AccountId: 011433970860
ContactId: 517230fc-14fd-4525-9795-954db8dd11c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3390459 ms
Total Talk Time (AGENT): 805990 ms
Total Talk Time (CUSTOMER): 1173662 ms
Interruptions: 22
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/517230fc-14fd-4525-9795-954db8dd11c6_20250425T19:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for the provider to check on a 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][NEUTRAL] Yes, [PII], do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I do have the policy number. Uh, the policy number is 60801.
[AGENT][NEUTRAL] And that looks like the group number. It should say policy search or member ID.
[CUSTOMER][NEUTRAL] Uh yeah, I don't, OK. Could you please search with, I don't have the policy number, the member number, just bear with me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It doesn't book that.
[AGENT][NEUTRAL] I can verify them by their first and last name as well.
[AGENT][NEUTRAL] Or I can look up their policy.
[CUSTOMER][NEUTRAL] Uh yeah, sure. Uh, I will give you the person's first name. I would like to spell it. It's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII]. No extension, it's a direct line.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK. And then can you please.
[CUSTOMER][NEUTRAL] Uh, are you there, uh, yeah.
[AGENT][NEUTRAL] Yes, I'm here. Can you please verify their date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, sure. The date of birth is, OK, the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then do you have a data service and a charge amount?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $535 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you. Just one second while I pull that claim up.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK and then what provider's office are you calling from?
[CUSTOMER][NEUTRAL] Yeah, sure, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] I'm calling from Genesis Healthcare Partners.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and I have that claim pulled up. So it looks like your claim number is 357.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 5892.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the received date is [PII].
[AGENT][NEUTRAL] And the process date is [PII].
[AGENT][NEUTRAL] And this claim was denied because office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK. So the office visits are not covered under the member's plan?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, bear with me just a minute. I have a few questions to ask.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so could you please tell me which CPT code is not covered under the member's plan?
[AGENT][NEUTRAL] The CPT code?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me check. Just one second.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we do not have access to those codes.
[CUSTOMER][NEUTRAL] OK, just a minute.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, I don't have access to the CPT code, but I have the procedure code. Is that what you're looking for?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, yeah, yeah. The procedure code.
[AGENT][NEUTRAL] OK, OK, sorry, it's 99203.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And could you please tell me, give me a minute. OK. Could you please tell me the time to find limit to submit the corrected claim?
[AGENT][NEUTRAL] There is no filing limit to submit a claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] OK. And could you please tell me mailing address to submit the correct claim?
[AGENT][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] So that is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And could you please tell me timely filing to submit an appeal or there is no timely filing?
[AGENT][NEUTRAL] There is no filing limit.
[CUSTOMER][NEUTRAL] And for the appeal, the address will be the same which you gave me for the correct claim.
[AGENT][NEUTRAL] Yes, that is the same.
[CUSTOMER][NEUTRAL] OK, and is there any specific form?
[CUSTOMER][NEUTRAL] For an appeal?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let me look up that phone number for you, just a second.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And now I'm talking, talking about, is there any specific form for an appeal.
[AGENT][NEUTRAL] There is not a specific phone number for an appeal, but there is a PO box.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, I'm talking about, is there any specific form, form, form.
[CUSTOMER][NEUTRAL] Not a phone number. I'm talking about the form. Is there any specific form for an appeal form?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Or just we need to submit an appeal.
[CUSTOMER][NEGATIVE] Nothing attached to it.
[AGENT][NEUTRAL] All right, just one minute.
[AGENT][POSITIVE] I will look that up for you.
[AGENT][NEUTRAL] OK, so it looks like there's not a specific document.
[AGENT][NEUTRAL] For the appeal?
[CUSTOMER][NEUTRAL] OK. Could you please provide me the claim nu[PII]?
[AGENT][NEUTRAL] Yes, the claim number is.
[AGENT][NEUTRAL] 357.
[AGENT][NEUTRAL] 5892.
[CUSTOMER][POSITIVE] OK. Thank you give me at the start of the call. Sorry for that.
[CUSTOMER][POSITIVE] Oh yeah, you gave me.
[CUSTOMER][NEUTRAL] OK, and could you please tell me your name once again?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And fairly, uh, how many claims you can assist me uh per call?
[AGENT][NEUTRAL] Uh, as many as you would like.
[CUSTOMER][NEUTRAL] OK. So I have
[CUSTOMER][NEUTRAL] Uh, 345 claims for the day.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So shall we move to the next claim? What will be the call reference number?
