AccountId: 011433970860
ContactId: 22cb1a49-2539-4aa8-a246-bff083316b26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1154760 ms
Total Talk Time (AGENT): 395412 ms
Total Talk Time (CUSTOMER): 309201 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/22cb1a49-2539-4aa8-a246-bff083316b26_20250324T13:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for Vica to check on the claim status. Please be informed that this call has been recorded and monitored for quality and training purposes. May I know if I can help you with the provider's information or the patient's information?
[AGENT][NEUTRAL] Yes, [PII], but first I do need a callback number in case we get disconnected, please.
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]. That's a direct line, no extensions.
[AGENT][NEUTRAL] Thank you, [PII]. And [PII], what is the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, the patient's policy number is D as in Delta 433.
[CUSTOMER][NEUTRAL] 02090.
[AGENT][NEUTRAL] [PII], our policy numbers are all numerical. Do you happen to have the policy certificate number for APL?
[CUSTOMER][NEUTRAL] Just a moment, let me check.
[CUSTOMER][NEUTRAL] No, I don't, I, I have only this number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just one second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the patient's last name?
[CUSTOMER][NEUTRAL] The patient's last name is [PII].
[AGENT][NEUTRAL] And first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what state is [PII] in?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is 700 and
[AGENT][NEUTRAL] OK, wait.
[AGENT][NEUTRAL] I'm, I'm so sorry, [PII]. I'm trying to locate his policy still. What is, what state does [PII] live in? I apologize.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's uh [PII]. Yeah, do you need the patient's date of birth?
[AGENT][NEUTRAL] In what state
[AGENT][NEUTRAL] I need the state that that [PII] lives in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] [PII]. Thank you. And now, what is his date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][POSITIVE] All right, perfect. Thank you.
[AGENT][POSITIVE] Bear with me just one second. I'm getting that pulled up for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. I do have a an active medical policy for [PII]. Our policy number is 247.
[AGENT][NEUTRAL] 24, I'm sorry, 2479424.
[AGENT][NEUTRAL] And that's the APL ID number.
[AGENT][NEUTRAL] And I can help you with that claim status. What is the data service?
[CUSTOMER][NEUTRAL] That was
[CUSTOMER][NEUTRAL] The date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the billed amount?
[CUSTOMER][NEUTRAL] The bill amount is $623 even.
[AGENT][NEUTRAL] And what is the facility name?
[CUSTOMER][NEUTRAL] Sure. The facility name is VHS Physician Network INC.
[AGENT][POSITIVE] All right, perfect. Thank you.
[AGENT][NEUTRAL] We did receive that claim. Let me get that received date for you. Bear with me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, [PII], that claim we did receive on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] Oh, let me get the original date. That was actually a duplicate. So let me get the original.
[AGENT][NEUTRAL] Received data. I apologize.
[AGENT][NEUTRAL] So that claim was denied as a duplicate.
[AGENT][NEUTRAL] OK. The original claim we did receive on.
[AGENT][NEUTRAL] Original claim was received on [PII].
[AGENT][NEUTRAL] 224.
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEGATIVE] The original claim was denied.
[AGENT][NEUTRAL] As this policy provides no benefits for charges made by a doctor for inpatient visits.
[AGENT][NEUTRAL] Would you like to claim the original claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Original claim number is 353.
[AGENT][NEUTRAL] 7051.
[CUSTOMER][NEUTRAL] OK. So you provided me the original claim, received and denied it, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And it was denied for duplicate?
[AGENT][NEUTRAL] The original, I mean, the claim number that I gave you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a duplicate claim that claim number 3562492 was the duplicate claim. The original claim.
[AGENT][NEUTRAL] Number is 353-7051.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Just a moment.
[CUSTOMER][NEUTRAL] And what happened with the original film?
[AGENT][NEUTRAL] It was denied, and the denial reason is the policy provides no benefits for charges made by a doctor for inpatient visits.
[CUSTOMER][NEUTRAL] So it's not covered under the member plan?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is the patient active on the data service?
[AGENT][NEUTRAL] Yes, sir, the effective date on the policy is [PII] and the policy is active.
[CUSTOMER][NEUTRAL] And there is a term rate?
[AGENT][NEUTRAL] No term date on file.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Which if it is not covered as per patient's policy.
[AGENT][NEUTRAL] All CPTs are not covered when the charges fees are made for an inpatient hospital stay.
[AGENT][NEUTRAL] That's all the CPT's listed on.
[CUSTOMER][NEUTRAL] Could you please?
[AGENT][NEUTRAL] The claim.
[CUSTOMER][NEUTRAL] OK. Could you please uh specify the CPTs?
[AGENT][NEUTRAL] 99233
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 93018.
