AccountId: 011433970860
ContactId: 408a59cb-873c-43b0-a8d1-6aaef434e970
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3171459 ms
Total Talk Time (AGENT): 508343 ms
Total Talk Time (CUSTOMER): 1271166 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/408a59cb-873c-43b0-a8d1-6aaef434e970_20250522T19:23_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patient's information or the provider's information?
[AGENT][POSITIVE] I'm Happy to check a claim for you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The policy number is 60801.
[AGENT][NEUTRAL] That's actually our payer ID.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, OK. Could you please check with the name and date of birth?
[AGENT][NEUTRAL] What's the last name?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The last name is [PII]
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] I would like to spell it [PII].
[AGENT][NEUTRAL] Let me repeat that back. [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the data service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the filled them out?
[CUSTOMER][NEUTRAL] $1120 even.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So we did receive a claim for the state of service. The claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claim was denied on [PII].
[AGENT][NEUTRAL] Uh, the max benefit payable for this state of service had already been paid.
[CUSTOMER][NEUTRAL] Yeah it is.
[CUSTOMER][NEUTRAL] OK. So the maximum amount for this service has been paid, so there will be no further payments?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] And could you please tell me your name once again?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else?
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] Yeah, I do have some questions um.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm mm mm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And could you please help me with the claim number?
[AGENT][NEUTRAL] 358.
[AGENT][NEUTRAL] 863 7.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 863588637.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK. Could you please tell me what is the allowed dollar amount for the services?
[AGENT][NEUTRAL] The patient's outpatient benefit max is per calendar day, which is $250.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 250 $250.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] So the maximum dollar amount for the service is worth $250 and it's been maxed out.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Could you please tell me when was the last this type of services were building?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, the patient had services billed for that same date. Are you, is that what you're asking?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, no. I'm asking what, when was the last, this type of service were built means.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm, I apologize. I don't understand your question.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm talking about means the, the service has been maxed out for this, uh, for the claim is denied this time for the services has been maxed out. There will be no further payments. So that's why I'm asking this type of services when was last billed.
[CUSTOMER][NEUTRAL] I I.
[AGENT][NEUTRAL] It was that date, so the patient max is per calendar day.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEGATIVE] So there was another claim submitted for the same date of service [PII] from a different provider and the full $250 was paid towards those services that's why there was nothing additional payable for any other services that day.
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh just a second.
[CUSTOMER][NEUTRAL] So the date of service means [PII] was the day when was the last service were built, this type of services were built.
[AGENT][NEUTRAL] Right, because the patient max is per calendar day.
[CUSTOMER][NEUTRAL] OK, could you please tell me timely filing limit to to submit the corrected claim.
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] And mailing address to submit the corrected claim.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] In [PII], [PII]. Zip code is [PII].
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And could you please help me with the timely filing limit to submit an appeal it will be the same, no timely filing limit.
[AGENT][NEUTRAL] Appeals must be submitted within 180 days of the decision.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and could you please help me with the uh mailing address for an appeal?
[AGENT][NEUTRAL] It's the same [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] In [PII], [PII].
[CUSTOMER][NEUTRAL] And [PII] is the mailing uh ZIP code.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Is there any specific form for an appeal?
[AGENT][NEUTRAL] It just needs to be an appeal in writing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that means there is no specific form, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just a second. And dinner is required by submitting a claim or an appeal?
[AGENT][NEUTRAL] Uh, yes, we need explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and what will be the call reference number, your name and today's date?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, give me a second, just a second.
[CUSTOMER][NEUTRAL] Could you please help me with uh a few claims more? I have 34 claims on the file.
[AGENT][NEUTRAL] Is it same patient or different?
[CUSTOMER][NEUTRAL] It's for the different patient.
[AGENT][NEUTRAL] Let me notate this so we can check another one moment.
[CUSTOMER][NEUTRAL] How many claims can you assist me per call?
[AGENT][NEUTRAL] As many as needed.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK, so there's a little bit collection in it. I have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have 8 claims on file. Could you please assist me with that?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The next policy number, uh, just a second. It's loading. The next policy number is 01673475.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII] and the last name is [PII]. The date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the build amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second, it's loading.