[AGENT][NEUTRAL] Yes, so the call reference number is my first name, [PII], and then last initial [PII] and then today's date.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] And then today's date, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Shall we move to the next claim?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Yes, I am ready. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, bear with me. I have a policy number.
[AGENT][NEUTRAL] OK, that's OK.
[CUSTOMER][NEUTRAL] OK. Uh, he, no need of the policy number because the member is the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and for the problem.
[AGENT][NEUTRAL] OK, and do you have a data service in it?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[CUSTOMER][NEUTRAL] I have.
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][NEUTRAL] And, and the amount will be, should I provide you the amount?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] $535 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so it looks like this is the same claim that you gave me before. It's the 357-589-2.
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, OK, OK. OK, shall we move to the next claim?
[AGENT][NEUTRAL] Yeah, that's the
[AGENT][NEUTRAL] Yeah, that's fine. That's the only claim we have on file. Yeah.
[CUSTOMER][POSITIVE] Yeah, I got it.
[CUSTOMER][NEUTRAL] OK, OK. That's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is this a different policy number?
[CUSTOMER][POSITIVE] Sorry for that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what's that policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is 01673475.
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] OK. And can you verify their first and last name and date of birth?
[CUSTOMER][NEUTRAL] And the first name of the member is [PII] and the last name is [PII]. And the date of birth will be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and that data service and charge amount please.
[CUSTOMER][NEUTRAL] And the date of service is [PII] and give me a minute. I will tell you the bill amount. Yeah, the bill amount is $102 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and so it looks like that claim number is 357.
[AGENT][NEUTRAL] 4645.
[AGENT][NEUTRAL] The received date was [PII].
[AGENT][NEUTRAL] And the process date is [PII].
[CUSTOMER][NEUTRAL] OK. And what's the claim status?
[AGENT][NEUTRAL] See.
[AGENT][NEGATIVE] And it looks like this claim was denied.
[CUSTOMER][NEUTRAL] Um, May I know the reason of the dinner?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Yes, it says all payable benefits were applied to the policy's deductible.
[CUSTOMER][NEUTRAL] So the claim was processed towards the deductible?
[AGENT][NEUTRAL] Yes, it says.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It says all payable benefits were applied to the policy's deductible.
[CUSTOMER][NEUTRAL] OK. Could you please tell me how much charges were processed towards the deductible, the process amount.
[AGENT][NEUTRAL] It, yes, it says that.
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] Uh, hold on just a minute. Let me go back.
[AGENT][NEGATIVE] It looks like 4458 was applied to the deductible.
[CUSTOMER][NEUTRAL] 16.
[CUSTOMER][NEUTRAL] 44.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 58. Mhm.
[CUSTOMER][NEUTRAL] 58 means $4,458.
[AGENT][NEUTRAL] No, $44.58.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was processed towards the directiver.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Could you please tell me what's the annual deductible amount and how much the patient met?
[AGENT][NEUTRAL] Yes, I can. Just a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Sorry, just one second. Let me pull up their certificate so I can get a better look at this.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[AGENT][NEUTRAL] OK, so it looks like they have a deductible that's 2000 per covered person per calendar year.
[AGENT][NEUTRAL] Let me see if they've used anything.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And how much did the patient met?
[AGENT][POSITIVE] I'm gonna look this up for you really quick.
[AGENT][NEUTRAL] Sorry, let me calculate this amount for you really quick, OK?
[AGENT][NEUTRAL] OK, so it looks like they have met.
[AGENT][NEUTRAL] $1,863.02.
[CUSTOMER][NEUTRAL] OK. And could you please tell me
[CUSTOMER][NEUTRAL] Was it the in-net network deductible or out network deductible?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That was outpatient deductible.
[CUSTOMER][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please tell me to which address was mailed to you?
[CUSTOMER][NEUTRAL] Could you please tell me which address you was mailed to?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So it looks like [PII].
[CUSTOMER][NEUTRAL] OK, so this address, so to this address, EOB was mailed to?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK. Could you please tell me the address once again to [PII].
[AGENT][POSITIVE] Yes, that's correct. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][POSITIVE] Yep, that's correct.
[CUSTOMER][NEUTRAL] OK, and could you please verify me the patient's account number?
[AGENT][NEUTRAL] The patient's phone number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Account number, account number.
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Is.
