AccountId: 011433970860
ContactId: 434ac529-af53-46e8-b3ea-f7b4c5160e74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371130 ms
Total Talk Time (AGENT): 164701 ms
Total Talk Time (CUSTOMER): 112881 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/434ac529-af53-46e8-b3ea-f7b4c5160e74_20250312T18:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling for claim status.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're checking claim status we can help you with that, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] I have 1451419.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying [PII], and could you provide the date of service and the amount?
[CUSTOMER][NEUTRAL] Yes, the data service is gonna be 13 of $24 for $24.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me see if I have that information and we can assist, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that we processed the claim and we're needing a copy of the major medical explanation of benefits. Um, I'm showing that the claim was processed under 351-438-9 that's the claim number.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was processed on uh.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Uh, 2024 looks like we paid the code. Is this an inpatient claim?
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][POSITIVE] Yes, they were impatient.
[AGENT][NEUTRAL] OK, so there were 2 codes on the claim?
[CUSTOMER][NEUTRAL] Um, I am not sure. Let me double check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Look like the same procedure code but there was a modifier on one of them.
[CUSTOMER][NEUTRAL] Um, for 12 of 24.
[CUSTOMER][NEUTRAL] I see a modifier on 12 of 24.
[AGENT][NEUTRAL] What's the modifier?
[CUSTOMER][NEUTRAL] The 76 modifier.
[AGENT][NEUTRAL] Yeah, on the is this a professional charge and not facility? Yeah, we received a professional charge. It has the 93,010 modifier 76 and then a second procedure code of 93,010 with no modifier.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, and one of them was 1467, the other one it was $24.
[AGENT][NEUTRAL] And we paid $1467 on the one with the modifier and requested the primary EOB for the $24 fee, the one you're calling on.
[CUSTOMER][NEUTRAL] And that was for 13 of 24 because I see on 12 of 24 they also build the same codes.
[AGENT][NEUTRAL] Oh, you know what, you know what? The modifier 76 is for [PII] and then the one without the modifier is for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you were looking for the [PII], OK, so we're needing a copy of the primary explanation of benefits.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Same claim number though.
[CUSTOMER][NEUTRAL] OK, um, and how would I submit that?
[AGENT][NEUTRAL] Um, mail it, fax it or submit it, uh, electronically.
[CUSTOMER][NEUTRAL] OK, um, how would I submit it electronically?
[AGENT][NEUTRAL] Our payer ID number is 60801.
[CUSTOMER][NEUTRAL] OK, I do have that on file so um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I've never done it like that before, so would I just, um, refile the claim?
[CUSTOMER][NEUTRAL] Like since this is a secondary claim and.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] Well, since you're sending it electronically, I don't think you can send it with the ELB so I don't believe.
[AGENT][NEUTRAL] So you don't have to send, you do not have to send resend the itemized bill we have that we just need the ELB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what is the fax number? Let me try that.
[AGENT][NEUTRAL] Yeah, [PII]. I think when you send it electronically it just you it's just looking for the itemization.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] I'm assuming I'm still within timely to submit that.
[AGENT][NEUTRAL] You are, there's not a timely filing limit under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you, did I give you the fax number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, the [PII].
[AGENT][NEUTRAL] Uh, that's it.
[CUSTOMER][NEUTRAL] OK, and I do have another data service for the member.
[AGENT][NEUTRAL] That date of service?
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] Any amount?
[CUSTOMER][NEUTRAL] It's also for $24.
[AGENT][NEUTRAL] And did you have any more dates of service?
[CUSTOMER][NEUTRAL] Um, yes, I believe so. Let me see.
[CUSTOMER][NEUTRAL] Um, yes, for [PII] for $334.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what we
[AGENT][NEUTRAL] And if you don't mind, [PII], I'm going into a meeting at [PII]. Can I call you back at the [PII]?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, sure, that's fine.
[AGENT][NEUTRAL] OK, I'll give you a call back with the other two claims, dates of service.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] Alrighty, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] All right bye.
[CUSTOMER][NEUTRAL] Mhm.