AccountId: 011433970860
ContactId: 55b2a4c9-79cd-45ef-ac85-ebf839690204
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2594290 ms
Total Talk Time (AGENT): 478071 ms
Total Talk Time (CUSTOMER): 972237 ms
Interruptions: 8
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/55b2a4c9-79cd-45ef-ac85-ebf839690204_20250520T19:57_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] I'm calling from provider's office to check up on a claims for a number. Could you please help me with that?
[AGENT][NEUTRAL] Sure, I can assist you with claims Mr. [PII] May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. That is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility from my location?
[CUSTOMER][NEUTRAL] Yeah. Sure. I'm calling from Kendall Aesthesia Associates.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Just a moment. The patient's policy is 008.
[CUSTOMER][NEUTRAL] 271-260.
[AGENT][NEUTRAL] OK, thank you. One moment, let me pull this information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm. Do you see any other numbers besides that one? That one is too long to be one of our policy numbers.
[CUSTOMER][NEUTRAL] Mhm. Uh, but I actually see those the member ID. Is it possible that you would, uh, pull out a patient with the member name and the date of birth?
[AGENT][NEUTRAL] Mhm. What is the spelling of the last name?
[CUSTOMER][NEUTRAL] Uh, my last name is [PII], that's spells as [PII].
[AGENT][NEUTRAL] OK, and the first name?
[CUSTOMER][NEUTRAL] Uh, that is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the first name, spelling of the first name?
[CUSTOMER][NEUTRAL] Uh, that is [PII], that's spells as [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah I'm still searching. Bear with me.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't have a uh [PII] on our system. Do you have any other information like a social security number or a claim number?
[CUSTOMER][NEUTRAL] Mm, I don't have the claim number, but the Social Security, uh, I do have only last four digits of the SSN. I don't have the complete SSN.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm, I cannot, you know, we cannot use the last 4.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I understand that. Let me see.
[CUSTOMER][NEUTRAL] Uh, no, I don't have, I don't have any other information. I just have the patient's name and that was the member ID I have for, uh, American Public Life. And so you mean to say that you're unable to find a member?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. Uh, and I'm, I'm really so sorry, I couldn't get your name. Could you please spell out for me?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] My name is So. That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] Thank you so much, sir. And I have a few more patients to check for. Could you please help me with that as well?
[AGENT][NEUTRAL] OK, sure. How many more you got?
[CUSTOMER][NEUTRAL] Uh, well, I actually have 10 patients today.
[AGENT][NEUTRAL] 10
[CUSTOMER][NEUTRAL] Yeah, that's right, you heard 10.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me go ahead and uh let my supervisor know, bear with me.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] Mhm. Just a moment. So the policy number is
[CUSTOMER][NEUTRAL] 007943
[CUSTOMER][NEUTRAL] 456.
[CUSTOMER][NEUTRAL] Wait.
[AGENT][NEUTRAL] OK, let me try it on.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, that's not our number either.
[AGENT][NEUTRAL] Are, are you trying to contact um APL American Public Life?
[CUSTOMER][POSITIVE] Oh, that's right.
[AGENT][NEUTRAL] OK, yeah, that's not our number either.
[CUSTOMER][NEUTRAL] Uh-huh, uh, just to confirm, like, is it, uh, United American Insurance is one of the affiliate with the American Public Life or is American Public Life that is affiliated with the United American Insurance?
[AGENT][NEUTRAL] We're not affiliated to none, so it's just American public life. We're not affiliated to any other companies.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. So is it, is it possible that you could try with the patient's name and date of birth on this one as well?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] What is the spelling of the last name?
[CUSTOMER][NEUTRAL] Uh, the last name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, spelling of first name?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] Mm, I don't have that number in the system.
[CUSTOMER][NEUTRAL] Mhm. OK, thank you. Let me pull the next patient. Give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So, yeah.
[CUSTOMER][NEUTRAL] It is the member ID that is A as in Oscar, sorry, um, I'm sorry, that is A apple 5,202,132,000.
[AGENT][NEUTRAL] That's not our policy number. We only check claim status for American Public Life, only APL.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, that's what, uh, here it says like it's, uh, American public like. There was a reason that I actually made a call just a moment. Let me see if that was a mistake from my side. I'm sorry, give me one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, just to confirm, may I know, uh, how, how, uh, like the pattern of the member ID for American Public Life, how, how many digits that would be.
