AccountId: 011433970860
ContactId: 4f730660-b1ae-43b7-ab75-f184760c6251
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 549599 ms
Total Talk Time (AGENT): 136200 ms
Total Talk Time (CUSTOMER): 203565 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/4f730660-b1ae-43b7-ab75-f184760c6251_20250516T20:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello this is [PII]. I'm just trying to verify some claim information for a patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Alright, that is 02415343.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh, I don't have a direct line, but my office number is [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And verifying the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, and you say you're calling for a claim status correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Um, the first, there's 3 of them, um, but the first one is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I've got a total charge of 416 but it may have been split up and how it looks on the claim.
[AGENT][NEUTRAL] And what was the next date of service?
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Total charge 1254.
[AGENT][NEUTRAL] OK, and the next.
[CUSTOMER][NEUTRAL] [PII] total charge 3546.
[CUSTOMER][NEUTRAL] Decimal 62.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] We all three claims for facility charges?
[CUSTOMER][NEUTRAL] Um, the 2 November ones were.
[CUSTOMER][NEUTRAL] The 1010 that um that one doesn't get split billing so it was what we would call physician billing.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] It's an office visit.
[AGENT][NEUTRAL] And what was the name of the provider?
[AGENT][NEUTRAL] For all 3.
[CUSTOMER][NEUTRAL] Um, location or doctor, so about two different.
[AGENT][NEUTRAL] Um, doctor.
[CUSTOMER][NEUTRAL] OK, um, for 2 of them, the [PII] and the [PII], that's a doctor.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then for the ER visit that's a Doctor [PII].
[CUSTOMER][NEUTRAL] Lied.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, let's see here.
[AGENT][NEUTRAL] 56
[AGENT][NEUTRAL] OK, um, I'm showing all three claims were received, um, for the [PII], that claim processed and paid $100 which marks the benefit for the data service.
[AGENT][NEUTRAL] And for the [PII], we paid $100 which marks the benefit for the data service, and the [PII], that claim processed as not a covered diagnostic test.
[CUSTOMER][NEUTRAL] OK, what's the because uh the reason I'm asking is because um for two of these.
[CUSTOMER][NEUTRAL] The EOB is not actually showing on my end like we've got the payments but um I don't like I I saw a note that said that [PII] was denied, but I wanna see if it's eligible for what we, you know, for a discount, but I need to know how it was denied, what code was used.
[AGENT][NEUTRAL] Or our own personal code that we have for our system which is uh not a covered diagnostic test and if you need that EOB I can fax that to you.
[CUSTOMER][NEUTRAL] Yeah, um, actually, do you mind, uh, faxing both the November ones?
[AGENT][NEUTRAL] Sure. Uh, what is your fax number?
[CUSTOMER][NEUTRAL] Yes, that is, give me just a moment.
[CUSTOMER][NEUTRAL] Alright 864.
[CUSTOMER][NEUTRAL] 560.
[CUSTOMER][NEUTRAL] 4023.
[AGENT][NEUTRAL] OK, I will fax these over to you, um, and just also let you know we do have an online service center where providers can check claim status as well as print out the ELBs, and that site is at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. I don't, that that would have to go through somebody higher up than me to get access to, um, but I will let them know, um, the the PB account, the 1010, that one I do see, uh, an EOB. It looks like we, we sent two claims. I think they corrected the claim and sent it so I'm showing the $100 payment on CPT 99214.
[CUSTOMER][NEUTRAL] But all I see is an EOV saying duplicate claim denied on the other three CPT codes, is that how it shows on your end?
[AGENT][NEUTRAL] Give me one moment, that one. Yeah, for the other codes, um, for the 85,610 and the 81001, that processes benefits of max for the data service. The other code, uh, process is not, uh, any puncture is not covered by the uh policy.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that will show the, the denial code on the EOB can you send.
[CUSTOMER][NEUTRAL] Can you send that one to then um so I don't have that denial.
[AGENT][NEUTRAL] Uh, yes, ma'am. And is there anything else, Ms. [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That'll be all, um, I'm sure you're, you already would but um in the.
[CUSTOMER][NEUTRAL] Cover page for the fax you can just include the patient's name and date of birth so that the office can get them scanned and I'll be on the lookout um how long do you think it takes to to get it faxed?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I would say give it 5 minutes or so.
[CUSTOMER][POSITIVE] OK fantastic all right I'll keep an eye out for that thank you so much I really appreciate it.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye
[AGENT][NEUTRAL] Hm