AccountId: 011433970860
ContactId: 2d973259-c32c-418c-b3ae-8493220c9d14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 953929 ms
Total Talk Time (AGENT): 426904 ms
Total Talk Time (CUSTOMER): 345695 ms
Interruptions: 7
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/2d973259-c32c-418c-b3ae-8493220c9d14_20250502T19:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII], and my first and last name is [PII]. I'm calling from provider office, and I just want to discuss about the claim. By the way, [PII], how are you?
[AGENT][NEUTRAL] I'm fine, [PII], and I can verify claim status for you. Uh, what is that policy number, please?
[CUSTOMER][NEUTRAL] Same here, more than that.
[CUSTOMER][NEUTRAL] Uh, yes, the policy number is 01986343.
[AGENT][POSITIVE] OK, thank you so much. Give me one moment and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] It's on.
[CUSTOMER][NEUTRAL] Yes, the call back callback number is [PII] and the [PII] is [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] OK, so the patient name is going to be [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and you say you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] OK, so the date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount is just.
[CUSTOMER][NEUTRAL] Just wait for total charge amount.
[CUSTOMER][NEUTRAL] Actually my system is working very slow so it will take for a while. OK, so the total charge amount is $264.57.
[AGENT][NEUTRAL] And I apologize, what was the date of service again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And, uh, [PII], do you have the balance after Primary Insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that amount is?
[CUSTOMER][NEUTRAL] Uh, the amount is 200, sorry, it's $198.92 because as for primary insurance they paid only S9083 and the amount of uh S9083 code is $198.92.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And while I'm looking up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at secured. AM as in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Medvice LLC.
[AGENT][NEUTRAL] Uh, it looks like we received this claim several times. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, the first time the claim was received, it processed as incorrect EOB as well as the 2nd time the claim was received. The 3rd time the claim was processed as needing primary EOB and the 4th time the claim processed as a duplicate.
[CUSTOMER][NEUTRAL] OK, so you need to say the most recent claim status is denied for duplicate, right?
[AGENT][NEUTRAL] The last time we received uh it processed as a duplicate. The claim before it processes needing primary EOB and they pass two claims before that they process as incorrect EOB. So essentially the main thing we need is the primary EOB.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but uh we have already sent the uh primary OB and uh you stated that uh as, as a second time, uh, you received incorrect OB, right?
[AGENT][NEGATIVE] Uh, the first and 2nd time the claim processed as an incorrect EOB.
[CUSTOMER][NEUTRAL] OK, but that was not uh incorrect to you be, um, the primary is processed with as a code and uh I have uh another date of service which is [PII]. And on this date of service you have processed with the BCBS uh primary UB and they process as 9083 code and you paid on behalf of that CPT code and you can check.
[AGENT][NEUTRAL] What was the total charge of, what was the total charge of the claim?
[CUSTOMER][NEUTRAL] And I can provide you the claim number.
[CUSTOMER][NEUTRAL] Um, for date of service [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mm, it's also $264.57.
[CUSTOMER][NEUTRAL] And you paid $50.
[AGENT][NEUTRAL] OK, what's that claim number?
[CUSTOMER][NEUTRAL] OK, so the claim number is.
[CUSTOMER][NEUTRAL] 3549951
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, yeah, for that data service of [PII], it looks like we had the information we need to process the claim and we paid $50 but that doesn't negate that the data service of [PII], we're needing the primary EOB.
[CUSTOMER][NEUTRAL] OK, you need, so you never ever uh receive primary.
[AGENT][NEUTRAL] As I stated, the initially, the claim process as needing the correct EOB and a process like that a second time, 3rd time process is needing primary EOB and the fourth time was a duplicate. So if you can submit the EOB for that data service of [PII] or [PII], and they go back and reprocess the claim.
[CUSTOMER][NEGATIVE] OK. I do not want to talk about the 3rd time or 4th time of denial. I just want to talk about the 1st and 2nd time you stated like uh you received incorrect UM, right? But uh for date of service, [PII], you receive same kind of
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Well, for [PII], apparently we had the information we need, so we were able to process and pay the claim. But for [PII], we do need the primary EOB.
[CUSTOMER][NEUTRAL] Yes, go on
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you also see what kind of uh information that you need from from primary will be.
[AGENT][NEUTRAL] Well, we need on the EOB it has to have the data service, amount of the charge, the procedure code as well as what is applied towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK, so you mean to say, uh, which I provide you, which I sent you the primary OB, uh, all the information that is not mentioned over the primary OB.
[AGENT][NEUTRAL] Well, I'm not sure what information was missing from the initial, but give me one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Please check because uh we have sent the correct TOB of primary and uh we on the behalf of primary OB uh we have to send the claim back for review.
[CUSTOMER][NEUTRAL] Because you have already processed the claim on behalf of primary will be on the date of service [PII].
[AGENT][NEUTRAL] OK, but so, those are two different dates of service and this on the [PII] is needing uh the primary EOB, but give me one moment while I review this, OK? Thank you.
