office. I was hoping to verify uh if you guys had received a claim I had faxed in.
[AGENT][NEUTRAL] Oh, sure, I can check and see if the claim has been received. And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, phone number [PII] direct.
[CUSTOMER][NEUTRAL] Policy number is 02262377ML8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] This is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you want me to check on?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $45 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Norani Medical Center LLC.
[AGENT][NEUTRAL] Oh yeah, this is it, OK.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That claim num
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm sorry, was that [PII]?
[AGENT][NEUTRAL] 25.
[CUSTOMER][NEUTRAL] November?
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][POSITIVE] Oh, OK, OK, perfect. OK, thank you.
[AGENT][NEUTRAL] And that claim number is 3558542.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], uh, it's two denial reasons. So 99211 was denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] 36415 was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Oh goodness, did they not send that in with it? OK, I understand. um, now am I able to the the number that I faxed the claim to, am I able to fax the prior, uh, the previous explanation of benefits?
[AGENT][NEUTRAL] Oh, yes, um, you'll fax it to the claims fax number and then we'll just continue processing and um give you the new decision for the 36415 code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh thank you so much and then with that claim, should I just reference that claim number you gave me 3558542 on my fax?
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][POSITIVE] OK, I understand. OK, thank you so much for your help. uh, that was all I needed today.
[AGENT][POSITIVE] Well, you're very welcome, sir. Well, thank you so much for calling APR. I hope you have a good day.
[CUSTOMER][POSITIVE] Thanks you as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.