AccountId: 011433970860
ContactId: 204564b2-c41b-4a98-b89f-bcfc07e69c2c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377079 ms
Total Talk Time (AGENT): 112198 ms
Total Talk Time (CUSTOMER): 114212 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/204564b2-c41b-4a98-b89f-bcfc07e69c2c_20250131T14:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII], and I'm calling for the provider's office to check on the claim reprocess status. Please be advised this call has been recorded and marked for quality and training purposes. How are you doing today?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][POSITIVE] I'm doing great. Thank you for asking.
[AGENT][NEUTRAL] That's good. Um, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. My callback number is going to be [PII] and it is a direct line.
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And OK.
[CUSTOMER][NEUTRAL] The policy number I have it is going to be.
[CUSTOMER][NEUTRAL] 244
[CUSTOMER][NEUTRAL] 3500.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] And what's the date of service and bill charges on the claim, please?
[CUSTOMER][NEUTRAL] Date of birth is on [PII] with the total charges of $1,069 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK. Do you have a claim number?
[CUSTOMER][NEUTRAL] Well, let me see.
[CUSTOMER][NEUTRAL] Yes. So the claim number I have, it is going to be 2004329.
[AGENT][NEUTRAL] OK, I'm not showing that claim number on file and I'm not showing um a claim with the date of service and bill charges that you gave me on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me just a moment, let me check on it. Just a moment.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] OK. So the claim number I have, it is going to be 35096003.
[AGENT][NEUTRAL] OK, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it paid out for $6.90.
[AGENT][NEGATIVE] It paid out that amount because line one denied. Line one is for the co-pay for the office visit, and that's not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it is not covered on patients.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And actually this cream was previously sent back for the process on [PII].
[AGENT][NEUTRAL] OK. Do you have a claim number for that one?
[CUSTOMER][NEUTRAL] Uh, that's the claim number I got you.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEGATIVE] Yes, and they're denied for that reason because office visits are not covered.
[CUSTOMER][NEUTRAL] OK, so it is not covered under the patient's plan, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And actually, previously we have received payments for the same security code.
[CUSTOMER][NEUTRAL] So, can I know why Ra is getting denied?
[AGENT][NEUTRAL] Because it's not covered under the patient's plan. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Can I have your appeal mailing address for my reference?
[AGENT][NEUTRAL] Yes, the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, got it. And what will be the family limit to submit an app bill?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's no timely filing limit?
[CUSTOMER][NEUTRAL] And do you have any uh fax number for our bills?
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 and please attention it to the claims department.
[CUSTOMER][NEUTRAL] OK. Thank you. And uh yes, can I have your call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The reference number is my name and today's date. My name is [PII], um, it's spelled [PII]
[AGENT][NEUTRAL] Last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you for your assistance in providing me the information and have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] OK.