AccountId: 011433970860
ContactId: 583ebbfb-fa3a-47c9-87d6-0a49f9ec50db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 885140 ms
Total Talk Time (AGENT): 249710 ms
Total Talk Time (CUSTOMER): 296602 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/583ebbfb-fa3a-47c9-87d6-0a49f9ec50db_20250121T15:33_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm so sorry I'm doing good. What is your name again?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. It's spelled [PII]. What's your good name you said?
[AGENT][NEUTRAL] My name is [PII]. Last initial is [PII]. Thank you. And [PII], what is your callback number please if disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh, my callback number is [PII] with the extension number [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number?
[CUSTOMER][NEUTRAL] So you're asking the member ID?
[AGENT][NEUTRAL] I'm asking for the policy number.
[CUSTOMER][NEUTRAL] Yeah, so before I proceed the call for, I would like to tell that this call is being recorded for quality and training purposes. So would you like to proceed the call for?
[AGENT][POSITIVE] Yes, thank you, [PII], thank you.
[CUSTOMER][NEUTRAL] Yes, so the member ID is 02475232.
[AGENT][NEUTRAL] OK, I have that as 02475232. Thank you.
[AGENT][NEUTRAL] And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh yes, so the patient's first name is.
[CUSTOMER][NEUTRAL] Yes, so the patient first name is?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and last name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for the verification process, [PII], and you're calling for claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You can check claim status by visiting our secure portal at [PII]. You'll be able to obtain ELBs from that website as well. And what is that date of service and total charge amount please?
[CUSTOMER][NEUTRAL] Uh yes, so basically the date of service is [PII].
[CUSTOMER][NEUTRAL] With the bill amount of $540 even.
[AGENT][POSITIVE] OK, thank you so much one moment.
[AGENT][NEUTRAL] OK, to repeat, I have that as [PII] for $540 even. One moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and if you could also verify the procedure code or codes bill for the service date or the several procedure codes bills.
[CUSTOMER][NEUTRAL] Yeah, sure. The procedure code will be is 992-0399385904719071581002.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 36415
[CUSTOMER][NEUTRAL] And the last one is 99213.
[AGENT][POSITIVE] Mm, thank you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Are these all built on the same claim or different claims?
[CUSTOMER][NEUTRAL] No, no, it was built on the same claim.
[AGENT][NEUTRAL] OK, same claim.
[AGENT][NEUTRAL] OK, and if you would just repeat the.
[AGENT][NEUTRAL] Procedure codes again because I do not show that claim on file please if you could go slow for me thank you.
[CUSTOMER][POSITIVE] Yeah, yeah, yeah, yeah, sure. And, no worries.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yes, so the first CPT is 99203.
[CUSTOMER][NEUTRAL] The second one is 99385.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The third one is 90471.
[CUSTOMER][NEUTRAL] The fourth one is 90715.
[CUSTOMER][NEUTRAL] The 5th 1 is 81002.
[CUSTOMER][NEUTRAL] The 6th 1 is 36415.
[CUSTOMER][NEUTRAL] And the last one is 99213.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I do not show that claim
[AGENT][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] Yes, yes, [PII], I'm there.
[AGENT][NEUTRAL] Thank you. I did not show that claim on file.
[CUSTOMER][NEUTRAL] OK. Uh, what is the payer ID you can see there?
[AGENT][NEUTRAL] I can see that, yes, one moment please, let me get back to that screen.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Payer ID is 64556.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Sorry, can you just repeat it once again?
[AGENT][NEUTRAL] Of course, it is 64556.
[CUSTOMER][NEUTRAL] Yeah, the same also I can see here. Let me check in my clearing house, just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][POSITIVE] Via Mountain climber would be good.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, [PII], I'm there. uh, yes [PII], thank you for being on, yeah, yeah, thanks for being on hold for the moment. Uh, yeah, can you just see any rejection is there in a clearing house for the claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm sorry, the claim is not on file?