[CUSTOMER][NEUTRAL] $358 even.
[AGENT][NEUTRAL] 258, is that what you said or 358?
[CUSTOMER][NEUTRAL] 358.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] So it's $358 even, correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Do you have a different amount after the primary paid?
[CUSTOMER][NEUTRAL] Just a second. Yeah, $160.25.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Claimants received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I
[AGENT][NEUTRAL] Claim was processed on [PII].
[AGENT][NEUTRAL] The bill amount was applied towards the patient's $250 deductible.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and the deductible amount is $250?
[AGENT][NEUTRAL] No, the bill amount was 16025.
[CUSTOMER][NEUTRAL] OK, and the whole amount was processed towards the deductible.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And could you please help me with the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number for this one.
[AGENT][NEUTRAL] 358.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 4361.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK. And could you please help me with the member's annual deductible amount and how much the patient with?
[AGENT][NEUTRAL] Uh, the deductible is $250.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] And patient meds 1625.
[AGENT][NEUTRAL] Let me see, just one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Patient method deductible, the 250.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] And was it in-network deductible or out-network deductible?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Was it uh in-network deductible or out-network deductible?
[AGENT][NEUTRAL] It was just their outpatient deductible. There is no in or out of network deductible.
[CUSTOMER][NEUTRAL] OK, so it's in your network. OK, network.
[CUSTOMER][NEUTRAL] Uh, and could you please help me to which address you guys mailed the copy of EOB? That means you can verify me the pay to address as well.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I need to pull up the provider's explanation, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Mhm. So it looks like it was sent to [PII]. It's to the provider.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And could you please verify the zip code once?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And could you please verify me the patient's account number as well?
[AGENT][NEUTRAL] 01673475.
[CUSTOMER][NEUTRAL] Uh, patient's account number I'm talking about that uh means V as in Victor. There are some numbers and then it's V as in Victor.
[AGENT][NEUTRAL] Are you're talking about with the provider?
[CUSTOMER][NEUTRAL] I'm talking about the patient's account number.
[AGENT][NEUTRAL] With a provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do you have patient's account number with you?
[AGENT][NEUTRAL] I mean, I can look on the claim that was submitted.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh no, I want the patient's account number.
[AGENT][NEUTRAL] I got it. 1227257, V as in [PII] 5499.
[CUSTOMER][POSITIVE] Perfect. That's what, that's what I want. And, and could you please tell me your name once again? I forgot your name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. And [PII], could you please send me the copy of your bill?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] It's [PII] in attention to the patient's account number.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] OK, one moment please while I send this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, don't mention it.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Was there anything else that you needed from this claim?
[CUSTOMER][NEUTRAL] Uh, no, I got everything. And how much time you will receive the copy of UB?
[AGENT][NEUTRAL] 5 minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[AGENT][NEUTRAL] Yup.
[CUSTOMER][NEUTRAL] Yeah, just a second, it's loading. Give me a minute.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh yeah. The next member ID is 02297881. Do you want it once again?
[AGENT][NEUTRAL] No, I haven't. Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] The bill amount will be $970.45.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] We did receive a claim for this on [PII]. The claim was denied on [PII]. Services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK, so the member was not active on the date of service.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] Could you please help me with the
[CUSTOMER][NEUTRAL] effective date and the term date for the member.
[AGENT][NEUTRAL] Effective date [PII]. Policy terminated [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please help me with uh when was the last coordination of benefits were updated?
[AGENT][NEUTRAL] There's no coordination of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Could you please help me with, do you see any other payer listed for this member?
[AGENT][NEUTRAL] No, I do not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the further details will remain the same.
[CUSTOMER][NEUTRAL] Corrected claims, mailing address and everything.
[AGENT][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, shall we move to the next one?
[AGENT][NEUTRAL] Let me just finish notating this. One moment.
[CUSTOMER][NEUTRAL] Yeah, me too. Give me a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] I'm ready for the next one you are.
[CUSTOMER][NEUTRAL] Yeah, just a second.
[CUSTOMER][NEUTRAL] Yeah, the next one will be, yeah. It's S as in Sierra, C as in Charlie, 12119906.