[CUSTOMER][NEUTRAL] And that is the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] uh
[AGENT][NEGATIVE] Well, on the EOB that we received initially, it does not have the correct amount of the charge as per the um HIFA form, and it does not have the correct procedure code as that was on the HIFA form. So it's not a correct EOB.
[CUSTOMER][NEUTRAL] OK, and uh, OK, let's talk about the date of service [PII] and what is the prime like, uh, what is the total charge amount and CPT was mentioned on the prime view. Could you please tell me?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Do the
[AGENT][NEUTRAL] Uh, that looks like the same, uh, should have been processed. It's needing correct EOB because the total charge on the claim is 264.57. The total charge on the EOB is 19892.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK, so are you talking about the uh date of service [PII], right?
[AGENT][NEUTRAL] The [PII], correct.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Yes, that's what I'm looking at, sir. So, and you said for the [PII], which we um do showing it, as I stated previously, that it is the same issue, but for some reason this claim went through.
[CUSTOMER][NEUTRAL] I'm talking about uh.
[CUSTOMER][NEUTRAL] I'm uh.
[AGENT][NEUTRAL] But we do need the correct EOB.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] No, it, it's not possible.
[AGENT][NEUTRAL] Yes, sir. That's the way the claim was processed.
[CUSTOMER][NEUTRAL] No, it's not possible. I can provide you the same charge amount and the same CPT because as for the BCBS contract they pay only SN 083 code. So how I can how I can provide you ENM code and different charge amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, we would need to correct the EOB then. So if that's information you can submit. I don't know, sir. I did not process the claim, but like I said, I can transfer you to claims.
[CUSTOMER][NEUTRAL] So why did you why did you process? OK, OK, let me just finish.
[CUSTOMER][NEUTRAL] Sorry for interruption.
[AGENT][NEGATIVE] You, yes, sir, you keep interrupting me. Go ahead.
[CUSTOMER][NEUTRAL] Yes, please, please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, please transfer your, uh, transfer the call your supervisor.
[AGENT][NEUTRAL] Uh, I'm not transferred to a supervisor, but I will transfer you to a representative and claims department that'll be able to assist you further, OK?
[CUSTOMER][NEUTRAL] Oh my
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] No, no, no, no. Oh.
[CUSTOMER][POSITIVE] Thank you. Hello.
[AGENT][NEUTRAL] Hello, hey.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII].
[AGENT][NEUTRAL] Who is this? Hey, [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] Doing well, [PII], thank you. How are you?
[AGENT][NEUTRAL] If I can teleport uh, uh, a karate chop to the throat, I would. But anyway, I'm gonna be good.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, I have a provider on the call. He is calling about a claim status for Metlink plan.
[AGENT][NEGATIVE] We call for 2 days of service. The first day of service, we process as needing the primary EOB twice and then uh the second time, well, 1 and 2nd time process is needing the correct EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And I explained to him on the ELB the amount on the EOB does not match what's on the claim, and he's telling me, well, you've already processed one for [PII] of the same day, and it has the same information, which I don't understand why, whatever. It, it wasn't processes uh needing correct LB, it was just processed and paid.
[CUSTOMER][NEUTRAL] Oh boy, OK.
[AGENT][NEUTRAL] And he wants to know why we paid on one but not on the other, and I, he saw you paid. I said, no, sir, I did not.
[AGENT][NEGATIVE] But he, he, uh, uh, he kept interrupting me the whole time. Like I couldn't even, when I, I'm just warning you, when I told him, I was like, well, the claim process is needing uh the correct EOB. He said, you received it. And when I try to tell him, he said, well, I'm not talking about the, the last time, I'm talking about the second time. I was like, wait, what? But anyway, I, yes, ma'am.
[CUSTOMER][NEGATIVE] Oh jeez. OK.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] It's like, dude.
[AGENT][NEUTRAL] Anyway, but um,
[CUSTOMER][POSITIVE] OK, sounds like a fun call.
[AGENT][POSITIVE] It is, and I appreciate you. Uh, policy number is 1986343.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the first day of service he called about it was [PII].
[AGENT][NEUTRAL] In the amount of 264. 57.
[AGENT][NEUTRAL] And the next one was [PII], and at the same amount.
[CUSTOMER][NEUTRAL] 26457.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and it's for [PII]? Is that right?
[AGENT][NEUTRAL] And I get
[AGENT][NEUTRAL] Uh, yeah. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Patients been verified correct?
[AGENT][NEUTRAL] Yes, I verified all the information, verify him or.
[AGENT][NEUTRAL] Um, got his callback number, you know, he said extension really fast, but yes, I verified information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's his name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and what's the call back number [PII]?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty I will do my best to.
[CUSTOMER][NEUTRAL] Assistant.
[AGENT][POSITIVE] You [PII], of course, I appreciate you.
[CUSTOMER][POSITIVE] No problem and you can go ahead and send him through when you're ready thank you hope you have a great weekend.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] All right, lady. Have a great weekend. You too.
[CUSTOMER][POSITIVE] You too thanks bye.
[AGENT][NEUTRAL] Bye.