[CUSTOMER][NEUTRAL] Uh, no, I'm talking about the patient's account number, means V as in Victor number, uh, which comes between the numbers.
[CUSTOMER][NEUTRAL] Means there are some numbers then V as in Victor, and then there are some numbers.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Patient's account number.
[AGENT][NEUTRAL] Yes, it is 1673475.
[CUSTOMER][NEUTRAL] OK. Could you please send me the copy of your?
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Uh, yes, I'm here. I'm trying to look up this.
[AGENT][NEUTRAL] Um, EMB for you. Hold on.
[CUSTOMER][NEUTRAL] Yeah, I just, yeah, yeah.
[CUSTOMER][NEUTRAL] If you need my fax number, I can tell you.
[AGENT][NEUTRAL] OK, yes, please. What is your fax number?
[CUSTOMER][NEUTRAL] Oh man, I see you.
[CUSTOMER][NEUTRAL] Yeah, the fax number is 866.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 8254869 in attention to the patient's account number.
[CUSTOMER][NEUTRAL] The patient's account number is 1216.
[CUSTOMER][NEUTRAL] 549 V as in Victor 5499.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and that is correct. [PII] [PII].
[CUSTOMER][NEUTRAL] OK. You also have cross-check it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And how much time you will receive the copy of UB?
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] How much time will it take for me to send you the EOB?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh yeah, means, uh, in how much time we will receive the copy of your if you send right now.
[AGENT][NEUTRAL] Yes, it will be like 3 to 5 minutes for the fax to go through.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK, then, sir, the call, what will the call reference number will be the same, your name and today's date?
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] OK. So shall we move to the next claim?
[AGENT][NEUTRAL] Yes, just one second, OK?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] If tell me once if you're ready for the next policy.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] The next policy number is 02449756.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, and the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII], and the date of birth will be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and date of service and charge amount please.
[CUSTOMER][NEUTRAL] The data service is
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the amount is $31,900.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so you said the charge amount was $2100.95?
[CUSTOMER][NEUTRAL] Uh, no, I said the amount is $31.90. $31.90 sorry, sorry, $31 and $1000 900 dollars. Sorry, what I'm doing?
[AGENT][NEUTRAL] Yeah you can just tell me the numbers that's OK.
[CUSTOMER][NEUTRAL] Uh yeah, yeah. No, it's 3.
[CUSTOMER][NEUTRAL] It's $31,000 31,900 dollars.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do see that claim on file.
[AGENT][NEUTRAL] And it looks like the received date was [PII].
[AGENT][NEUTRAL] And the process date is [PII].
[AGENT][NEGATIVE] And it looks like this, this claim was denied.
[AGENT][NEUTRAL] OK, so this one looks like it's a duplicate. Let me check a different claim for you.
[AGENT][NEUTRAL] Sorry, I'm here. Just give me one second to look up these claims.
[AGENT][NEUTRAL] OK, so I did find another claim and it looks like the received date for this one is [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the process date was [PII].
[AGENT][NEUTRAL] And that claim number is 351.
[CUSTOMER][NEUTRAL] OK. So [PII], uh, before you give me the information for the previous claim, I just want to know that why you guys have denied the claim as duplicate because we have submitted the claim with the records, medical records, and the letters. So why you guys have denied this duplicate, I just want to know the reason.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I did find uh other claims that were paid for this data service and this charge amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And I'm going to those claims so I can tell you exactly what we paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, and why are you guys scared?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Denied as duplicate.
[AGENT][NEUTRAL] Yes, so if you guys accidentally send in another EOB, it's just going to be denied as a duplicate if we paid it or not, um.
[CUSTOMER][NEUTRAL] I know we have submitted the claim with the medical records and the letters. So I just want to know the reason why you have guys denied us duplicate.
[AGENT][NEUTRAL] So the claim that I was looking up was just denied as a duplicate, so I'm going to list the other claims available for that charge amount.
[AGENT][NEUTRAL] So it looks like we paid.
[AGENT][NEUTRAL] $481.01 on [PII].
[AGENT][NEUTRAL] And this is for claim number 351.
[AGENT][NEUTRAL] 659 2.
[CUSTOMER][NEUTRAL] OK, so you're giving me the original claim status?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. When you guys received the original claim?
[AGENT][NEUTRAL] So the received date for this one was [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the process
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And the process date was [PII].
[CUSTOMER][NEUTRAL] And could you please tell me uh the claim number for this one and for the duplicate one also, the claim number.
