AccountId: 011433970860
ContactId: 4289e08d-406e-44bf-8180-84c5712d2470
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 569109 ms
Total Talk Time (AGENT): 187485 ms
Total Talk Time (CUSTOMER): 257222 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/4289e08d-406e-44bf-8180-84c5712d2470_20250210T18:57_UTC.wav
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[AGENT][NEUTRAL] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] And the initial to my last name is [PII]. I'm so sorry, I missed out your name. May I have your name once again, please?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] OK. And what's the initial to your last name?
[AGENT][NEUTRAL] [PII], can I have the call back number for you please just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure. Uh, the callback number is [PII] and the extension is [PII]. And I'm so sorry, I still didn't get your, the initial to your last name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] How can I assist you today, [PII]?
[CUSTOMER][NEUTRAL] Um, I wanted to know the reason for a claim denied.
[AGENT][NEUTRAL] Can I have that policy number of the member that you're inquiring claim status for?
[AGENT][POSITIVE] And I'll be able to assist you.
[CUSTOMER][NEUTRAL] Yeah, sure. That's.
[CUSTOMER][NEUTRAL] Sure. The policy number is 020.
[CUSTOMER][NEUTRAL] 880.
[CUSTOMER][NEUTRAL] 717
[CUSTOMER][NEUTRAL] M as in Mike,
[CUSTOMER][NEUTRAL] L as in Lima,
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] So there's too many numbers you gave me 020880717. Could you verify that policy number, [PII], because it's not pulling up a policy unfortunately.
[CUSTOMER][NEUTRAL] Hold on for a second.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] It does the mhm yeah give me a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 20.
[CUSTOMER][NEUTRAL] 989, yeah. Oh yes, sure. The policy number only uh is 020.
[CUSTOMER][NEUTRAL] 80717.
[AGENT][NEUTRAL] Thank you, [PII]. Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient's name is [PII]. And uh date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring about?
[CUSTOMER][NEUTRAL] It's uh [PII] with the total charge of $1,064 even.
[AGENT][NEUTRAL] Do you have a procedure code?
[CUSTOMER][NEUTRAL] Yeah, it's uh 00790. That's the anesthesia code.
[AGENT][NEUTRAL] 00790.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] How many times did you submit the claim?
[CUSTOMER][NEUTRAL] Um, as far as we are aware, this claim was submitted once, uh, electronically, but we are actually not sure whether the business since the primary payer for this member was BCBS, Blue Cross Blue Shield. So we are not sure whether they had internally forwarded the claim from their end or not.
[CUSTOMER][NEUTRAL] So that might have happened. That is the reason we actually wanted to know was that the reason for the claim being denied as duplicate because.
[CUSTOMER][NEUTRAL] Maybe we had also submitted the claim electronically and simultaneously they had also uh send the claim uh along with the EOB from their end internally that might have also.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But you should have received a check though. We, do you, would you like the check number?
[CUSTOMER][NEUTRAL] Uh, yes, sure.
[CUSTOMER][NEUTRAL] Yeah, may I have the check number?
[AGENT][NEUTRAL] It is 202-4629. It's 2024629, and it's for $493.45.
[CUSTOMER][NEUTRAL] OK. Uh, all right. OK. It's a bulk check, right?
[AGENT][NEUTRAL] No, it's single chick.
[CUSTOMER][NEUTRAL] That's a single check, OK.
[CUSTOMER][NEUTRAL] All right. Um.
[CUSTOMER][NEUTRAL] So, uh, was this the, uh, was this the paid amount?
[AGENT][NEUTRAL] And it was sent out on the [PII].
[AGENT][NEUTRAL] Mhm, that was the paid amount for one of the claims, yes, for one of the claims you submitted two claims with the same CPT code, but this is for the one with the QX.
[CUSTOMER][NEUTRAL] [PII] of uh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Modifier.
[CUSTOMER][NEUTRAL] Mm. Correct. The QX for the, right. The one submitted with QX modified, that's for CRNA uh claim, certified registered nurse, and the one which I'm also inquiring about, that's for the doctor.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that means the claim was actually paid for 400.
[AGENT][NEUTRAL] This is for the anesthesia.
[CUSTOMER][NEUTRAL] Anesthesia, right. OK. First of all, I would like to focus on the first one, that's uh $493.45. May I have the um original claim number, please?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] 3556367. It's 3556367 and that is for the anesthesia charge.
[CUSTOMER][MIXED] Correct. OK. And the allowed amount was $493.45. There was no patience responsibility at all, right?
[AGENT][NEUTRAL] That is correct. No.
[CUSTOMER][NEUTRAL] OK, OK. Could you, uh, confirm me the paid date once again? You told me that it was on [PII]. Am I correct?
[AGENT][POSITIVE] That is correct, [PII].
[CUSTOMER][NEUTRAL] OK. And uh when was the check issued? Was it check uh issued on the same day?
[AGENT][NEUTRAL] The check was, so it was processed on the [PII] and um it may have not went out depending on that day that it was the time that it was processed, it may have went out two days after it was processed. So if it was a Monday, it may have went out in the mail on a [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. All right. And uh along with that, the, since, uh, there's another claim for the CRNA bill with QX modifier, we also have the paid amount for that.
[AGENT][NEUTRAL] For the QK modifier cause I just gave you the information for the QX modifier.
[CUSTOMER][NEUTRAL] Oh, you provided me for the QX modifier. OK. All right. OK.
[AGENT][NEUTRAL] Right, that claim that I just gave you the information of the 3556367, I stated that was for the QX.
[AGENT][NEUTRAL] Modifier, not the QK.
[CUSTOMER][NEUTRAL] QX, OK.
[CUSTOMER][NEUTRAL] Of the QK. OK. Now, may I have the information about the QK modifier clip?
[AGENT][NEUTRAL] So the QK modified claim?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There was $493.45 paid on that claim as well.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. And may I have the check number?
[AGENT][NEUTRAL] Check number is 2024622. That's 2024622.
[CUSTOMER][NEUTRAL] OK. And also may I have the claim number, please?
[AGENT][NEUTRAL] Process the same day is [PII] and the claim number is 3,556,360.
[CUSTOMER][POSITIVE] All right. Thank you so much. And how can we get the EOB?
[AGENT][NEUTRAL] I can send it to you by fax if you would like.
[CUSTOMER][NEUTRAL] Sure. Uh, that would be quite helpful. May I, OK, let me provide you the fax number.
[AGENT][NEUTRAL] Could you give me a moment, please? I'm gonna request that from you.
[CUSTOMER][POSITIVE] Sure, absolutely.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what's your fax number?
[CUSTOMER][NEUTRAL] Yeah. Fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So I have [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Correct. Attention to my name. The first name is [PII] and initial to the last name is [PII].
[AGENT][NEUTRAL] All right, [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, just one more question. Do you have that particular information whether the check has been cleared? Uh, is it still pending?
[AGENT][NEGATIVE] No, it has not been cleared. It just was sent out. It has not been cleared in our system yet. You have to wait 30 days, 30 to 31 days to call back to request a copy of the check.
[CUSTOMER][NEUTRAL] To get a copy of check. OK. All right. Thank you so much. That would be all. And may I have the call reference number at the end?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't provide those unfortunately, [PII], however, you can use my name and today's date as a reference. Would you like for me to spell my name for you again?
[CUSTOMER][POSITIVE] Uh, no, I got it. Thank you so much, uh [PII], for that information.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and have a great day, [PII].
[CUSTOMER][POSITIVE] Yeah, you too. Have a wonderful day. Take care. Bye-bye.
[AGENT][POSITIVE] Thanks. Goodbye.