[AGENT][NEUTRAL] OK, it's gonna be starting with a 0 followed by 7 digits only.
[CUSTOMER][NEGATIVE] 02 digits only I guess this is not done.
[CUSTOMER][POSITIVE] Let me see. I'm really so sorry if I'm taking much time of yours. Just, but bear with me just one moment.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] uh getting the.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Could you check with this one I have a member ID as uh
[CUSTOMER][NEUTRAL] 01611844
[AGENT][NEUTRAL] OK, yeah, that sounds like us.
[CUSTOMER][NEUTRAL] He was
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 1618.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I, I should just work. I should.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, what's the name and date of birth of this patient?
[CUSTOMER][NEUTRAL] The member's name is [PII] and the date of birth [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, there is service for.
[CUSTOMER][NEUTRAL] [PII] and with the charges of uh one moment, yeah, on the charges of $1,316 even 1316.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, and that was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me look at this.
[CUSTOMER][NEUTRAL] you cannot.
[CUSTOMER][NEUTRAL] It was never to second.
[CUSTOMER][NEUTRAL] I can be.
[CUSTOMER][NEUTRAL] No, that is Medicaid is not Medicaid. Medicaid is the last primary and we have to build the after taking medica.
[CUSTOMER][NEUTRAL] Medicaid is the last uh OK. He has the last name, last name Medicaid is the last.
[AGENT][NEUTRAL] OK, so we process the claim on [PII] and we send a benefit amount of $56.15.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so that, that was paid, right?
[CUSTOMER][NEUTRAL] I know
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] OK. OK, thank you so much. And uh just to confirm, may I know how much was the patient, uh, responsibility that was left on the claim?
[AGENT][NEUTRAL] Um, let me see how much the major medical applied.
[CUSTOMER][POSITIVE] Alright you're welcome.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the major medical applied, $99.24 and it looks like the remaining benefit amount for this member was $56.15. So with that payment, she assessed the benefit.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you so much for that information, sir.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do you need a claim number?
[CUSTOMER][NEUTRAL] Mm, I'm sorry, I was talking on [PII], I guess. Yeah, I'm good with that. I, I, I'm fine. I have the claim number. Uh, could you please check the next patient I have the member ID that was uh one of uh American Public Life.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, bear with me just a minute. Let me finalize the note on this one.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, what's the next policy number?
[CUSTOMER][NEUTRAL] Um, that is 008187219.
[CUSTOMER][NEUTRAL] 11,950
[AGENT][NEUTRAL] Mm, yeah, it doesn't sound like our number.
[AGENT][NEUTRAL] No, that's not our number.
[CUSTOMER][NEUTRAL] Mhm. OK, thanks for confirming that just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Uh, it doesn't seem like that is one of American as well. I have, uh, last, uh.
[CUSTOMER][NEUTRAL] 2 patients or 3 patients, I guess. Just give me a moment, let me open the other one as well. I don't see that the member ID goes with that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, uh, could you please check this one, the member ID is 008.
[CUSTOMER][NEUTRAL] 424
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 349
[AGENT][NEUTRAL] That's our number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mhm OK, thank you so much, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, could you please check this one? This is uh 02473403.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, yes. uh, what's the name and date of birth?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Mm. My my name is uh [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm sorry, give me that number one more time.
[CUSTOMER][NEUTRAL] The member ID?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that is
[CUSTOMER][NEUTRAL] 0247 uh yeah, that is 02473403.
[AGENT][NEUTRAL] 13.
[AGENT][NEUTRAL] OK. Mhm. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, but the service is for [PII].
[CUSTOMER][NEUTRAL] With the charges of $2,444 even.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me see if I can find this claim, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me pull this thing on me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So looking at this.
[AGENT][NEUTRAL] I'm still waiting on the EOB.
[CUSTOMER][NEUTRAL] Den
[CUSTOMER][POSITIVE] Yeah, sure. Take your time, ma'am.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But.