[AGENT][NEUTRAL] That's not one of our policy numbers. Ours don't have letters in them.
[CUSTOMER][NEUTRAL] OK, so could you please check with the
[CUSTOMER][NEUTRAL] Yeah, OK, for the previous one, I didn't take the claim number. Could you please help me with the claim number?
[AGENT][NEUTRAL] 358-6982
[CUSTOMER][NEUTRAL] OK. So could you please uh uh check with the claim, uh, sorry, claim number I'm, uh, name and date of birth?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, what's the last name?
[CUSTOMER][NEUTRAL] The last name is [PII], [PII], [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] The first name is [PII], [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] like
[AGENT][NEUTRAL] What state do they reside in?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. No, give me a second, just a second, not [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh, just a second, sir. Just a second. It's not [PII] sir. Sorry for that.
[CUSTOMER][NEUTRAL] It's loading. Give me a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] There's not any member information that comes up matching that.
[CUSTOMER][NEUTRAL] OK, so you're not able to find the member?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall we move to the next one?
[AGENT][NEUTRAL] Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, it's loading just a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The next member ID is
[CUSTOMER][NEUTRAL] 02474837.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the date of service will be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] The bill amount is $1570 even.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Right. So claim is received for this on [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Claim is processed [PII].
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $500.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] This exhausted the calendar year max, so there was nothing additional payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what's the claim number for this one?
[AGENT][NEUTRAL] 349-056-7.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh sorry, we can move ahead with the next patient.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, what's the next one?
[CUSTOMER][NEUTRAL] Yeah, it's loading.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] The next member ID is 21,780.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If that would be better if that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the patient's first and last name?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] The date of service will be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the build out?
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] The bill amount will be $948 even.
[AGENT][NEUTRAL] $948.
[CUSTOMER][POSITIVE] Yeah, perfect.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And for this one.
[CUSTOMER][NEUTRAL] I'm, I just want the copy of you, [PII].
[AGENT][NEUTRAL] Do you have a different amount after the primary paid?
[CUSTOMER][NEUTRAL] Yeah, I have $75 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Give me just one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hey, I don't show that we got any claims for either build amounts, so nothing on file.
[CUSTOMER][NEUTRAL] For the [PII].
[AGENT][NEUTRAL] No, I don't see any claims for $948 or $75.
[CUSTOMER][NEUTRAL] 948, just a second.
[CUSTOMER][POSITIVE] Yeah I got it.
[CUSTOMER][NEUTRAL] Because I have the claim status with me. The claim has been paid.
[CUSTOMER][NEUTRAL] I just want the copy of you.
[AGENT][NEUTRAL] The claim number that you have, does it end in 66542?
[CUSTOMER][NEUTRAL] Uh, do you see?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, just a second, I will check with it, but do you have the claim on file for $454 even?
[AGENT][NEUTRAL] $454.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] There's one claim on file from Florida Women Care, and it ends in 6542.
[CUSTOMER][NEUTRAL] The claim number.
[CUSTOMER][NEUTRAL] No, 6542. The claim number is 355. Yeah, yeah. Yeah, yeah. 6542, yeah, you're right.
[AGENT][NEUTRAL] OK, that bill amount showed $60. I'll send you the EOB.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, to the same uh fax number and just could you please uh uh
[CUSTOMER][NEUTRAL] I will provide the
[CUSTOMER][NEUTRAL] Patient's account number. The patient's account number is [PII] in attention to the patient's account number.
[CUSTOMER][NEUTRAL] And sir, I need to verify the details as well. The paid amount is $14.79. Am I right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then the pay date was [PII] and it was
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a second, and um and it was paid for, OK, I gave you the paid. And it was a single check payment and the check number is 2024744.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] And cleared on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So could you please send me the copy of your.
[AGENT][POSITIVE] Yep, it's on its way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall we move to the next one?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I got a little bit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the next policy?
[CUSTOMER][NEUTRAL] Yeah, it's loading, just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next policy number is
[CUSTOMER][NEUTRAL] 02448997 M as in Mike, L as in Lima, and the number 8.
