AccountId: 011433970860
ContactId: 3d10b964-9d69-48b7-a2e3-72c8bd9e0cf2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463839 ms
Total Talk Time (AGENT): 107994 ms
Total Talk Time (CUSTOMER): 156885 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/3d10b964-9d69-48b7-a2e3-72c8bd9e0cf2_20250516T19:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office.
[CUSTOMER][NEUTRAL] Checking on the claim status.
[AGENT][POSITIVE] All right, I'm happy to check on a claim. What's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, the policy number is 101678796.
[AGENT][NEUTRAL] OK, 10167.
[AGENT][NEUTRAL] 8796.
[CUSTOMER][NEUTRAL] No, no, no, no, no, no, sorry. No, no, no. 01678796.
[AGENT][NEUTRAL] Thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you, data service.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII]. Total charge amount is $349 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It looks like we did receive a claim for the state of service. The claim was received [PII].
[AGENT][NEUTRAL] The claim was processed on [PII]. The claim was denied. Services are not covered.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] When performed in a doctor's office.
[CUSTOMER][NEUTRAL] OK, and the specialty, right?
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] Yeah, the service specialty is not covered, right, you said?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, but uh the CPT code is right, right? The CPT, the service code is uh 71046, right? The service special is Radio Roger, right?
[CUSTOMER][NEUTRAL] Just correct email, right?
[AGENT][NEUTRAL] Yes, I'm showing that as the procedure code, yes.
[CUSTOMER][NEGATIVE] Yeah, then why you they, they denied this incorrectly?
[AGENT][NEUTRAL] How do you figure it was denied incorrectly?
[CUSTOMER][NEUTRAL] Yeah. You see, right, the CPT code is radiology and specialty is radiology. It is correct, right?
[AGENT][NEGATIVE] I show the procedure code was 71046 and I'm showing that it's not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK. Non-covered under the patient plan, right? You said?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Claim number, please.
[AGENT][NEUTRAL] 3504815
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] OK. Uh, may I know this, um, patient responsibility amount?
[AGENT][NEUTRAL] Not able to advise on patient responsibility, that's up to the facility or provider.
[CUSTOMER][NEUTRAL] This is uh for patient plan or provider plan?
[AGENT][NEUTRAL] Or their secondary plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Are you ready for the next date of service?
[AGENT][NEUTRAL] Is it the same patient or a different one?
[CUSTOMER][NEUTRAL] Same member?
[CUSTOMER][NEUTRAL] Same patient.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, uh, [PII]. Sorry for that. Sorry, sorry. Uh, [PII] and total charge amount is $147 even.
[AGENT][NEUTRAL] No claim on file for [PII] for 147.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There is no claim on file, right? You said?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] [PII] and the amount is $147. OK. And um
[CUSTOMER][NEUTRAL] A member eligibility, please?
[AGENT][NEUTRAL] Policy effective date is [PII], still active.
[CUSTOMER][NEUTRAL] OK. And uh timely filing, please, initial timely filing to submit the claim.
[AGENT][NEUTRAL] There
[AGENT][NEUTRAL] There is none.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No DSL, right? OK. May I know this uh mailing address and payer ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[AGENT][NEUTRAL] Claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] OK. Uh, yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, may I know the spell out your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Your last initial two names?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, call reference number for this number?
[AGENT][NEUTRAL] Is my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can check on for you?
[CUSTOMER][NEUTRAL] OK, [PII]. Please bear with me.
[CUSTOMER][NEUTRAL] Yeah, I have 2 more claims, uh, same member, but different, different date of service. Bear with me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, we don't have any claims on that. Thank you for providing this information. Have a great day and bye-bye.
[AGENT][NEUTRAL] You too bye bye.