[AGENT][NEUTRAL] 93016 and 78452.
[CUSTOMER][POSITIVE] Thank you so much for that all information. And what is the time filing to submit and correct it claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, no, tell me filing for corrected claim.
[CUSTOMER][NEUTRAL] OK. And mailing address to submit correctly?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] And timely failing to submit an appeal?
[AGENT][NEUTRAL] 180 days from the date of denial and the original date of denial was [PII].
[CUSTOMER][NEUTRAL] OK. Mailing address to submit an appeal is same as correctly or different?
[AGENT][NEUTRAL] It's the same.
[CUSTOMER][NEUTRAL] OK. And is there any specific form for pills?
[AGENT][NEUTRAL] We would just need a formal written appeal letter stating the reason that you are appealing the claim decision.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Could you please reconfirm the claim number?
[AGENT][NEUTRAL] Claim number is 353.
[AGENT][NEUTRAL] 7051.
[CUSTOMER][NEUTRAL] OK, that's great. And what, what will be the call reference name and number for this claim? I have 2 more claims for the same patient.
[AGENT][NEUTRAL] Sure. The call reference is going to be the same for the entire call and it is my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is your last initial, [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Should I provide you the second date of service?
[AGENT][NEUTRAL] I'm ready for that data service.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] So what
[AGENT][NEUTRAL] Is it for the same facility, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it is for the same facility.
[AGENT][NEUTRAL] And that build out?
[CUSTOMER][NEUTRAL] It's $289 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim we received on [PII].
[AGENT][NEGATIVE] And processed on [PII], that was denied for the same reason.
[AGENT][NEUTRAL] And I can provide that claim number for you.
[CUSTOMER][NEUTRAL] Sure, go ahead.
[AGENT][NEUTRAL] That claim number is 353.
[AGENT][NEUTRAL] 71 I'm sorry, 7710.
[CUSTOMER][NEUTRAL] The claim number is 353-7710.
[AGENT][NEUTRAL] Yes, sir, and all the information is the same as the other denied claim.
[CUSTOMER][NEUTRAL] OK, so the CPT codes are, are also the same.
[AGENT][NEUTRAL] 99233. Yes, sir.
[CUSTOMER][NEUTRAL] OK. And all the information are the same.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Just the claim number is different. OK.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, I have one more claim for the same patient and same provider.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what is that billed amount?
[CUSTOMER][NEUTRAL] Sure, the bill amount is $753 even.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Getting that received date for you. Bear with me.
[AGENT][NEUTRAL] Received on [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Process on [PII], denied for the same reason, that's both CPT codes 99255 and 93306.
[AGENT][NEUTRAL] And that claim number?
[CUSTOMER][NEUTRAL] The CPT code are different.
[AGENT][NEUTRAL] Yeah, 99255 and 93306.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 353-772-0.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And all other information are same.
[AGENT][NEUTRAL] Yes, the denial reason is the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have one more claim for same patient.
[AGENT][NEUTRAL] Alright, what's that data service?
[CUSTOMER][NEUTRAL] So, the date of service is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that built out
[CUSTOMER][NEUTRAL] The bill amount is $289 even.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Getting that claim pulled up for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that claim we received on 12-4-25 and processed on 12-5-25.
[AGENT][NEGATIVE] And denied for the same reason.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that CPT code is 99233.
[AGENT][NEUTRAL] And claim number is 353.
[AGENT][NEUTRAL] 7715.
[CUSTOMER][NEUTRAL] And the CPT code is only one CPT code has been denied, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and all the other information is same.
[AGENT][NEUTRAL] It's the same. You are correct.
[CUSTOMER][NEUTRAL] OK. I have one more claim for the patient.
[AGENT][NEUTRAL] OK, what's that data service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] Build out.
[CUSTOMER][NEUTRAL] The bill amount is $289 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Claim was received on [PII] and processed on 125 and denied for the same reason.
[AGENT][NEUTRAL] That CPT code is 99233.
[AGENT][NEUTRAL] And claim number is 353-7724.
[CUSTOMER][NEUTRAL] You're also ones it is only, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, no need to verify all other information. I have one more claim for the same patient.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] I guess.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] Bill amount is $289 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Received on [PII] and processed on [PII], denied for the same reason. CPT code 99233.
[AGENT][NEUTRAL] And claim number 353.
[AGENT][NEUTRAL] 7712.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And all the information is the same.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. and call reference number will be also same.
[AGENT][NEUTRAL] Yes, sir, my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for all that information. Have a nice day ahead.
[AGENT][POSITIVE] And [PII], it's been a pleasure to assist you with that claim status. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all for the day.
[AGENT][POSITIVE] Well, thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.