[AGENT][NEGATIVE] OK, looks like it was denied. It was processed on [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And the reason for this denial is the maximum benefit payable for the date of service has been met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] do
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. Uh, is it based on the dollar value or the unit's value or the, for the service value? How, how, how is it that?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I think it's gonna be Dollar value, but let me double check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, this one had a daily value of $300 per day.
[CUSTOMER][NEUTRAL] OK, the value of $300 per day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you mean to say that for the same data service the claim has already paid?
[AGENT][NEGATIVE] We received another claim and she exhausted her benefit.
[CUSTOMER][NEUTRAL] Uh, um, sorry, I actually, so I couldn't get that. Could you please give me a little elaboration on this?
[AGENT][NEUTRAL] OK. So the benefit is $300 per day. So if we receive the claim for the provider, the claim for the facility, the claim for the diagnostic, any claims we receive for that same day, she only has that $300. So when we receive, um, we get the claims, we pay as we get them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So by the time we have received your claim and process your claim, she already exhausted that benefit.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK. So, yeah, I got that. Thank you so much for that information. Uh, could you uh cross verify is that paid for the same facility, uh, that, that would be, uh,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Kendal anesthesia Associates.
[AGENT][NEUTRAL] No, it's not the same facility.
[CUSTOMER][NEUTRAL] But it's a different provider.
[AGENT][NEUTRAL] Correct, it's a different provider.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. Um, just a moment.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, uh, may I know when was the claim received?
[AGENT][NEUTRAL] Your claim, um, let's see, one moment.
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] OK, that is 98477.
[AGENT][NEUTRAL] Received on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, thank you so much for that information. And may I have the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, the claim number is
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] 3569847
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you so much. And uh since we do not have actually any response on this one from the payer, could you please fax us the EOB?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] That's going to be [PII]. Attention to Max [PII].
[CUSTOMER][NEUTRAL] Got 149.
[AGENT][NEUTRAL] OK. [PII]?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, um, I need to send it before I move forward to the next one. So do you mind holding for me while I send this fax out to you?
[CUSTOMER][NEUTRAL] Yeah, sure. And may I know how much time they're gonna be taking?
[AGENT][NEUTRAL] A few minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 1195. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. Is there any, uh, you have one more claim you said?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, that's right. And for that, uh, so just to confirm, uh, if, if we didn't receive that in uh next uh few hours, uh, like, should we call back or should we wait, uh, should we give it 24 hours?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, if, if you don't receive the, the fax that I just sent, um, you can call back in about, I'll say, um, give it about 30 minutes to 1 hour and call back and, and have somebody send it again because it should be there in a few minutes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mhm. Yeah, sure. Thank you so much for that information. And uh just a moment, I have one last one.
[AGENT][NEUTRAL] OK. What's the policy number?
[CUSTOMER][NEGATIVE] Oh yeah, that is 0.
[CUSTOMER][NEUTRAL] 245
[CUSTOMER][NEUTRAL] 8027
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Uh, member's name is [PII] and date of birth [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, the rail service is for [PII] with the charges of $1,692 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, it's [PII], correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, let me try this one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] You be.
[AGENT][NEUTRAL] I'm still waiting.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 119
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I find that one. Let me try one more.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Check out 60.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, yes. All right, we processed the claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $234 to the provider.
[CUSTOMER][NEUTRAL] Uh-huh. So you mean to say that was paid, right?
[AGENT][NEUTRAL] That is the maximum that was paid, yes. Mhm.
[CUSTOMER][NEUTRAL] so
[CUSTOMER][NEUTRAL] Uh, may I know when was the claim received?
[AGENT][NEUTRAL] Um, it was received, let's see.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. And may I have the claim number?
[AGENT][NEUTRAL] It's 345.
[AGENT][NEUTRAL] 4063.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. Uh, and, uh, may I know the mode of payment, how that was paid?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Check, single check, paper check.
[CUSTOMER][NEUTRAL] OK, that was single check just a moment.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm. So, uh, just to confirm, uh, could you confirm on what modify that was paid?
[AGENT][NEUTRAL] What modify.
[CUSTOMER][NEUTRAL] Yeah, because, you know, uh, well, uh, due to the services were rendered by two different providers, and I guess the claim was, uh, billed twice with the different, uh, it was billed separately and I see one of the payment was received of 234 uh for the modified QY.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Find out
[AGENT][NEUTRAL] Um, let me check on that. Bear with me just a minute.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] How long, how long do you have?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] OK, the modifier is a P2.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm. And uh could you see any other modified like QX or QY? Because uh P2 is a standard for both the, uh, both the claims, but the modify the changes has actually a QX and uh QY.
