AccountId: 011433970860
ContactId: 1eef1350-f28f-4d7d-a199-75c95a812519
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 687969 ms
Total Talk Time (AGENT): 217751 ms
Total Talk Time (CUSTOMER): 364772 ms
Interruptions: 9
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/1eef1350-f28f-4d7d-a199-75c95a812519_20250213T16:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] of office to check on the claim status. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. I'm happy to check on a claim for you today. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I have the policy number.
[AGENT][NEUTRAL] OK, go ahead whenever you're ready.
[CUSTOMER][NEUTRAL] 0 yeah 0.
[CUSTOMER][NEUTRAL] And 1419068.
[CUSTOMER][NEUTRAL] In the in the money.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah. The patient's name would be Tiny, and the last name would be [PII], and the date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and then what's the date of service?
[CUSTOMER][NEUTRAL] Data service would be.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The data service would be [PII] and the bill amount would be
[CUSTOMER][NEUTRAL] $176 even.
[AGENT][POSITIVE] All right, thank you. Let me take a look.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. May I know when the number of the?
[AGENT][NEUTRAL] And just to confirm, data service is [PII]. Is it [PII] or [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] June, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not showing any claims on file for that date of service.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And by the way, [PII], I need to know the patient's effective date and the termination date.
[AGENT][NEUTRAL] Uh, effective date is [PII]. There is no termination date. Patient is still active.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And by the way, may I know the timely filing limit to submit the claim?
[AGENT][NEGATIVE] No timely filing limit.
[CUSTOMER][NEUTRAL] You can submit a claim through fax or mail address.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, you can fax or mail.
[AGENT][NEUTRAL] Do you need the mailing address or fax number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, may I know the fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK. By the way, we need to submit the primary EOB and the secondary claim form, and we need to submit the fax. Is it right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And by the way, can we move to the next date of service for the same patient?
[AGENT][NEUTRAL] Uh, yeah, what's the other data service?
[CUSTOMER][NEUTRAL] [PII] and the bill amount would be $352 even.
[AGENT][NEUTRAL] All right, let me check on that.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you have an amount after the primary?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, the primary amount would be $352 even.
[AGENT][NEUTRAL] Now, do you have an amount?
[AGENT][NEUTRAL] Do after the primary paid?
[CUSTOMER][NEUTRAL] Yeah, the premium has been paid $9.
[CUSTOMER][NEUTRAL] The co-pay would be $100.
[CUSTOMER][NEGATIVE] And we got payment also $56.75. And may I know one line item has got denied. I don't know what happened for this claim. And we do not have the valid information for the portal. So I called.
[AGENT][NEUTRAL] Um, let me see what this one is one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK OK for the diagnostic that is.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So it's like no I'm like.
[AGENT][NEUTRAL] So it looks like we did receive a claim where there was a benefit payment made for $56.75. Um, it looks like.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] One line item was declined because major medical pays the benefits were only payable if there was something for us to pay Major medical covered it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we do.
[CUSTOMER][NEUTRAL] So it will be OK.
[AGENT][NEUTRAL] So, or if it's denied, so it looks like in this situation it's stating benefits are payable only if major medical provider provides benefits. If this claim is later paid by major medical, please resubmit with explanation of benefits.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah I'll pay like $150.10 dollars.
[CUSTOMER][NEUTRAL] And by the way, you do not have the payment status like how it has been paid and I need to know the status we need to like check or EFT.
[AGENT][NEUTRAL] Um, yeah, so this claim, the benefit payment was sent by single check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The check number is 1825148.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. When it was pay date, may I know the pay date?
[AGENT][NEUTRAL] Uh, the check was issued on [PII].
[CUSTOMER][NEUTRAL] When it was cleared.
[CUSTOMER][NEUTRAL] Um, I'm sorry.
[AGENT][NEUTRAL] I don't have a date of cleared. It has been cached.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, that has been cashed by the way. You can verify the pay to address.
[AGENT][NEUTRAL] I was sent to Cora Physical Therapy [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, sir. And by the way, you don't know for what reason one line item got denied. Is it right?
[AGENT][NEUTRAL] Uh, the reason for the denial.
[AGENT][NEUTRAL] On the two other line items was because
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] The major medical didn't provide any benefit. So.
[CUSTOMER][NEUTRAL] Oh, and I didn't I'm I'm going I don't know.
[AGENT][NEUTRAL] We only pay if major medical pays.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So for this one, we need to submit again one more time, please submit the claim or is we can bill the patient for $43.
[AGENT][NEUTRAL] You can resubmit the claim if the major medical paid and you have an explanation of benefits otherwise this isn't going to pay anything additional.
[CUSTOMER][NEUTRAL] Hey I'm I'm like.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] By the way, previously for the patient got payment by the data service would be [PII]. We got paid for the major CPT code. By the way, could you check for that one?
[CUSTOMER][NEUTRAL] And could you take back for reprocess this plan?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] You would have to submit the primary EOB for this to be resubmitted.
[CUSTOMER][NEUTRAL] No, by the way, previous data service, [PII], we have been billed for the same CPT code. By the way, we got payment for the claim. For this claim, [PII].
[CUSTOMER][NEGATIVE] We have been received only $56.75.
[AGENT][NEUTRAL] I understand that. For anything else additional to be paid, an explanation of benefits from the primary insurance would need to be submitted.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much for giving information. And by the way, [PII], may I know the call reference number for today's conversation? And by the way,
[AGENT][NEUTRAL] Call reference is my name, yeah.
[CUSTOMER][NEUTRAL] Uh-huh, yes, yeah, sorry, sorry, go ahead, go ahead.
[AGENT][NEUTRAL] Call reference is
[CUSTOMER][NEUTRAL] Dating dating.
[CUSTOMER][NEUTRAL] Yeah, may I have the reference number?
[AGENT][NEUTRAL] Call reference is my name with my last initial. My last initial is [PII].
[AGENT][NEUTRAL] So call reference would be [PII] and then today's date.
[CUSTOMER][POSITIVE] Thank you so much and by the way, may I know
[CUSTOMER][NEUTRAL] The mailing address one more time, could you tell me the mailing address, please?
[AGENT][NEUTRAL] Mailing address would be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] [PII], have a wonderful day. Take care. Bye-bye for assisting me today.
[AGENT][NEUTRAL] You too. Bye.
[CUSTOMER][NEUTRAL] Hm.