AccountId: 011433970860
ContactId: 2893ae90-0755-4bff-acc5-df24c0f25379
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465109 ms
Total Talk Time (AGENT): 174798 ms
Total Talk Time (CUSTOMER): 177650 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/2893ae90-0755-4bff-acc5-df24c0f25379_20241231T16:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, sir. My name is [PII]. I'm calling from provider's office and I want to check up on the claim status.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have a callback number just in case we get disconnected, so.
[CUSTOMER][NEUTRAL] OK. Callback number is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, for it's uh 022.
[CUSTOMER][NEUTRAL] 846
[CUSTOMER][NEUTRAL] 30
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK. And what is the day of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total amount is $1,904 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if I can find this claim for future. You can check claim status online through our website at [PII]. And let's see.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] Do you know what's the procedure code?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, I don't know that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if it's this one.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Bear with me, I have several claims for that date of service and I don't see that amount, so I'll have to pull them up. One moment.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the total charge is $1,904?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Mm, OK, one moment, I don't see that amount at all.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you cannot find the CPT codes, the procedure codes, because that will be a lot faster to find your claim.
[CUSTOMER][NEUTRAL] Uh, uh, give me a moment. I will search.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, that's good.
[AGENT][NEUTRAL] OK, I think I found it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Mr. [PII], it looks like we processed this claim [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $904.83.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $904.
[AGENT][NEUTRAL] $4.83.
[CUSTOMER][NEUTRAL] And what about the rest of them all?
[AGENT][NEUTRAL] Um, my address, um, let me see, I will have to pull the primary AV. One moment, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We are the secondary, OK? So let me check and see how much the primary applied towards the patient's responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Actually, uh, hello?
[AGENT][NEUTRAL] Mhm mhm. Yes, go ahead.
[CUSTOMER][NEUTRAL] Uh, what's your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK. So, uh, I have an information that would, I think, uh, would be helpful. Uh, uh, I can see in my software that we have, uh, the balance left is $19.78.
[CUSTOMER][NEGATIVE] But uh I don't have any information why this balance left.
[AGENT][NEUTRAL] That's because one of the codes is not listed on the form.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, let me check and see which one is missing. 1234.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 60. Uh, the last, um,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] The 76937 is not on the claim. It looks like we received the first page and it's probably, it was probably two pages of the 1500 form because it's missing one of the codes that is on the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] So based on the 1500 form, we pay the um the codes that were listed.
[CUSTOMER][NEUTRAL] So what should we do now? We should build rebuild the claim with the CPT code.
[AGENT][NEUTRAL] Yeah, if, if you're missing a payment, which it looks like based on the explanation of benefits from the primary insurance, it's gonna be the last code, which is the code um 76937 modify your 26. Um, we just need uh the 1500 form with that code because that code was not listed on the one we received.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 693 7. Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you for the information. That would be all.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, no, you, uh, you are very helpful.
[AGENT][POSITIVE] Well thank you for calling ATL. Have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] They
[CUSTOMER][POSITIVE] Happy [PII].
[AGENT][POSITIVE] Thank you, you as well bye bye.