AccountId: 011433970860
ContactId: 35471814-525e-4c88-8618-d4ad817ce4b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1176369 ms
Total Talk Time (AGENT): 238289 ms
Total Talk Time (CUSTOMER): 419166 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/35471814-525e-4c88-8618-d4ad817ce4b0_20250211T18:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] And it's nice.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, hi, I'm [PII] calling from provider's office regarding our claims.
[AGENT][NEUTRAL] OK [PII], I can help you with the claim. Can you please give me your call back number?
[CUSTOMER][NEUTRAL] The callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you sir and then what is the patient's name?
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Yeah, patient's first name is um [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] um.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[AGENT][NEUTRAL] And the policy number please?
[CUSTOMER][NEUTRAL] And the policy number is uh
[CUSTOMER][NEUTRAL] 01912852 M as in Mike L as in Lima number 8.
[CUSTOMER][NEUTRAL] And then guys.
[AGENT][NEUTRAL] OK, let me look that policy up for us real quick.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 66556.
[AGENT][NEUTRAL] OK, and then what is the date of service of the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] with the bill amount of $237 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. And then what is the amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, actually, after the primary insurance paid, the, uh, remaining balance is $35 even.
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] Did you hear me?
[CUSTOMER][NEGATIVE] Yeah, I'm sorry, I'm unable to hear you clearly.
[AGENT][NEUTRAL] OK OK what is the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. Just give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The name of the facility is Gastrohealthy.
[AGENT][NEUTRAL] OK I'm gonna put you on a brief hold while I look up that claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] 591
[CUSTOMER][NEUTRAL] Sure, please.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me, [PII]. I do have the claim for you. The claim number is 354-423-1.
[AGENT][NEUTRAL] The claim was received on [PII] and was processed on [PII]. The claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Yeah, uh, you're stating that, uh, the claim was denied that office visits are not covered under the patient uh patient's policy. OK. May I know what does the patient policy has?
[CUSTOMER][NEUTRAL] You can help me the patient's policy name member's plan name.
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] Mail link, right? M A D I.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Aiding plan.
[CUSTOMER][NEUTRAL] Sure, go can you send me a copy of your be through fax for this claim.
[AGENT][NEUTRAL] Yes, what is your fax number, sir?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] 3536.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you. I'll be right back, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], looking at this, I do see that [PII] called earlier and we already sent the EOB to her.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, got it. OK. I just wanted to confirm the claim number. Uh, the claim number is 354-423-1. Am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, can you spell your name with the last name initial, so for the documentation purpose please.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] And you said the last name sorry?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK, uh, OK, [PII], I do understand. Shall we move to another claim? I do have another, like more 4 claims. Can you please help me with that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me make my note real quick and then we'll move on to the next one.
[CUSTOMER][NEUTRAL] Oh I think for this one
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Sure, right, take your time.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] 8240.
[CUSTOMER][NEUTRAL] 617.
[CUSTOMER][NEUTRAL] Because.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, thank you so much. And then what is the next patient's name?
[CUSTOMER][NEUTRAL] Next patient's name is uh [PII], and the last name is uh [PII].
[AGENT][NEUTRAL] OK, and then what is um the date of service?
[AGENT][NEUTRAL] I'm sorry, first, go ahead and give me the policy number.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] The policy number is 01.
[CUSTOMER][NEUTRAL] 989-438 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's just
[AGENT][NEUTRAL] OK, what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yeah, the date of birth is uh.
[CUSTOMER][NEUTRAL] Mhm yeah, [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service, sir?
[CUSTOMER][NEUTRAL] The date of service is uh [PII].
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] And the charge amount bill amount is uh $4,072 even.
[CUSTOMER][NEUTRAL] It's 407281.
[AGENT][NEUTRAL] OK, and then the charges after primary paid their part?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] After the primary period the part, uh, the charge amount is $148. 70 cents.
[AGENT][NEUTRAL] OK. And is it also for gastrohealth?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, you are right.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold. I'm gonna look that up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh shoot, I didn't want to do that.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] So.
[AGENT][POSITIVE] And thank you for holding for me. I do have the claim.
[AGENT][NEUTRAL] The claim number is 3541294.
[CUSTOMER][NEUTRAL] and with the I can.
[AGENT][NEUTRAL] The claim was denied for the same reason. um, these services not covered when performed in an office or clinic.
