AccountId: 011433970860
ContactId: 2cc8492f-a105-4afd-9706-b7de1d2464a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383609 ms
Total Talk Time (AGENT): 116818 ms
Total Talk Time (CUSTOMER): 141841 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/2cc8492f-a105-4afd-9706-b7de1d2464a7_20250108T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Uh, hi [PII]. I'm calling to check on a claim for a patient of ours.
[AGENT][NEUTRAL] All right, I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and initial is [PII].
[AGENT][NEUTRAL] [PII], can I please have a callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Policy number for the member.
[CUSTOMER][NEUTRAL] Policy number, uh, it's in.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 02477821
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Could you please verify the member's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] [PII], thank you so much for verifying the information today. You're calling in for claim status. Could you please verify the date of service of the claim?
[CUSTOMER][NEUTRAL] Yes, uh, I have a couple of dates. The first one is [PII].
[AGENT][NEUTRAL] Charge amount please.
[CUSTOMER][NEUTRAL] $12 even.
[AGENT][NEUTRAL] You said $12?
[CUSTOMER][NEUTRAL] Yes, just $12.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Is this for CP code [PII]?
[CUSTOMER][NEUTRAL] Yes, I think so.
[CUSTOMER][NEUTRAL] So you know.
[AGENT][NEUTRAL] Alright, so looks like that it was submitted to us two times. The first one under claim 351-8669. That was denied as the venue purchase is not covered under the members um plan. Then it was resubmitted again under 352-4074 and that was denied as a duplicate.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and what was that uh first code?
[CUSTOMER][NEUTRAL] I mean, uh first claim I'm sorry.
[CUSTOMER][NEUTRAL] Your
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] For your mouth.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 351-866-669
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Uh, no, OK.
[CUSTOMER][NEUTRAL] And I have another data service for her.
[CUSTOMER][NEUTRAL] Uh, the next day service is 8:19.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] The charge amount please.
[CUSTOMER][NEUTRAL] Uh, $114 even.
[CUSTOMER][NEUTRAL] Co
[AGENT][NEUTRAL] So the first claim was submitted on 351-8666.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That's the claim number for the first submission. The venue purchase was denied as that's not covered under the member's policy, um.
[AGENT][NEUTRAL] The 847-02 CPT code was denied as they maxed the office visits um for that calendar year.
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Benefits Max.
[AGENT][NEUTRAL] It was resubmitted again.
[AGENT][NEUTRAL] Under claim 352-4078, that claim was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, and I have one last data service for you, and this one is 10:31 24.
[CUSTOMER][NEUTRAL] And the bed amount is 462 either.
[AGENT][NEUTRAL] $462.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I don't have a charge amount for $462.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You don't have to charge.
[AGENT][NEUTRAL] What's the CPT code?
[CUSTOMER][NEUTRAL] Uh, hold on one second, let me see.
[CUSTOMER][NEGATIVE] Cause you don't got all them.
[CUSTOMER][NEUTRAL] So I.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Z 11.3 and Z01.419.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The 874-9187591 and 8766188175.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I don't have any of those. I have a charge for $486 but that is not the CPT code or the amount that you're looking for.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, let me.
[CUSTOMER][NEUTRAL] What's that payer ID we submitted this to?
[CUSTOMER][NEUTRAL] Yes, so.
[AGENT][NEUTRAL] Um, it is.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 608-601.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Uh, give it to me again. I'm sorry, you said 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][POSITIVE] 801. OK. Well, hey, um, thank you so much for all your help. Have a great one.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, you gotta call work number.
[AGENT][NEUTRAL] It'll be my name in today's date.
[CUSTOMER][NEUTRAL] I go.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day. Bye-bye.