[AGENT][NEUTRAL] Yes, so the claim number for the one we paid is 351.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 659 2.
[CUSTOMER][NEUTRAL] You
[AGENT][NEGATIVE] And then the one that was denied as a duplicate.
[AGENT][NEUTRAL] It's 353.
[AGENT][NEUTRAL] 9272.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Let's move to the claim paid one. What will be the allowed amount and paid amount?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so we paid $481.01.
[AGENT][NEUTRAL] For the claim 351-6592.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] And what's the allowed amount?
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Uh, I don't see the allowed amount. Let me go through these claims with you because we actually
[CUSTOMER][NEUTRAL] Please
[AGENT][NEUTRAL] We paid multiple on this one, hold on.
[AGENT][NEUTRAL] OK, so it looks like in [PII] they reached their outpatient amounts for the calendar year.
[AGENT][NEUTRAL] And so that's why we covered the, the $481.01.
[CUSTOMER][NEUTRAL] So what's the claim status then? Do you guys paid the claim has been paid?
[AGENT][NEUTRAL] Yes, the claim has been paid in the amount of $481.01.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what will be the dollar amount then?
[AGENT][NEUTRAL] Would you like me
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] The allowed will be allowed amount will be the same as the paid amount. Is there any member's responsibility or not?
[AGENT][NEUTRAL] No, we do not determine patient's responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the allowed amount and pay amount will be the same.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and what will be the claim pay date?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, the pay date is [PII].
[CUSTOMER][NEUTRAL] And could you please, uh, was it a single check or a bulk check?
[AGENT][NEUTRAL] This was one check.
[CUSTOMER][NEUTRAL] OK, just um single.
[AGENT][NEUTRAL] Yes, single check.
[CUSTOMER][NEUTRAL] Number?
[AGENT][NEUTRAL] Check number is 200.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 75.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 81.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And could you please verify me the payment's mailing address?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What.
[AGENT][NEUTRAL] Zip code [PII].
[CUSTOMER][NEUTRAL] I think that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK. And could you please verify me the patient's account number?
[AGENT][NEUTRAL] I can give you the policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, you don't have the patient's account number?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I can give you their policy number, but I cannot give you their account number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Give me the policy number.
[AGENT][NEUTRAL] OK. The policy number is 2449756.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and could you please send me the copy of EOB?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I can send it to the fax number that you gave me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In attention to the patient's account number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so the patient's account number will be [PII] [PII] in Victor 3199. Got it?
[AGENT][POSITIVE] Yes, got it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Could you please help me with the payment cash clear date?
[AGENT][NEUTRAL] So it looks like the check is cleared.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me put in that check number again.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was 114, 0 jeez, no, let me go back. That's not the first one.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, that was, yes, why is it saying 114 2004?
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] 351-6592.
[AGENT][NEUTRAL] OK, that was 10-25, 2024.
[CUSTOMER][NEUTRAL] OK, 1025, 2024.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK, it was cleared on this. OK. And in how much time we will receive the uh EOB?
[AGENT][NEUTRAL] It would be the same timing, 3 to 5 minutes once we're off the phone.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Shall we move to the next claim? The call reference number will be the same.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][NEUTRAL] I'm ready for the policy number.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK. The policy number is 002558162.
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] OK. And the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII]. And uh date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] OK, and then if you have any claims questions for this policyholder, you will have to contact WEBTPA and I can give you their phone number.
[CUSTOMER][NEUTRAL] I never.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you can give me the phone number at the end of the call. Uh, should we discuss the next number?
[AGENT][NEUTRAL] OK. Yes. Let me write down their number for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, and then what's the next policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the next policy number is
[CUSTOMER][NEUTRAL] 79.
[CUSTOMER][NEUTRAL] 5153.
[CUSTOMER][NEUTRAL] It is on file, but that will be submitted is incorrectly submitted. Now it is just submitted it it is need to be submitted the form, but that form is.
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] OK. And then patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and we're checking claim status for him?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Bear with me. Let me just check. Yeah, the claim status for this.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, you're fine.
[AGENT][NEUTRAL] OK, and then what's the charge amount and the bill amount or sorry, the charge, the date of service and charge amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah, I got it, got it. The data service is [PII] and the total charges are $210.29.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, just bear with me really quick.
[AGENT][NEUTRAL] OK, and it looks like the received date is [PII].
[AGENT][NEUTRAL] The process date is [PII].