[CUSTOMER][NEGATIVE] OK, services are not performed.
[AGENT][NEUTRAL] The services are not covered if they are performed in an office or a clinic.
[CUSTOMER][NEUTRAL] It's so. I, I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just wanted to make sure, uh, like, uh, like you're stating that the services are, uh, the claim was not denied due to the services are not per uh, are not covered as they performed in office or in clinic, am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, actually, uh, I just wanted to make sure the CPT codes, uh, the bill for this claim is [PII] and 45381. Am I right? 243 24239005.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] You're wanting the CPT codes?
[CUSTOMER][NEUTRAL] Yes, I'm confirming the the CPT course build with uh like 453-85143239945381.
[AGENT][NEUTRAL] No, I don't have those CPT codes.
[CUSTOMER][NEUTRAL] Actually.
[CUSTOMER][NEUTRAL] Like, uh, we have been with the claim along with this 4 CPD only.
[AGENT][NEUTRAL] Uh, no, this, um, claim was billed with CPT codes 88305.
[CUSTOMER][NEUTRAL] I watch it.
[AGENT][NEUTRAL] 88312.
[AGENT][NEUTRAL] 883-41.
[CUSTOMER][NEUTRAL] Then we have.
[AGENT][NEUTRAL] 88313.
[CUSTOMER][NEUTRAL] There's no limit.
[AGENT][NEUTRAL] Those were the were the codes that were built on this claim.
[CUSTOMER][NEUTRAL] Did you send it through email.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Like, no, no, no, no. Actually, upon checking, I do have the CPT codes like 453-8514323945381. This is the not the claim.
[AGENT][NEUTRAL] How about I
[AGENT][NEUTRAL] How about I send you a copy of the EOB so you can see it?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, uh, like, can you please check with the date of service and the bill amount once, please.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] She
[AGENT][NEUTRAL] Yes, I'm gonna put you on a hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I got a copy of the EOB going to you now.
[CUSTOMER][NEUTRAL] Yeah, hello, [PII]. Actually, the bill amount is $4,072. It's 4072.
[AGENT][NEUTRAL] OK, let me recheck it. It'll be, I'll, I'll be right back.
[CUSTOMER][NEUTRAL] Sure. You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, upon further review um adding up the amounts for them that I gave you, we do not have the claim on file for that bill amount.
[CUSTOMER][POSITIVE] Very fun to try to.
[CUSTOMER][NEUTRAL] You got
[CUSTOMER][NEUTRAL] For the OK, you are stating that bill amount is, uh, not on, uh, not on file, right? OK, could you please, what is the payer ID of yours so that I can refile the claim.
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][NEUTRAL] 60801. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Could you please help me now what is the mailing address of yours, please?
[CUSTOMER][NEUTRAL] It's.
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mm, OK, uh, OK, it's Ok [PII]. Am I right?
[AGENT][NEUTRAL] And that's in
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK. Could you please help me uh member effective and terminations, please?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The member is active [PII].
[AGENT][NEUTRAL] And the policy terminated on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You got it. Uh, what is the time to submit the claim?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] Yeah, OK. You are studying uh for this date of service like in [PII] with the bill amount of $40072. There's no claim on file, am I right, ma'am?
[AGENT][NEUTRAL] Yes, there's no claim on file for that bill amount.
[CUSTOMER][NEUTRAL] You got it, you move to another claim. It's for different number as well.
[AGENT][NEUTRAL] It's the same member you said? OK, what is the data service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's a different number.
[AGENT][NEUTRAL] Oh, different member. OK, what is the member's name?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Member's first name is going to be uh [PII] and the last name is uh [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the date of birth is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what is the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, policy number is 01989.
[CUSTOMER][NEUTRAL] Uh, actually, I'm sorry, it's for the same number. Uh, the member ID I will help you with that. It's 01989438 M as [PII]. Please submit uh.
[AGENT][NEUTRAL] OK, what is, um, the data service?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. Uh, the bill amount is different. The bill amount is $4,1003. It's $4103 even 4000 not $3 even.
[AGENT][NEUTRAL] OK, alright, it's gonna be a brief hold um and is it for the same uh facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it's gonna be a brief hold while I look that claim up.
[CUSTOMER][NEUTRAL] Sure.