[AGENT][NEUTRAL] And name and date of birth?
[CUSTOMER][NEUTRAL] The member's first name is.
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] How you.
[AGENT][NEUTRAL] And the build out.
[CUSTOMER][NEUTRAL] Yeah, it's loading. Just a second.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] $278 even.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Claim is received on [PII], denied on [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Dinner on which date? [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh so the
[CUSTOMER][NEGATIVE] Service is not covered under the member's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, the office visits.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Could you please help me with the claim number for this one?
[AGENT][NEUTRAL] 358-617-9.
[CUSTOMER][NEUTRAL] And which CPT code is not covered under the member's plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. There is only one CPD code, 99213.
[CUSTOMER][NEUTRAL] And could you please
[CUSTOMER][NEUTRAL] OK. The further details will remain the same, the claim submission, corrected claim.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] timely filing and all.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and just the last question, uh.
[CUSTOMER][NEUTRAL] Denied you is required while submitting the claim or an appeal.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, uh, yeah.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Shall we move to the next one?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, the next member ID is 79.
[CUSTOMER][NEUTRAL] 5126.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII]. The date of birth is [PII].
[CUSTOMER][NEUTRAL] She.
[AGENT][NEGATIVE] Pain of service.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] In the buildout?
[CUSTOMER][NEUTRAL] $257.17.
[CUSTOMER][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] Claim for this was received on [PII], denied [PII]. Services were rendered after uh the policy was terminated.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So the member was not active on the date of service.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So can you please help me with the claim number for this one?
[AGENT][NEUTRAL] 3,589,670.
[CUSTOMER][NEUTRAL] What will be the member's effective date and the term date?
[AGENT][NEUTRAL] Effective [PII].
[AGENT][NEUTRAL] Terminated on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And the further details will remain the same. There is no CAB COB updates and there is not the payer listed for this member and the timely filing and the mailing address.
[AGENT][POSITIVE] Mhm, correct.
[CUSTOMER][NEUTRAL] Education
[CUSTOMER][NEUTRAL] Shall we move to the next one?
[AGENT][NEUTRAL] Let me just finish notating this one moment.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] Uh just a second, it's fetching my system is.
[CUSTOMER][NEGATIVE] Giving me a lot of issues. Just a sec.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. The next member ID will be 02.
[CUSTOMER][NEUTRAL] 286-531 M as in Mike, L as in Lima, and the number 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The member's first name is [PII] and the last name is [PII]. The date of birth will be [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the amount will be $120 even.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And billed out was $120.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim is received. It looks like it was denied due to office visits not being covered under the member's policy. Claim is received on [PII], denied on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so could you please help me with the uh with the claim number and the CPT code.
[AGENT][NEUTRAL] 358-845-3
[AGENT][NEUTRAL] CBT code was [PII].
[CUSTOMER][NEUTRAL] OK, shall we move to the next one?
[AGENT][NEUTRAL] I have to notate this 11 moment.
[CUSTOMER][NEUTRAL] And the next claim will be the last claim for the day.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] I like to be.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] 1105147 M as in Mike, L as in Lima, and the number 5.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII]. The date of birth is [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] The date of service is [PII] and give me a second for the bill amount. It's loading. $408.78 is the bill amount.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have a different amount after the primary paid?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I do have. It's $30 even.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't see a claim on file for that amount.
[CUSTOMER][NEUTRAL] Uh, just a second. I do have one more one with me, just a second. Do you have for $350.44?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'm looking to uh the address.
[AGENT][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this claim was denied, office visits are not covered under the member's policy.
[AGENT][NEUTRAL] It looks like the claim was received. One moment.
[AGENT][NEUTRAL] Claim is received on [PII]. Claim is denied on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] CPT code?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 99214.
[CUSTOMER][NEUTRAL] It would be.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] 358-44887.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the further detail details will remain the same.
[CUSTOMER][NEUTRAL] I think
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] OK, sir. Thanks for helping me with a lot of claims and I hope you have a wonderful
[CUSTOMER][POSITIVE] Wonderful day.
[AGENT][POSITIVE] You too. You too, [PII]. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.