[AGENT][NEUTRAL] OK and then what is the provider's office?
[CUSTOMER][NEUTRAL] OK, the provider's office is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] OK, and it looks like this claim was denied because these services were rendered after after coverage was terminated.
[AGENT][NEUTRAL] So this policy.
[CUSTOMER][NEUTRAL] OK, so the member was not active on the date of service.
[AGENT][NEUTRAL] Yes, um,
[AGENT][NEUTRAL] No, sir. It looks like their policy termed on 601 [PII].
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] That way
[CUSTOMER][NEUTRAL] OK. So the member was term long back.
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] Let me see if they have any other policies with us.
[CUSTOMER][NEUTRAL] 601.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No. No, they don't.
[CUSTOMER][NEUTRAL] OK, so the member was not active on the date of service means he was.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, sir. That's correct.
[CUSTOMER][NEUTRAL] OK, just a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Could you please tell me the
[CUSTOMER][NEUTRAL] Effective date and the term date of the member ones.
[AGENT][NEUTRAL] Yes, so the effective date is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And um date which you gave me is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] And could you please tell me when was the last COB updated coordination of benefits when was the last updated?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let's see, so you gave me date of service [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the policy was termed at that time.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Means the policy was termed on [PII] on [PII].
[AGENT][NEUTRAL] No, the policy was termed, I think in [PII].
[AGENT][NEUTRAL] Uh, 601-2020.
[CUSTOMER][NEUTRAL] You give me the um date.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, so that's what I'm asking. The member was not active on the date of service. Am I right? Because the date of services after the term date.
[AGENT][POSITIVE] Yes, you are right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so that's what I'm asking what's the coordination of benefits? When was the last coordination of benefits updated?
[CUSTOMER][NEUTRAL] COB coordination of benefits.
[AGENT][NEUTRAL] So the last claim that we paid was [PII].
[AGENT][NEGATIVE] Everything after that was not paid because their policy wasn't active.
[AGENT][NEUTRAL] I don't have an exact date for you.
[CUSTOMER][NEUTRAL] OK. Are you primary? OK. Are you primary or secondary for the member?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We're a secondary insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so you don't have any updates, so you don't have any information about the coordination of benefits?
[CUSTOMER][NEUTRAL] When was it updated?
[AGENT][NEUTRAL] No, the, uh, the claim, the data service that you gave me.
[CUSTOMER][NEUTRAL] What
[AGENT][NEGATIVE] I can give you the received date and the processed date that we processed this EOB, but it was still denied.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK. Do you see any other pay listed for this patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] No, I do not, not for this data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the timely filing to submit the corrected claim?
[AGENT][NEUTRAL] Yes, so the
[CUSTOMER][NEUTRAL] It will be the same which you gave me for the first one, no timely filing limit.
[AGENT][NEUTRAL] Yes, there is no filing limit.
[CUSTOMER][NEUTRAL] And timely filing to submit the
[CUSTOMER][NEUTRAL] Corrected claim, sorry, mailing address for the corrected claim is [PII], uh sorry, [PII].
[AGENT][NEUTRAL] Yes. 7.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And for the uh mailing address, OK, give me a minute. Just a minute, just a minute. I must.
[CUSTOMER][NEGATIVE] OK. And for appeal as well, there is no timely filing.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, there's not.
[CUSTOMER][NEUTRAL] And for the appeals mai[PII] address, it will be go it will go to the same address which I gave you right now.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] There is no specific form for an appeal, and you didn't provide me the claim number. What will be the claim number?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] 4973.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so it's denied you will be required by submitting a claim or an app fee.
[AGENT][NEUTRAL] So you can submit a claim. There's no filing limit.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, no, I'm asking about the EOB explanation of benefits is required by submitting an appeal or a claim.
[CUSTOMER][NEUTRAL] We need to attach the copy of uh explanation of benefits.
[AGENT][POSITIVE] Yes, I can fax it to the number that you gave me.
[CUSTOMER][NEUTRAL] Uh, no, I'm asking you about, we need to attach the copy of EOB while submitting the claim.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] So we need to attach. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK. And [PII], thanks for your assistance. That's it. uh I was having.
[CUSTOMER][POSITIVE] So this thanks for your assistance and I love the partnership and have a great day.
[AGENT][NEUTRAL] Yeah. Is there anything else I can help you with?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][POSITIVE] OK. Well, thanks for calling APL and have a good day.