[CUSTOMER][POSITIVE] So, if you could kindly check that, that would be grateful.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yo.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is the only information that I see on the 1500 form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, OK, just a moment.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] 00160. Uh, give me one quick moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you see the same modifier, right? So the same.
[CUSTOMER][NEUTRAL] Anesthesiaoda was 00160.
[AGENT][POSITIVE] 00160, yes, that is correct.
[CUSTOMER][NEUTRAL] That is correct. Uh, but the modifier which you see is a P2. Uh, well, actually P2 is the standard one that refers to the patient's health criteria, but the modifier, which was, uh, different, uh, QX and QY. I see one of the modifier was paid which is Q1 and QX wasn't paid. Uh, just to confirm, do you see, uh, two different, uh, two claims for this patient for the data service or only one claim?
[AGENT][NEUTRAL] 11.
[CUSTOMER][NEUTRAL] The one claim. OK. So you're referring to the claim number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That ends with um.
[CUSTOMER][NEUTRAL] Just a moment. Let me see if that was the same claim number or a different one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I go.
[CUSTOMER][NEUTRAL] Yeah. So the claim number which you provided that 3454063, right? So, there was a paid one. I do see the paid one, but that was, that was actually uh uh for a different claim. So just to make sure, so initially, the claim was built to Cigna and this is a secondary, right? So the Cigna is requested for a split claim. And so since there were two different modifiers were billed for the same procedure,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, the claim was split with the two different, uh, the same charges, and one is paid and I don't see any uh payment for the other one. And you said that there is no claim on file and we have billed that on [PII].
[CUSTOMER][NEUTRAL] Could you please cross verify that again?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, Mr. [PII], I can only give you the information I'm looking at, OK? OK, so I'm looking at the 1500 form. I see the name of the patient. I see the date of birth. I see the date of service. I see the code which is 00160. I see modifier P2. I see diagnosis diagnosis A. I see the amount 1692. Um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, see, I see that it's for Doctor [PII] Flamingo Anesthesia Associates, and that's what I have. I don't have more information than that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So that was already paid, you said Fleming Aish Associates, that's correct.
[CUSTOMER][NEUTRAL] So you mean to say that you have only uh one claim on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So one claim and that was paid and you don't see any other claim, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you so much. And uh just to confirm, uh,
[CUSTOMER][NEUTRAL] Uh, may I know what would be the general claims time limit?
[AGENT][NEUTRAL] The standard filing limit, we don't have filing limits.
[CUSTOMER][NEUTRAL] OK, can we uh resubmit a claim for that one then?
[AGENT][NEUTRAL] You can submit the claim, yes.
[AGENT][NEUTRAL] Now, if it's the same one, it probably will deny us a duplicate, but if it's different, we'll go ahead and process.
[CUSTOMER][NEUTRAL] Mhm. Yeah, sure. Thank you so much for that information. And just to confirm, we have the, your information as the payer ID 60801. Is that right?
[AGENT][NEUTRAL] Mhm, yes. Now this one is best to send it by mail or fax because it's a secondary and we need the primary attached to it, the primary.
[CUSTOMER][NEUTRAL] OK. Um, so, uh, so do you access the paper claims?
[AGENT][NEUTRAL] We do.
[CUSTOMER][NEUTRAL] OK. And uh we have your address as [PII]. Is that right?
[AGENT][NEUTRAL] Mm, yes.
[CUSTOMER][POSITIVE] Thank you so much for that information. And the moment.
[CUSTOMER][NEUTRAL] The liner.
[CUSTOMER][NEUTRAL] To modify.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much for that information. Uh, yes, and we have the.
[CUSTOMER][NEUTRAL] Call reference number for conversation.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's day if you would like.
[CUSTOMER][POSITIVE] Thank you so much for that information, [PII]. I really appreciate all your patience and your efforts. Have a great day.
[AGENT][POSITIVE] You as well. Thank you for calling APR. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm, sure, yeah.
[CUSTOMER][NEUTRAL] I