[CUSTOMER][NEUTRAL] So as I can see in our clearing house, uh, for the one CPD that is 99213 you have received the claim so can you check it for that one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, I'm so sorry. Let me just make certain of, OK, so you wanted to know a claim status for a total charge of $540 is that correct?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for you named off several procedure codes and you wanted to know we received one claim with the procedure code 99213, is that correct?
[CUSTOMER][POSITIVE] Correct, correct.
[AGENT][NEUTRAL] OK, so we're not looking for a claim bill for $540 is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, just wanna make sure I have my notes correct because you told me $540 OK? Now if you could verify the provider as well, please just to make certain. thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The billing provider, if you could verify that, please.
[CUSTOMER][NEUTRAL] Uh, yes, you want the provider's name?
[AGENT][NEUTRAL] I want the billing provider's name please.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And who billed the claim for [PII]?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, so it's [PII] and uh billing provider is American Health Network of Indiana.
[AGENT][NEUTRAL] OK, thank you for the verification process of that. We received the claim for procedure code 99213 only and we paid a maximum of $50.
[CUSTOMER][NEUTRAL] OK, you said you have paid the amount of $50.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, but here I can see there is a denial for the CPT code 99213 stating maximum benefit.
[CUSTOMER][NEUTRAL] For this time period reached.
[AGENT][NEUTRAL] OK, for procedure code 99213.
[AGENT][NEUTRAL] We made a payment of $50 which is the max.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] With a paper check.
[AGENT][NEUTRAL] And with that payment it maxed out the payment.
[AGENT][NEUTRAL] For that visit, which is $50.
[AGENT][NEUTRAL] What is the claim number that what you have that you just read to me? What's that claim number?
[CUSTOMER][NEUTRAL] OK, so the.
[CUSTOMER][NEUTRAL] Uh, yes, uh, so sorry, [PII], basically I'm having the UB but there is no claim number in that.
[AGENT][NEUTRAL] You don't see a reference number from what you just read to me?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, just a moment, let me check here I'm having, I'm only having the check number. I don't have anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the check number?
[CUSTOMER][NEUTRAL] Yes, uh, it's 1852131.
[AGENT][NEUTRAL] Yes, that is under claim number 3446814. Thank you for providing that check number.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Just a moment, what is the claim number?
[AGENT][NEUTRAL] 344-6814 and that should be on that you you just read to me.
[CUSTOMER][NEUTRAL] 3344344681.
[AGENT][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] OK. And the check number is this I just stated it was a paper check, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] And when was it cleared?
[AGENT][NEUTRAL] Uh, let me check that for you one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, that check cleared as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, no worries, and I just stated that for the CPT 99213, the amount is only $50. And what about the rest amount?
[AGENT][NEUTRAL] OK, and as stated, um, that is the maximum payable.
[AGENT][NEUTRAL] For that service, APL is not determining patient's responsibility.
[CUSTOMER][NEUTRAL] So, can we just transfer the balance to the patient?
[AGENT][NEUTRAL] Again, um, we are not, we're not responsible for patients responsibility.
[AGENT][NEUTRAL] We cannot determine that IPL does not determine that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK. No worries, [PII], and, and for the CPT, what can we do now?
[AGENT][NEUTRAL] I'm sorry, for which CPT code 99213?
[CUSTOMER][NEUTRAL] Uh, uh, no, no, for the rest of the CPT as you stated that it is not claim on file.
[CUSTOMER][NEUTRAL] So for that case.
[AGENT][NEUTRAL] The claim can be submitted, yes, the claim can be submitted again because we have no claim on file.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much. And can you just provide me the call reference number?
[AGENT][NEUTRAL] We do not use call reference numbers. You can use my name and today's date, and you're welcome. My last initial is [PII].
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling.
[CUSTOMER][POSITIVE] Thank you so much for your assistance.
[CUSTOMER][POSITIVE] Yeah, [PII], thank you so much.
[AGENT][POSITIVE] You're welcome sir.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Bye-bye. Have a nice day.
[AGENT][POSITIVE] You as well thanks for calling APL. Take care bye.