AccountId: 011433970860
ContactId: 2b8c8206-6b69-4665-b505-71cbf9f596a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423290 ms
Total Talk Time (AGENT): 116295 ms
Total Talk Time (CUSTOMER): 171007 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/2b8c8206-6b69-4665-b505-71cbf9f596a6_20250303T18:40_UTC.wav
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[AGENT][NEUTRAL] For calling ATL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status Da real if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02507926 ML8.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh yeah, the patient's name is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And what is the
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, [PII] for $410 even.
[AGENT][NEUTRAL] And what's your tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Looks like we received that claim twice. The first time it denied because office visits are not covered under the policy, and the second time it denied as a duplicate.
[CUSTOMER][NEUTRAL] For which, uh, for [PII] date of service?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and may I know when the claim was received and denied initially?
[AGENT][NEUTRAL] Claim was received on [PII]. Claim denied on [PII].
[CUSTOMER][NEUTRAL] So office visit is not covered under the uh patient's meddling policies, so it's a patient responsibility.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And what about the procedure code 17,110?
[AGENT][NEGATIVE] It's not covered in the um office visit in an office setting.
[CUSTOMER][NEUTRAL] So, uh, it denied as doctor's office, or clinic.
[CUSTOMER][NEGATIVE] But it is not performed.
[AGENT][NEUTRAL] Yes, the
[AGENT][NEGATIVE] The treatment, now, because it was billed as a treatment in a doctor's office, it was denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Because it will only be covered on an outpatient basis.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] So, it is also a patient responsibility?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And can you fax me the EOB?
[AGENT][NEUTRAL] Yes, what's that fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And to whose attention?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, you should receive that fax by close of business today. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Yeah, may I have the claim number for this one?
[AGENT][NEUTRAL] Claim number is 3555625.
[CUSTOMER][NEUTRAL] OK. So we will receive the UB within today?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And I have one more patient. Can you help me?
[AGENT][NEUTRAL] OK, one moment, let me notate this account.
[AGENT][NEUTRAL] And what's that policy number?
[CUSTOMER][NEUTRAL] It's 02559264.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] A date of service for this claim is [PII] for $465 even.
[AGENT][NEUTRAL] And the tax ID.
[CUSTOMER][NEUTRAL] Tax ID is [PII].
[CUSTOMER][NEUTRAL] Mm mm mm.
[AGENT][NEUTRAL] OK, I'm showing a payment was made on the claim in the amount of $94.19.
[CUSTOMER][NEUTRAL] When will the receive and process date?
[AGENT][NEUTRAL] Claim was received on [PII]. Claim paid on [PII].
[CUSTOMER][NEUTRAL] OK. So $94.19 has been paid.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And what about the procedure code 99,230. It is also denied as office visit is not covered under Melink.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So the patient responsibility as well.
[CUSTOMER][NEUTRAL] OK. And uh may I have the payment information?
[AGENT][NEUTRAL] Check number is 202-7665.
[CUSTOMER][NEUTRAL] 202-7665
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And it's a single check or a check?
[AGENT][NEUTRAL] Um, single check.
[CUSTOMER][NEUTRAL] And the issue date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the P2 address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And the claim number?
[AGENT][NEUTRAL] Claim number is 3563335.
[CUSTOMER][NEUTRAL] 356-3335
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And you'll be also sent to the provider's office with the check.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, thank you. And uh the check is still outstanding. We need to allow some more days?
[AGENT][POSITIVE] Yes, it's still outstanding.
[CUSTOMER][NEUTRAL] OK. Can you spell your name for me?
[AGENT][NEUTRAL] [PII]. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] That's all for today. Thank you for asking. And the call reference will be?
[AGENT][NEUTRAL] My name and today's date and time.
[CUSTOMER][NEUTRAL] Your name and today's date.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for the information you provided me on this call.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye.
[AGENT][NEUTRAL] OK.