AccountId: 011433970860
ContactId: 4453fc6c-78d4-4e3d-a972-ecf40fe2247b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297079 ms
Total Talk Time (AGENT): 60511 ms
Total Talk Time (CUSTOMER): 129740 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/4453fc6c-78d4-4e3d-a972-ecf40fe2247b_20250501T20:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII], uh, and my first and last name is. I'm calling from provider office, and I just want to discuss about the claim.
[AGENT][NEUTRAL] OK, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII], uh, and the extension is [PII].
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, yeah, just give me one moment.
[CUSTOMER][NEUTRAL] Uh, the policy ID is going to be 01986343.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge amount is just give me one moment, the total charge amount is.
[CUSTOMER][NEUTRAL] $264.57.
[CUSTOMER][NEUTRAL] Uh, actually I think, uh.
[CUSTOMER][NEUTRAL] There is discrepancy between the total charge. Just give me one moment. I, I'll provide you the total charge amount.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, the total charge amount is $264.57.
[AGENT][NEUTRAL] OK. Let me see.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, looks like we received it on.
[AGENT][NEUTRAL] 1 13 2025, process 114 2025.
[AGENT][NEGATIVE] Uh, the primary explanation of benefits did not match the bill charges.
[CUSTOMER][NEUTRAL] OK, um, what's the bill, uh, charges, uh, what is the charge billed on the primary?
[AGENT][NEUTRAL] Uh, let me pull it up. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it looks like on the primary explanation of benefits, it was a different code and the bill charges were 19892.
[CUSTOMER][NEUTRAL] Yeah, that's, uh, because, uh, it just happened because, uh, the BCBS process only S908 as per our contractor they they do not process the ENM code or anything, any code apart from S9083 code. That's why we, uh, built, we send you the pri primary will be with uh code S9083.
[AGENT][NEUTRAL] Right, but for us to process the claim, they have to match. We have to see that primary um
[AGENT][NEUTRAL] Primary considered the 99213, and that's not anywhere on the EOB.
[CUSTOMER][NEUTRAL] OK, uh, but how it can be possible because, uh, BCs do not process ENM code as per our contract. They only, they process only S9083 code. So how can be billed to you or sent to you, uh, ENM code?
[AGENT][NEUTRAL] We have to have the primary EOB considering that code, otherwise it's not gonna be able to be processed.
[AGENT][NEUTRAL] There's no exceptions around it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, no problem, thank you so much. Please provide me call reference.
[AGENT][NEUTRAL] That's my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], for checking. Have a good day.
[AGENT][POSITIVE] Thank you for calling APL as well. Bye bye.